Validation Study Of A Web-based Assessment Of Functional Recovery After Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  IT / Internet / E-mail
Article Date: 04 Nov 2010 - 5:00 PDT


In the journal Health and Quality of Life Outcomes, Dr. Andrew Vickers and colleagues at Memorial Sloan Kettering Cancer Center describe a web-based survey for patient-reported outcomes after radical prostatectomy (RP) for prostate cancer (CaP). The benefit of a web-based approach would be to obtain more unbiased and accurate assessment of patient outcomes by patients rather than their physicians and to eliminate the aspect of a paper questionnaire. The system used is called "Symptom Tracking and Reporting" (STAR), which was initially developed for use by patients receiving outpatient chemotherapy. It was adapted for patient symptom reporting from home-based Internet and can be used by patients with no prior computer experience.

The questionnaire was a shortened and modified version of their previous clinic questionnaire and included 6 questions from the IIEF-II survey, 6 questions regarding urinary domains, 2 questions on bowel symptoms and a 0-10 scale on global health related quality of life for a total of 15 questions. Patients providing an email address at the time of treatment were emailed an invitation to complete a questionnaire at 3, 6, 9, 12, 18, 24, 36, and 48 months after surgery. The investigators hypothesized that erectile and urinary function would decrease with age and comorbidity and increase with time from surgery and performance of a nerve-sparing procedure. Physician and patient reported assessments of function were also compared. Between 2009 and 2010 a total of 1,581 men were sent at least one email inviting them to participate, and of these, 1,235 completed at least one survey for an overall response rate of 78%. Less than 1% of participants accessed the survey in the foreign languages available. Almost all surveys were completed in their entirety with 4% missing one question and 3% missing more than one question. Questions measuring the same function (erectile, urinary or bowel) were more highly correlated than measures assessing different functions. There was a positive correlation between function and quality of life with urinary function correlating more than sexual function. The correlation between total sexual and urinary functions and overall were 0.27 and 0.47, respectively. An increase in comorbidities was associated with poorer urinary and sexual function and patients with 3 or more comorbidities had a 7-point lower urinary score and a 13-point lower sexual score than those without any comorbidity. Age, time from surgery and nerve sparing status were all significantly associated with both urinary and sexual function. Both erectile and urinary function improved significantly with time, especially within the first year after RP. Erectile function continued to improve after this while urinary function stabilized. Sexual function decreased with age; at age 55 the one-year function score was 58 compared with 34 for men age 70. Urinary function was constant until age 70, after which it decreased slightly. Patient-reported sexual and urinary function scores predicted physician-assessed function with a high level of discrimination (AUC for sexual function 0.86 and for urinary function 0.87).

The authors conclude that this web-based survey approach has excellent psychometric validity.

Vickers AJ, Savage CJ, Shouery M, Eastham JA, Scardino PT, Basch EM

Health Qual Life Outcomes. 2010 Aug 5;8(1):82.

doi: 10.1186/1477-7525-8-82

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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