背景:了解身体功能(PF)和生活质量(QoL)治疗效果对于老年癌症患者的治疗决策非常重要。然而,对于患有转移性去势抵抗性前列腺癌(mCRPC)的老年男性患者,数据有限.我们评估了治疗对老年mCRPC患者PF和QoL的影响。
方法:这项多中心前瞻性观察研究纳入了65岁以上的mCRPC患者。PF措施包括日常生活的工具性活动,握力,椅子的立场,和步态速度。QoL测量包括疲劳,疼痛,心情,和癌症治疗的功能评估(FACT)-一般总分和分量表得分。结果在基线时收集,三,还有六个月.线性混合效应回归模型用于检查不同治疗队列随时间的PF和QoL差异。
结果:我们招募了198名开始化疗的男性(n=71),阿比特龙(n=37),恩扎鲁他胺(n=67),或镭-223(n=23)。在基线,开始化疗的男性的PF指标更差,QoL,疼痛,和情绪比其他群体。随着时间的推移,所有PF措施保持稳定,疼痛改善,但是所有队列的功能健康(FWB)和情绪都显着恶化。然而,所有结局随时间的变化在治疗队列之间没有明显差异.最坏情况敏感性分析确定了减员(六个月内减员为22%至42%)是我们研究的主要限制,特别是镭-223队列。
结论:FWB和情绪最容易随着时间的推移而恶化,而疼痛通过治疗得到改善。尽管开始化疗的患者基线PF和QoL较差,与mCRPC的其他常用疗法相比,化疗与随时间的恶化程度无显著相关性.这些发现可能有助于与患者进行治疗讨论。然而,考虑到样本大小适中,自然减员,以及后续行动的时间表,在这种情况下,治疗对PF和QoL结果的影响需要进一步研究,特别是镭-223。
Understanding physical function (PF) and quality of life (QoL) treatment effects are important in treatment decision-making for older adults with cancer. However, data are limited for older men with metastatic castration-resistant prostate cancer (mCRPC). We evaluated the effects of treatment on PF and QoL in older men with mCRPC.
Men aged 65+ with mCRPC were enrolled in this multicenter prospective observational study. PF measures included instrumental activities of daily living, grip strength, chair stands, and gait speed. QoL measures included fatigue, pain, mood, and Functional Assessment of Cancer Therapy (FACT)-General total and sub-scale scores. Outcomes were collected at baseline, three, and six months. Linear mixed effects regression models were used to examine PF and QoL differences over time across various treatment cohorts.
We enrolled 198 men starting chemotherapy (n = 71), abiraterone (n = 37), enzalutamide (n = 67), or radium-223 (n = 23). At baseline, men starting chemotherapy had worse measures of PF, QoL, pain, and mood than the other groups. Over time, all PF measures remained stable, pain improved, but functional wellbeing (FWB) and mood worsened significantly for all cohorts. However, change over time in all outcomes was not appreciably different between treatment cohorts. Worst-case sensitivity analyses identified attrition (ranging from 22 to 42% by six months) as a major limitation of our study, particularly for the radium-223 cohort.
FWB and mood were most prone to deterioration over time, whereas pain improved with treatment. Although patients initiating chemotherapy had worse baseline PF and QoL, chemotherapy was not associated with significantly greater worsening over time compared to other common therapies for mCRPC. These findings may assist in treatment discussions with patients. However, given the modest sample size, attrition, and timeframe of follow-up, the impact of treatment on PF and QoL outcomes in this setting requires further study, particularly for radium-223.