In the clinical management of metastatic prostate cancer, health-related quality of life (HRQoL) is an important consideration.1,4 Assessment of performance status (PS) remains a recognized index of quality of life from the clinician’s perspective which may not be representative of the health-related quality of life from the patient’s perspective. There are indications from some studies that performance status assessment does not give the entire quality of life picture of the patient such that while PS gives adequate information on functional autonomy of the patient, it provides limited information on other aspects of health that are important to the patient.11
This study reveals that the mean age of these men presenting with metastatic hormone naïve prostate cancer is 70.62 ± 7.34 which is similar to findings from other studies.12,13 The median serum total prostate-specific antigen (tPSA) of 83.70(IQR 47.90–107.00) is also similar to findings from other studies as well.13 A high proportion (84.9%) of ISUP ≥ 3 patients among participants is in keeping also with observations from cohorts of men presenting in advanced stages of prostate cancer.14 Aggressive prostate cancers are commoner in advanced stages of prostate cancer possibly because the disease becomes more aggressive over a period of time.15,16 It is observable from this study, as in other studies,14,17,18 that lower urinary tract symptoms (LUTS), bone pain and weight loss are the prevalent clinical features at presentation of these patients.
The FACT-P scores and the utility scores from EQ-HVI and EQ-VAS are relatively low in this cohort.19,20 However, there are strong evidences that the FACT-P derived HRQoL score and the EQ-HVI and EQ-VAS utility scores reported by participants vary with the clinician-preferred ECOG-PS: the better the participant-reported HRQoL (higher FACT-P/EQ-HVI/EQ-VAS scores), the higher the clinician-preferred PS (lower ECOG-PS scores). So, as reported from previous studies, these tools are assessing similar or closely related parameters in the participants.8,20,21 Upon teasing out the scores in the well-being domains, the observed variation of FACT-P scores is not reflected in every well-being domain within the FACT-P HRQoL tool. Specifically, the social/family well-being (SFWB) and the emotional well-being (EWB) domains are not seen to vary with the clinician-preferred ECOG-PS. While deteriorating levels in the PWB and FWB domains correlate strongly with deteriorating ECOG-PS preferences, there is no evidence that such are the observations with the SFWB and EWB domains. These observations are similar to the observations of Bergerot and colleagues7 thereby supporting the assertion that ECOG-PS as determined by the clinician is not reflective of some aspects of health of the patient. Similarly, variation in pain, for instance, was not observed by De Vincentis and colleagues to reflect in the psychological status of men with advanced prostate cancer evaluated using specific items of the EORTC QoL questionnaires C30 and BM22.22 Understandably, clinician preferred ECOG-PS is essentially an assessment of functional reserves of the patient, and so it is limited in its capacity to assess social and mental dimensions of health necessitating that these be appropriately assessed through other tools in addition.7
Focusing more closely on the questionnaire items within the PWB and the FWB domains, it is observed from our study that GP3 and GP7 items of the PWB domain as well as the GF5 and GF6 items of the FWB domain relate strongly with the ECOG-PS preference of the clinician. In other words, having problems meeting the needs of the family on account of extant condition (GP3) and spending longer times in bed due to the debilitating illness (GP7) stand out as items in the PWB domain that evidently relate with the clinician-preferred ECOG-PS. Similarly, failure to enjoy the things one would usually do for fun (GF6) is a FWB domain item that significantly relate to the assigned ECOG-PS. The response to sleeping well in item GF5 appear to have mirrored the response to item GP7.
Though the prostate cancer subscale (PCS) domain scores appear to deteriorate with worsening ECOG-PS categories, none of the domain questionnaire items evidently relate with ECOG-PS when items in the PWB and the FWB domains are controlled for. Responses to questionnaire items assessing pain, bowel symptoms, urinary symptoms, sexual functions as well as emotional and other social aspects of health do not seem to vary with performance status as captured by the clinician. This observation may as well be a reflection of the observation of Msaouel and colleagues that more global issues arising from symptoms appear to matter more in patient reported outcome questionnaire items.23