Physician assessment of pretreatment functional status: a process-outcomes link

Abstract

Purpose: Since all interventions for localized prostate cancer have a significant impact on health related quality of life, pretherapy assessment of functional status remains an essential quality of care indicator. We determined whether accurate pretherapy assessment has a significant role in forecasting health related quality of life after definitive treatment for prostate cancer.

Materials and methods: We examined data from CaPSURE™ to identify men who underwent treatment for localized prostate cancer between 1995 and 2006. We restricted our analysis to those who completed the UCLA-PCI survey before and after therapy. We performed multiple logistic regression for the outcome measure (decrease in each of the 6 UCLA-PCI domains) on the predictor (whether the physician performed an assessment that was in agreement with patient reported pretherapy status) while adjusting for clinical and sociodemographic characteristics.

Results: Of the 2,195 men included in the analysis 1,411 (64%) did not have pretherapy function documented. Of the remaining 784 men only 354 (45%) had pretherapy physician assessments that were concordant with patient reported status. On multiple logistic regression analysis men who were not assessed were more likely to experience decreased sexual function (OR 1.66, 95% CI 1.23-2.23), sexual bother (OR 1.46, 95% CI 1.09-1.97) and bowel function (OR 1.43, 95% CI 1.02-2.00) according to post-therapy UCLA-PCI scores than those who were assessed and concordant.

Conclusions: Pretherapy functional assessment of patients with localized prostate cancer is associated with less decrease in health related quality of life. This simple yet mutable process of care measure serves as a potential target to improve quality of care for patients with prostate cancer.