Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time. To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart. Participants completed surveys at baseline and various time points thereafter.
We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies. Multivariable
Richard del rosario wife sexual dysfunction regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains.
The study is limited by its observational design and possibility
Richard del rosario wife sexual dysfunction unmeasured confounding. Richard del rosario wife sexual dysfunction of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades.
These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations. Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms.
Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research. Treatment for localized prostate cancer yields potential short- and long-term negative impacts on health-related quality of life HRQOLparticularly in the urinary, sexual, and bowel function domains [ 1 — 4 ].
However, little is known regarding how the reporting of dysfunction Richard del rosario wife sexual dysfunction these domains may have changed over time and how such differences may alter the interpretation of patient-reported outcomes in comparative effectiveness research. The public has certainly become more aware of prostate Richard del rosario wife sexual dysfunction and the negative effects of its treatment over the past two decades.
There has also been rapid expansion of direct-to-consumer DTC advertising, possibly reducing the stigma of conditions such as urinary incontinence or erectile dysfunction ED that would, in turn, increase patient reporting of such functional deficiencies [ 1 — 4 ]. Although stigma serves as a barrier to seeking treatment and information for a particular illness [ 56 ], it is not known whether stigma reduction results in meaningful changes in patient reporting.
Patient-reported outcomes PROs have become the cornerstone of measurement of the comparative harms of prostate cancer treatment. As such, understanding how patients report function in different time periods is essential in interpreting the results of comparative effectiveness research, and failing to recognize the profound contribution of contemporary norms will, without question, result in study bias.
As we begin to use PROs in quality and performance measurement, it will become increasingly important to understand the constructs that contribute to patient reporting in prostate cancer and other disease states. To this end, we sought to evaluate changes in the reporting of pretreatment sexual and urinary dysfunction in two prospective prostate cancer cohorts enrolled nearly 20 yr apart.
Institutional review boards at all participating sites including the Vanderbilt University coordinating site approved the study. Details of the objectives and methods of PCOS were reported previously [ 78 ]. The PCOS sampled subjects from 11— eligible cases. Because Richard del rosario wife sexual dysfunction the practical limitation of interviewing men with prostate cancer before diagnosis, baseline assessment was conducted at 6 mo, at which time participants were asked to recall their prediagnosis function.
Nonetheless, prior studies demonstrated strong agreement between baseline and 6-mo estimates of prediagnostic urinary and sexual function [ 9 ].
During the 1-yr enrollment period, the study contacted eligible men. Of these, After enrollment in PCOS, men completed a survey that included items regarding clinical and sociodemographic issues, comorbid conditions, and disease-specific HRQOL [ 78 ].
In both studies, individual items with multi-item responses were dichotomized to facilitate clinical interpretation. We included four items in the urinary incontinence domain and three items in the sexual function domain.
We derived modified domain summary scores based on the common between-study items, scaled 0— with representing optimal function. We compared baseline characteristics using appropriate parametric and nonparametric statistical tests.
We performed multivariable logistic regression analysis with individual item response as the dependent variable and multiple a priori identified covariates as independent variables. We also performed multivariable linear regression analysis with domain
Richard del rosario wife sexual dysfunction score as the dependent variable and included the same a priori identified covariates as independent variables in the linear regression models. Principal analyses were performed on the complete study sample.
A sensitivity analysis was performed on the subgroup of CEASAR who had initiated treatment at the time of baseline survey completion. We identified multiple between-study differences in sociodemographic factors. Complete data are presented in Table 1. Table 2 presents the complete clinical data. CEASAR participants were more likely to report pretreatment severe urinary incontinence, defined as having no urinary control or frequent leakage, than PCOS participants 7.
A total of Table 3 shows the unadjusted percentages and adjusted ORs for individual items in the urinary incontinence and sexual Richard del rosario wife sexual dysfunction domains. Unadjusted responses to individual items and logistic regression models for individual items. Results from the domain-specific multivariable linear regression models were consistent with individual item findings. After adjustment for multiple relevant covariates, the sexual function summary score was 7.
Not surprisingly, age, self-reported overall health status, income, marital status, diabetes, heart failure, and hypertension were all independently associated with sexual function. Table 4 presents the complete domain-specific models. Adjusted for insurance status, employment, education, emphysema, heart attack, and angina. Sensitivity analyses including only CEASAR participants who had initiated treatment at the time of response to the baseline survey found no material differences in the main study findings, Richard del rosario wife sexual dysfunction they did note increased magnitude of both the absolute and relative between-study differences in the individual item model Supplementary Table 1 and the summary score model Supplementary Table 2.
PROs are essential in the measurement of treatment-related harms in prostate cancer and other disease states. Despite the relative importance placed on PROs, the evolution of patient reporting over time remains poorly characterized. This is particularly germane in domains where cultural norms may change with time, Richard del rosario wife sexual dysfunction as Richard del rosario wife sexual dysfunction and urinary function.
