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VA RESEARCH ON PROSTATE CANCER AND QUALITY
OF LIFE -- Low education predicts lower quality
of life for prostate cancer patients.
Story here...
http://www.eurekalert.org/
pub_releases/2007-04/uoc--lep041207.php
Story below:
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Contact: Steve Tokar
steve.tokar@ncire.org
415-221-4810 x5202
University of California - San Francisco
Low education predicts lower quality of life
for prostate cancer patients
Non-high school graduates especially at risk
for lower quality of life after prostate cancer treatment
Among men who have received similar treatments for prostate cancer,
those with less education –– particularly those who did not graduate
from high school –– experience a significant drop in their quality of
life after treatment compared with men who have more education,
according to a study led by researchers at the San Francisco VA Medical
Center (SFVAMC).
“These men did not start out with a lower quality of life before
cancer,” says lead author Sara J. Knight, PhD, a staff psychologist at
SFVAMC. “What’s surprising is that after treatment, they have clinically
significant problems across the board –– mental and emotional as well as
physical –– in managing their lives.”
The authors acknowledge that low educational level is often associated
with lower income, which can lead to lower quality of life, but stress
that for the men in their study, low education alone was associated with
lower quality of life, irrespective of income. “In our analysis, it’s
their lower educational level that has made them more vulnerable to the
effects of prostate cancer and its treatment,” says Knight, who is also
an assistant professor of psychiatry and urology at the University of
California, San Francisco (UCSF).
The paper is available in the on-line Early View section of the journal
Cancer.
The researchers analyzed the results of a self-reported quality-of-life
survey completed by 248 patients who were diagnosed with prostate cancer
between 1989 and 2002 and treated at three Veterans Affairs medical
centers. Treatments included surgery, radiation therapy, hormone
therapy, and observation or “watchful waiting.”
After adjusting for a host of factors including severity and stage of
cancer, treatment, age, education, income, marital status, and other
diseases, the researchers found that men without high school diplomas
“experienced greater decline and less recovery” during the first year
after prostate cancer treatment across a wide variety of domains,
including physical, emotional, and social functioning, vitality, mental
health, general health, urinary function, and sexual function.
“More generally, the lower your educational level, the greater the
likelihood that you would have a lower quality of life after diagnosis
and treatment,” says Knight.
She points out a key aspect of the study: The subjects, as VA patients,
all had equal access to the same quality of health care. “Since health
care access is a key factor in predicting health outcomes, it’s
significant that we were able to control for this variable,” she says.
The good news, she says, is that clinicians across the country can
immediately begin to identify and help prostate cancer patients who are
at greater risk for poor quality of life. “We can identify these men by
their educational levels, ask them what difficulties they’re having in
managing their day-to-day lives, and try to provide them with the
appropriate resources.” She notes that VA medical centers offer a broad
range of counseling and referral services to help veterans with mental,
emotional, career, and other problems.
Knight says that the study is “as far as we know, the first to emphasize
the impact of educational level on quality of life after prostate cancer
treatment, as opposed to health literacy, a much more narrow measure
which we’ve known for some time has an effect on health outcomes.”
The study authors indicate they do not know why education plays such a
large role in determining quality of life after prostate cancer
treatment. One reason, they say, might be that “even in an equal-access
health care system” such as the VA, men with less education have more
trouble understanding educational materials about prostate cancer, its
treatment, and post-treatment management, which in turn may lead to
poorer disease management, greater worry, and greater difficulty
adjusting to life as a cancer survivor.
“If that’s the case, then we can begin to address the problem by
creating educational materials that are better targeted to men with less
education,” says Knight.
She says another possible explanation is economic: “Men with less
education might, indeed, have fewer financial resources, so prostate
cancer is going to have a greater negative impact on their lives. For
example, if you’re driving a cab or working on a delivery truck, urinary
dysfunction can become extremely disabling. It’s hard to manage your
symptoms, take breaks, and get enough rest when you’re worried about
keeping your job.”
Knight stresses that, thanks to today’s effective treatments, “men with
prostate cancer can live a long time. If these problems go unaddressed,
these men will have a much worse time over the course of their lives.”
The researchers caution that because their study is based on results
from only three VA medical centers, additional research will be needed
to determine if the results can be generalized to all VA patients or to
men in general.
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Co-authors of the study are David M. Latini, PhD, of Baylor University
and the Houston VA Medical Center; Stacey L. Hart, PhD, of SFVAMC and
UCSF; Natalia Sadetsky, MD, MPH, of UCSF; Christopher J. Kane, MD, of
SFVAMC and UCSF; Janeen DuChane, PhD, of Baxter International, Inc.; and
Peter R. Carrol, MD, of UCSF. Patients in the study were enrolled in
Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a
nationwide longitudinal observational study of prostate cancer patients.
Carroll is principal investigator of CaPSURE and Sadetsky is a CaPSURE
investigator.
The study was funded by the National Institutes of Health and UCSF.
CaPSURE is supported by TAP Pharmaceutical Products Inc.
SFVAMC has the largest medical research program in the national VA
system, with more than 200 research scientists, all of whom are faculty
members at UCSF.
UCSF is a leading university that advances health worldwide by
conducting advanced biomedical research, educating graduate students in
the life sciences and health professions, and providing complex patient
care.
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Larry Scott --
