CHANGES IN QUALITY OF LIFE AMONG LOW-INCOME MEN TREATED FOR PROSTATE CANCER RONDEEP BRAR, SALLY L. MALISKI, LORNA KWAN, TRACEY L. KRUPSKI, AND MARK S. LITWIN ABSTRACT Objectives. To investigate as the primary objective changes over time in general and disease-specific health-related quality of life (HRQOL) among low-income men treated for prostate cancer in a longitudinal prospective study. Methods. Study participants were recruited from a state-funded program providing free prostate cancer treatment to impoverished men. We included men who completed telephone interviews and self-adminis- tered questionnaires at study enrollment and 6 months of follow-up. Covariates univariately associated with HRQOL change scores were included in multivariate linear regression models. All HRQOL models were controlled for age at enrollment, race, baseline HRQOL, and treatment effects at baseline and follow-up. Results. Subjects with greater baseline Gleason scores experienced more negative changes in their physical health than did men with lower Gleason scores. Men with less than a high school education experienced greater improvement in their mental well-being than did men with more than a high school education. Those experiencing treatment effects at baseline displayed greater positive changes in their urinary function than did those without treatment effects at baseline. Finally, men experiencing treatment effects at follow-up were characterized by profound reductions in sexual function compared with those free of treatment effects at follow-up. Conclusions. This work provides new insights into HRQOL over time in a low-income, multiethnic group of patients with prostate cancer. UROLOGY 66: 344–349, 2005. © 2005 Elsevier Inc. H ealth-related quality of life (HRQOL) is impor- tant for the more than 220,000 men diagnosed annually with prostate cancer, particularly low-in- come men adversely affected by a variety of param- eters. 1 Because clinical trials examining survival have not demonstrated benefit of one treatment over others, HRQOL outcomes are of considerable interest. Previously, we described the physical bur- den of prostate cancer and decreased general and disease-specific HRQOL in afflicted men. 2–5 However, longitudinal data concerning HRQOL af- ter prostate cancer treatment are limited. One study demonstrated decreased HRQOL after surgery with gradual improvement in urinary, bowel, and hor- monal domains 1 month postoperatively. 2,3 Another revealed rapid deterioration of sexual function and increase in sexual bother after either prostatec- tomy or external beam radiotherapy. 2,4 Although informative and well-designed, these analyses did not include low-income men. Current analyses of data from disadvantaged men enrolled in a California public assistance pro- gram have revealed that they scored worse than age-matched comparisons in every domain of gen- eral and prostate-specific HRQOL. Also, reduced self-efficacy for interacting with physicians among low-income patients with prostate cancer is asso- ciated with diminished satisfaction with care, worse symptom distress, and low confidence in providers. 5 Because nearly 41 million Americans are unin- sured and ethnic minorities endure a dispropor- tionately high cancer burden, it is prudent to ac- crue such data so that factors predictive of changes in HRQOL may be identified. 6,7 Ultimately, identi- fication of at-risk individuals and the development of appropriate interventions will contribute to op- This study was supported by the California Department of Health Services. From the Department of Urology and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Health Ser- vices, Los Angeles, California Reprint requests: Sally L. Maliski, Ph.D., R.N., Department of Urology, University of California, Los Angeles, Jonsson Compre- hensive Cancer Center, A2-125 CHS, Box 956900, Los Angeles, CA 90095. E-mail: smaliski@sonnet.ucla.edu Submitted: October 19, 2004, accepted (with revisions): March 4, 2005 ADULT UROLOGY © 2005 ELSEVIER INC. 0090-4295/05/$30.00 344 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.03.020