The purpose of the current study was to compare differences in baseline reporting of these two domains in two prostate cancer cohorts enrolled nearly 20 yr apart. A number of explanations are plausible for the observed study findings. There are well-documented temporal increases in the prevalence of obesity [ 15 — 18 ] and diabetes mellitus [ 1920 ], both of which have been associated with ED [ 192122 ] and urinary symptoms [ 1523 — 25 ].
The distribution of comorbidity between provides some reassurance that prostate cancer diagnosis and treatment has been appropriately directed at healthier men.
However, despite harboring more comorbid illnesses, PCOS participants reported more favorable pretreatment function than CEASAR participants, suggesting that comorbidity does not explain the study findings. Conversely, the observed findings could reflect differences in reporting due to dynamic changes in sociocultural norms and patient perception of stigmatized conditions.
Important sociological changes occurred between the time of PCOS enrollment — and CEASAR enrollment — that may have contributed to the significant between-study differences. This resulted in considerable investment in DTC marketing during the late s through the first decade of
Richard del rosario wife sexual dysfunction 21st century [ 15 ].
Proponents of DTC advertising contend that the practice serves to educate patients, promotes adherence, and enhances the patient—physician relationship [ 26 ].
Opponents of the practice believe that DTC advertising encourages inappropriate prescribing practices, promotes overdiagnosis, and ultimately increases health care costs with no net benefit to society [ 151718 ]. It is possible that both medicalization and stigma reduction have resulted in the observed study findings. The past two decades have certainly witnessed the medicalization of ED.
Stigma reduction in ED was largely accomplished through recategorization [ 5 ]. Public exposure to DTC advertising through prominent public figures including US senator and presidential candidate Bob Dole and the professional American football player Tony Siragusa may have indeed Richard del rosario wife sexual dysfunction in recategorization. The Richard del rosario wife sexual dysfunction of celebrity promotional campaigns is well described.
The current study suggests that the reporting of ED and urinary incontinence has increased from — to — It is possible that stigma reduction has resulted in increased reporting of pretreatment sexual and urinary dysfunction, raising the possibility of underreporting of baseline dysfunction in historical studies of prostate cancer patient—reported outcomes and thus overestimation of treatment-related morbidity.
Given the inclusion of treatment-related harms in formulating the US Preventive Services Force recommendations surrounding prostate cancer screening [ 30 ], identifying dynamic changes in pretreatment urinary and sexual dysfunction is an essential component of estimating the burden of population-level harms attributable to prostate cancer treatment.
These findings are of paramount
Richard del rosario wife sexual dysfunction when considering the use of PROs in comparative effectiveness research. Specifically, the use of historical data may not accurately reflect the contemporary Richard del rosario wife sexual dysfunction and, as such, may result in considerable bias when evaluating differences in PROs over time.
The current study suggests that exogenous societal factors may influence reporting of baseline function among men with prostate cancer. Our study findings underscore the need for longitudinal data analysis and raise significant concerns about the use of cross-sectional study designs in the evaluation of comparative effectiveness.
This study has a number of limitations. To this end, the psychometric properties of the modified scales have not been established. Acknowledging this, the multivariate logistic regression analyses of the individual items use effectively identical end points between the two studies. The fact that the findings between the two analyses are consistent lends validity to the results. Second, it is possible that other unmeasured factors modulated the relationship between time and baseline disease-specific function in the current study.
Finally, whether the observed between-study differences are of sufficient effect to achieve clinical significance remain largely unknown. Contemporary patients with newly diagnosed prostate cancer are more likely to report pretreatment urinary and sexual dysfunction than patients Richard del rosario wife sexual dysfunction two decades ago even after adjustment for known confounders. These findings suggest that nonclinical factors may influence patient perception and reporting of disease-specific function, particularly in cases where cultural norms change over time.
These data have important implications for study design in comparative effectiveness research. We thank the men who participated in CEASAR and PCOS, the physicians in the SEER regions who assisted in the collection of data Richard del rosario wife sexual dysfunction their patients and from medical records, all the study managers and chart abstractors for their efforts in data collection, and all the staff in each of the six cancer registries for their help with these studies.
Resnick had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Analysis and interpretation of data: Hoffman, Kaplan, Greenfield, Penson.
Critical revision of the manuscript for important intellectual content: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, Richard del rosario wife sexual dysfunction, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
National Center for Biotechnology InformationU. Author manuscript; available in PMC Jun 1. Barocasa Alicia K. Morgansc Sharon E. Phillipsd Tatsuki Koyamad Peter C.
Albertsene Matthew R. Hamiltoni Karen E. Hoffman,j Richard M. Hoffman,k Sherrie H.
Kaplan,h Dan McCollum,l Lisa E. Paddock,m. To evaluate differences in pretreatment urinary and sexual function in two Similarly, self-reported erectile dysfunction was more common among .
Not married vs married,–, −, − to − Richard del rosario wife sexual dysfunction MD, Crandall WV, Leibowitz IH, Duffy L, del Rosario F, Kim SC, et al. Sexual function and patients' perceptions in inflammatory bowel disease: a case- control survey Johnson P, Richard C, Ravid A, Spencer L, Pinto E, Hanna M, et al.
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