Partnership status affects the association between gastrointestinal symptoms and quality of life after radiation therapy for prostate cancer

Figures & data

Table I. Categories of gastrointestinal symptoms*.

Symptom category	Designated symptoms with cut-off levels
Altered composition	• Black blood in stools, at least once a week • Distended bowel because of excess gas, at least once a week • Frequent loose stools, diarrhea, at least once a week • Hard stools, constipation, at least once a week • Mucus in stools, at least once a week • Red blood in stools, at least once a week
Flatulence	• Uncontrolled passing of gas, at least once a week.
Leakage	• Fecal leakage while awake, at least once a month • Fecal leakage while asleep, at least once a month • Fecal leakage while coughing, laughing or sneezing, at least once a month • Fecal leakage during physical exercise, at least once a month • Leakage of mucus while awake, at least once a week • Leakage of mucus while asleep, at least once a week • Leakage of red blood while awake, at least once a week • Leakage of red blood while asleep, at least once a week • Unexpected total emptying of all stools into clothing, at least once the previous six months
Pain	• Abdominal pain, at least once a week • Abdominal cramps, at least once a week
Sensory	• Sensation of incomplete evacuation, at least half of the occasions • Sensation of passing gas but in effect passing feces, at least once a week
Urgency	• Defecation urgency prompting the immediate need to visit a toilet, at least once a week
Any gastrointestinal symptom	• Any of the above mentioned symptoms

*In the questionnaire, responders were asked to assess symptom occurrence the previous six months.

Table II. Characteristics of the study-population.

	Group A: Symptom/unpartnered n = 73	Group B: No symptom/unpartnered n = 27	Group C: Symptom/partnered n = 496	Group D: No symptom/partnered n = 263	P-value
Age in years, mean (range)	70.7 (59–80)	73.0 (62–80)	71.3 (53–80)	70.0 (49–80)	0.009
Time to follow-up in years, median (range)	5.8 (2–12)	6.6 (2–14)	6.1 (2–15)	5.8 (2–14)	0.44
Radiation modality, No. (%)					0.02
EBRT	25/73 (34)	10/27 (37)	187/496 (38)	74/263 (28)
EBRT-BT	34/73 (47)	16/27 (59)	201/496 (41)	115/263 (44)
Postoperative EBRT	14/73 (19)	1/27 (4)	108/496 (22)	74/263 (28)
Educational level, No./total No. (%)					0.24
Primary school	28/73 (38)	16/27 (59)	200/493 (41)	104/263 (40)
High school	23/73 (32)	4/27 (15)	119/493 (24)	54/263 (21)
College or post-graduate	22/73 (30)	7/27 (26)	174/493 (35)	105/263 (40)
Widower, No./total No. (%)	21/73 (29)	9/25 (36)	17/475 (4)	9/251 (4)	< 0.0001
Comorbid diseases, No./total No. (%)					0.05
Yes	44/73 (76)	24/27 (62)	285/453 (63)	153/263 (53)
Smoking, No./total No. (%)					0.022
Yes	13/70 (19)	3/27 (11)	47/487 (10)	17/262 (6)

BT, brachytherapy; EBRT, external beam radiotherapy; No., number.

Table III. Prevalence of gastrointestinal symptoms among prostate cancer survivors with or without partner, who had been treated at the Sahlgrenska University Hospital, Gothenburg, Sweden between 1994 and 2006.

	No. with symptom/ total No. (%)
Symptom category*	Partner N = 764	No partner N = 100	Prevalence ratio (95% CI)
Altered composition	302/758 (40)	37/100 (37)	0.9 (0.7–1.2)
Flatulence	155/754 (21)	16/98 (16)	0.8 (0.5–1.3)
Leakage	136/757 (18)	21/100 (21)	1.2 (0.8–1.8)
Pain	74/758 (10)	7/99 (7)	0.7 (0.3–1.5)
Sensory	168/763 (22)	25/100 (25)	1.1 (0.8–1.6)
Urgency	217/756 (29)	35/98 (36)	1.2 (0.9–1.7)
Any gastrointestinal symptom	496/759 (65)	73/100 (73)	1.1 (1.0–1.3)

*As displayed in Table I.

