When Antiandrogens Work, Patients Have Normal Quality of Life

FARMINGTON, Conn--Men with advanced prostate cancer who are in remissionwhile on treatment with an LHRH agonist and flutamide (Eulexin) have aquality of life (QOL) that is similar to an equivalent norm for a matchedpopulation of US men without prostate cancer, say Peter C. Albertsen, MD,and his colleagues from Connecticut, Am-sterdam, and Boston.

These men in remission had a significantly better quality of life thanprostate cancer patients who were no longer responding to antiandrogentherapy.

Dr. Albertsen, of the Division of Urology, University of ConnecticutHealth Center, says that issues surrounding health-related quality of life"have become more relevant as our society faces the mounting pressureof health care cost containment."

Health care payers are increasingly reluctant to pay for interventionsthat have not been shown to lead to patient improvement, Dr. Albertsennotes, and patients themselves are more likely to demand quantitative evidenceof treatment efficacy.

The Connecticut study, funded by Schering-Plough, included 113 patientswith stage D2 prostate cancer (60 in remission and 53 with disease progression).

Patients were administered the EORTC Quality of Life Questionniare-C30(a cancer-specific instrument); the more general Medical Outcomes StudyShort Form Health Survey SF-36; and a prostate cancer-specific module developedspecifically for the project.

Analysis of the EORTC and prostate cancer-specific module showed thatpatients in remission had a significantly higher overall quality of lifethan patients with disease progression. Patients in remission had a significantlyhigher level of physical function, and had less fatigue, pain, appetiteloss, and weight gain (Urology 49:207-217, 1997).

Results of the SF-36 scale were similar: Patients in remission had significantlyhigher levels of vitality, social functioning, and mental health, and sufferedless pain.

"Among patients who respond to total androgen ablation, flutamideand an LHRH agonist provide meaningful benefits to recipients independentof any possible improvement in longevity," Dr. Albertsen concluded.

Editorial Comment

In an editorial comment, Michael O. Koch, MD, of Vanderbilt University,noted that the study findings "are highly predictable," ie, patientswho are responding to therapy have a better quality of life than thosewho are not.

Dr. Koch pointed out that some of the differences in quality of lifeseen in this study may be due to the more extensive disease volume in thosewith androgen-insensitive disease. However, a separate analysis of patientswith minimal versus extensive disease found that "a significant differencestill exists in those patients who are responding to therapy as comparedwith those patients who are not responding to therapy."

Dr. Koch cautioned that the study lacked a control arm and cannot beused to make any conclusions about the efficacy of androgen ablation withLHRH agonists and flutamide, "other than to say that when maximalandrogen ablation does work, patients appear to have a normal quality oflife, as measured by the tools used in this study."

He went on to call the article "very important," since itshows that by using several different quality of life instruments, verysignificant differences in quality of life can be demonstrated, "givingus new tools to measure treatment effectiveness."