Patients with advanced prostate cancer who received more intensive treatment experienced worse quality of life three months after treatment, but a better quality of life in the long term, compared to those on standard therapy, according to a new Northwestern Medicine study.
The findings were published in the Journal of Clinical Oncology.
“Treatment of prostate cancer is far more than just treating a cancer — it’s treating a person,” said first author Dr. Alicia Morgans, associate professor of medicine in the division of hematology and oncology, and a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “That means we need to truly understand what men with prostate cancer experience — both due to the disease and due to the treatments we prescribe. If we don’t specifically ask questions about quality of life in our studies, we won’t have be able to support men and their families as they go through treatment.”
Prostate cancer is one of the most commonly diagnosed cancers in American men. For patients with an advanced form of the disease called metastatic hormone-sensitive prostate cancer (mHSPC), hormone therapy has long been the backbone of treatment.
More recently, a landmark clinical trial called E3805 demontrated that patients with mHSPC on hormone therapy who also receive a chemotherapy drug called docetaxel live significantly longer than those who undergo hormone therapy alone.
But it was not known how quality of life might be affected in men receiving docetaxel and hormone therapy, versus those receiving the standard treatment alone. Understanding quality of life in patients with prostate cancer is especially important, the authors note, since metastatic prostate cancer is incurable and commonly affects older men with comorbidities.
In the current study, patients in the E3805 clinical trial randomized to each treatment group also completed quality of life assessments. The 790 participants reported measures of quality of life — including physical, functional and emotional well-being — at baseline and at three-month intervals for up to a year after treatment.
The investigators found that at three months, patients who received chemotherapy in addition to hormone therapy reported significantly worse quality of life. However, at one year, the group reported significantly higher quality of life measures, compared to those who received hormone therapy alone.
“In other words, paying a bigger price up front is probably worth it in the long run, for the right patients,” Dr. Morgans said.
The authors note that the findings from the study — the first comparison of quality of life in this population — will be critical in helping patients and providers make more informed decisions about treatment for advanced prostate cancer.
In the trial, the benefit of more intensive treatment appeared to be biggest for patients with high-volume disease — a larger amount of metastatic prostate cancer — although this is still being confirmed in additional clinical trials, Dr. Morgans added.
The study was also co-authored by Dr. Maha Hussain, deputy director of the Lurie Cancer Center and the Genevieve E. Teuton Professor of Medicine — who was also a co-author of the original E3805 publications and subsequent analyses — and by Dr. David Cella, the Ralph Seal Paffenbarger Professor and chair of medical social sciences. Dr. Cella is also director of the Center for Patient-Centered Outcomes at the Institute for Public Health and Medicine, and the associate director for Cancer Prevention and Control Research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
The study was supported by the National Cancer Institute of the National Institutes of Health under the following award numbers: CA180820, CA180794, CA180888, CA180847, CA180867, CA180799, CA189859, CA180802, and CA180853. It was also sponsored by Sanofi via a grant to Eastern Cooperative Oncology Group-American College of Radiology Imaging Network.