AJ Greisinger, Houston VA Medical Center; K Wristers, Houston VA Medical Center; CM Ashton, Houston VA Medical Center; JA Clark, Bedford VA Medical Center; B Brody, Baylor College of Medicine; RB Giesler, Indiana University School of Nursing; J Souchek, Houston VA Medical Center; NP Wray, Houston VA Medical Center

Objectives: For men with metastatic prostate cancer, the most important health outcome is improving the quality of the patient's life. This study's objective was to measure the impact of advanced prostate cancer on quality of life (QOL).

Methods: Published QOL scales specific to prostate cancer focus primarily on physical symptoms and side effects of treatment (e.g., urinary symptoms, weight gain, hot flashes). In a previously published study, we conducted a series of focus groups with advanced prostate cancer patients and developed a scale based on the psychological concerns that patients identified as important to their own QOL. Psychometric analyses (principal components analysis and multitrait scaling) revealed nine dimensions of QOL: body image, self-image, cancer distress, cancer acceptance, sexual problems, masculine image, spouse affection, spouse worry, and regret about treatment. In the current study, the validated 35-item QOL scale was administered to a new sample of 120 metastatic prostate cancer patients at baseline and every 3 to 6 months until death. Patients had undergone orchiectomy or hormonal therapy at the VA, Methodist or Ben Taub Hospitals in Houston, Texas.

Results: Patients reported being concerned or worried either "all of the time" or "most of the time" about body image (31% of patients), self-image (42%), cancer distress (40%), cancer acceptance (56%), and sexual problems (33%). Patients also responded either "definitely true" or "mostly true" to concerns about masculine image (52%), spouse affection (48%), and spouse worry (95%). Fewer patients (10%) expressed regret about treatment decisions.

Conclusions: This study revealed that treatment significantly impinges on QOL in advanced prostate cancer. However, no published studies describe structured psychological interventions that may improve the quality of these men's lives. We are currently developing and testing the effect of a psychosocial intervention on QOL in metastatic prostate cancer.

Impact: The degree to which psychological factors impact QOL in patients with advanced prostate cancer has not previously been investigated. The QOL scale developed in this study can be used to identify patients with specific needs for psychological interventions.