Patient-reported persistent symptoms after radiotherapy and association with quality of life for prostate cancer survivors

Figures & data

Table 1. Patient, disease and treatment characteristics in the cohort eligible for analysis.

Age (years)	72 (67–75)
BMI/missings	26 (24–29)/18 (6%)
Smoke/missings	38 (14%)/13 (4%)
Alcohol/missings	139 (50%)/16 (5%)
Diabetes	47 (16%)
Hypertension	164 (57%)
Cardiovascular disease	75 (26%)
Hypercholesterolemia	11 (4%)
Urological disease	15 (5%)
Gastrointestinal disease	26 (9%)
Anticoagulants	21 (7%)
Cardiovascular drugs	195 (67%)
Antiaggregants	100 (36%)
Antidepressive	16 (6%)
TURP	36 (15%)
Previous abdominal surgery	113 (39%)
PSA	6.5 (5.1–10.1)
Gleason score/missings	8 (3%)
<7	100 (34%)
=7	137 (47%)
>7	32 (16%)
T stage/missings	11 (4%)
T1	161 (57%)
T2	88 (31%)
T3-4	19 (7%)
TX	14 (5%)
Hormone therapy	165 (58%)
Prostate PTV D95% (Gy)
CONV (n = 136)	76.3 (74.7–77.1)
HYPO (n = 147)	67.9 (66.7–69.4)
Seminal vesicles irradiation	227 (78%)
Prostate + seminal vesicles PTV D95% (Gy)
CONV (n = 113)	79.1 (78.4–79.6)
HYPO (n = 114)	74.6 (71.5–76.1)
Pelvic lymph node irradiation	133 (46%)
Dose prescribed to lymph nodes (Gy)^a
CONV (n = 62)	50.0 [46–50.4]
HYPO (n = 70)	51.8 [48.0–54.4]

Proportions are given with number (percentages), or median (interquartile range: IQR). Missing values are <2%, unless declared (in italics).

BMI: body mass index; TURP: transurethral resection of the prostate; PTV: planning target volume; D95%: minimum dose delivered to 95% of the PTV; CONV: conventional radiotherapy; HYPO: hypofractionated radiotherapy

^aFor dose prescribed to lymph nodes, minimum and maximum values are reported instead of IQR.

Table 2. Proportions of patients with MSP symptoms with and without worsening compared to baseline condition.

Symptoms	No MSP (%)	MSP and worsening (%)	MSP not worsening (%)
IPSS total	190 (64.8)	43 (14.7)	60 (20.5)
ICIQ-O	261 (89.1)	24 (8.2)	8 (2.7)
Urinary incontinence	264 (90.1)	22 (7.5)	7 (2.4)
Incomplete emptying	278 (94.9)	8 (2.7)	7 (2.4)
Urinary frequency	254 (86.7)	27 (9.2)	12 (4.1)
Urinary intermittency	275 (93.9)	15 (5.1)	3 (1.0)
Urinary urgency	267 (91.1)	20 (6.8)	6 (2.0)
Weak stream	245 (83.6)	35 (11.9)	13 (4.4)
Urinary straining	287 (98.0)	6 (2.0)	0 (0.0)
Nocturia	232 (79.2)	36 (12.3)	25 (8.5)
Diarrhoea	227 (77.5)	35 (11.9)	31 (10.6)
Tenesmus	231 (78.8)	31 (10.6)	31 (10.6)
Faecal urgency	136 (46.4)	88 (30.0)	69 (23.5)
Faecal incontinence	271 (92.5)	20 (6.8)	2 (0.7)
Mucus discharge	248 (84.6)	35 (11.9)	10 (3.4)
Rectal pain	262 (89.4)	19 (6.5)	12 (4.1)
Blood in stools	267 (91.1)	22 (7.5)	4 (1.4)
Pain	271 (92.5)	17 (5.8)	5 (1.7)
Need to rest	216 (61.8)	48 (16.4)	64 (21.8)
Weakness	179 (61.1)	51 (17.4)	63 (21.5)
Tiredness	161 (54.9)	54 (18.4)	78 (26.6)
Insomnia	216 (73.7)	38 (13.0)	39 (13.3)

MSP: moderate-severe persistent; ICIQ-O: Objective ICIQ-SF

Table 3. Proportion of patient with MSP gastrointestinal and systemic (pain, fatigue, and insomnia) symptoms defined using a stricter threshold for persistence (score ≥3).

Symptoms	No MSP (%)	MSP and worsening (%)	MSP not worsening (%)
Diarrhoea	288 (98.3)	3 (1.0)	2 (0.7)
Tenesmus	290 (99.0)	1 (0.3)	2 (0.7)
Faecal urgency	277 (94.5)	13 (4.4)	3 (1.0)
Faecal incontinence	293 (100)	0 (0.0)	0 (0.0)
Mucus discharge	291 (99.3)	2 (0.7)	0 (0.0)
Rectal pain	293 (100)	0 (0.0)	0 (0.0)
Blood in stools	291 (99.3)	2 (0.7)	0 (0.0)
Pain	292 (99.7)	1 (0.3)	0 (0.0)
Need to rest	285 (97.3)	6 (2.0)	2 (0.7)
Weakness	284 (96.9)	7 (2.4)	2 (0.7)
Tiredness	283 (96.6)	8 (2.7)	2 (0.7)
Insomnia	284 (96.9)	4 (1.4)	5 (1.7)

MSP: moderate-severe persistent

Figure 1. Mean and 95% confidence intervals for EORTC-C30 Global health/QOL during late follow-up for patients without and with MSP urinary symptoms.

Figure 2. Mean and 95% confidence intervals for EORTC-C30 Global health/QOL during late follow-up for patients without and with MSP gastrointestinal symptoms.

Figure 3. Mean and 95% confidence intervals for EORTC-C30 Global health/QOL during late follow-up for patients without and with MSP pain, fatigue, and insomnia.

Figure 4. Mean QOL deteriorations over 5 years for patients with MSP symptoms. Values are shown when statistically significance was found with LMM. Clinical relevance was assigned according the guidelines to interpret changes in EORTC-C30 scores [35].

Cocks K, King MT, Velikova G, et al. Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Eur J Cancer. 2012;48(11):1713–1721. doi: 10.1016/j.ejca.2012.02.059.

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Data availability statement

The data that support the findings of this study are available from the corresponding author, SS, upon reasonable request.