Table IV. Prevalence ratio of low* quality of life, among irradiated prostate cancer survivors with or without a partner, who had been treated at the Sahlgrenska University Hospital, Gothenburg, Sweden between 1994 and 2006.

Symptom category^†	Group A: Symptom/ unpartnered	Group B: No symptom/unpartnered	Group C: Symptom/ partnered	Group D: No symptom/ partnered
Altered composition
Low* quality of life, No./total No. (%)	9/43 (21)	3/54 (6)	24/333 (7)	7/415 (2)
Prevalence ratio, (95% CI)	12.4 (4.7–31.7)	3.3 (0.9–12.4)	4.3 (1.9–9.8)	1.0 (Reference)
	2.9 (1.4–5.8)	0.8 (0.2–2.5)	1.0 (Reference)
	3.8 (1.1–13.1)	1.0 (Reference)
Flatulence
Low* quality of life, No./total No. (%)	2/16 (13)	9/79 (11)	14/154 (9)	17/591 (3)
Prevalence ratio, (95% CI)	4.3 (1.1–17.2)	4.0 (1.8–8.9)	3.2 (1.6–17.2)	1.0 (Reference)
	1.4 (0.3–5.5)	1.3 (0.6–2.8)	1.0 (Reference)
	1.1 (0.3–4.6)	1.0 (Reference)
Leakage
Low* quality of life, No./total No. (%)	6/21 (29)	6/76 (8)	14/135 (10)	17/613 (3)
Prevalence ratio, (95% CI)	10.3 (4.5–23.5)	2.9 (1.2–7.0)	3.7 (4.5–23.5)	1.0 (Reference)
	2.8 (1.2–6.4)	0.8 (0.3–6.4)	1.0 (Reference)
	3.6 (1.3–10.1)	1.0 (Reference)
Pain
Low* quality of life, No./total No. (%)	2/7 (29)	9/89 (10)	8/72 (11)	23/677 (3)
Prevalence ratio, (95% CI)	8.4 (2.4–29.0)	2.9 (1.4–6.2)	3.3 (1.5–7.0)	1.0 (Reference)
	2.6 (0.7–9.8)	0.9 (0.4–2.2)	1.0 (Reference)
	2.8 (0.8–10.6)	1.0 (Reference)
Sensory
Low* quality of life, No./total No. (%)	7/23 (30)	5/74 (7)	15/167 (9)	16/587 (3)
Prevalence ratio, (95% CI)	11.2 (5.1–24.5)	2.5 (0.9–6.6)	3.3 (1.7–6.5)	1.0 (Reference)
	3.4 (1.5–7.4)	0.8 (0.3–2.0)	1.0 (Reference)
	4.5 (1.6–12.8)	1.0 (Reference)
Urgency
Low* quality of life, No./total No. (%)	7/34 (21)	3/61 (5)	17/216 (8)	14/531 (3)
Prevalence ratio, (95% CI)	7.8 (3.4–18.1)	1.9 (0.6–6.3)	3.0 (1.5–5.9)	1.0 (Reference)
	2.6 (1.2–5.8)	0.6 (0.2–2.1)	1.0 (Reference)
	4.2 (1.2–15.1)	1.0 (Reference)
Any gastrointestinal symptom
Low* quality of life, No./total No. (%)	10/71 (14)	2/26 (8)	28/491 (6)	3/259 (1)
Prevalence ratio, (95% CI)	12.2 (3.4–3.0)	6.6 (1.2–38.0)	4.9 (1.5–16.0)	1.0 (Reference)
	2.5 (1.3–4.9)	1.3 (0.3–5.4)	1.0 (Reference)
	1.8 (0.4–7.8)	1.0 (Reference)

*0–2 on a visual digital scale ranging from 0 to 6, where 0 denoted lowest possible and 6 denoted highest possible; ^†As described in Table I.

Figure 1. Quality of life among 874 long-term prostate cancer survivors who had been treated with radiation therapy between 1994 and 2006. The results are presented according to partnership status (partnered/unpartnered) and presence of gastrointestinal symptoms (yes/no). Quality of life was assessed on a visual digital scale ranging from 0 to 6, where 0 denotes “worst possible” and 6 denotes “best possible”.