Education predicts quality of life among men with prostate cancer cared for in the department of Veterans affairs

A longitudinal quality of life analysis from CaPSURE

Authors

  • Sara J. Knight PhD,

    Corresponding author
    1. San Francisco VA Medical Center, San Francisco, California
    2. Department of Psychiatry, University of California, San Francisco, California
    3. Department of Urology, University of California, San Francisco, California
    • Health Services Research and Development (151R), San Francisco VA Medical Center, San Francisco, CA 94121
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    • Fax: (415) 379-5614

    • Research was performed using the resources and facilities at the Program to Improve Care for Veterans with Complex Comorbid Conditions at the San Francisco VA Medical Center.

  • David M. Latini PhD,

    1. Scott Department of Urology, Baylor College of Medicine, Houston, Texas
    2. Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, Texas
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    • Research was performed using the resources and facilities at the Houston Center for Quality of Care and Utilization Studies at the Michael E. DeBakey VA Medical Center.

  • Stacey L. Hart PhD,

    1. San Francisco VA Medical Center, San Francisco, California
    2. Department of Psychiatry, University of California, San Francisco, California
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  • Natalia Sadetsky MD, MPH,

    1. Department of Urology, University of California, San Francisco, California
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  • Christopher J. Kane MD,

    1. San Francisco VA Medical Center, San Francisco, California
    2. Department of Urology, University of California, San Francisco, California
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  • Janeen DuChane PhD,

    1. TAP Pharmaceutical Products Inc., Lake Forest, Illinois
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  • Peter R. Carroll MD,

    1. San Francisco VA Medical Center, San Francisco, California
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  • the CaPSURE Investigators

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    • The current CaPSURE investigators are: Peter R. Carroll, MD (University of California, San Francisco, San Francisco, CA), James S. Cochran, MD (Urology Clinics of North Texas, Dallas, TX), Christopher J. Kane, MD (Veterans Administration Medical Center, San Francisco, CA), Donald P. Finnerty, MD (PAPP Clinic, Newnan, GA), Eugene V. Kramolowsky, MD (The Virginia Urology Center, Richmond, VA), Robert M. Segaul, MD (Urology Associates of West Broward Belle Terre, Sunrise, FL), Paul Sieber, MD (Urological Associates of Lancaster, Lancaster, PA), Stanley A. Brosman, MD (Pacific Clinical Research, Santa Monica, CA), Lynn W. Conrad, MD (The Conrad Pearson Clinic, Germantown, TN), Ronald A. Chee-Awai, MD (Urologic Institute of New Orleans, Marrero, LA), Michael Flanagan, MD (Urology Specialists, Waterbury, CT), Jeffrey K. Cohen, MD (Triangle Urology Group, Pittsburgh, PA), Jerrold Sharkey, MD (Urology Health Center, New Port Richey, FL), Thomas W. Coleman, MD (Mobile Urology Group, Mobile, AL), Elliott C. Silbar, MD (Clinic of Urology, Milwaukee, WI), Paul S. Ray, DO (Cook County Hospital, Chicago, IL), David Noyes, MD (Berkshire Urological Associates, P.C., Pittsfield, MA), Mohammed Mostafavi, MD (Urology Group of Western New England, Springfield, MA), Louis Keeler, III, MD (Delaware Valley Urology, LLC-Voorhees, Voorhees, NJ), James Gottesman, MD (Seattle Urological, Seattle, WA), Bhupendra M. Tolia, MD (Associated Advanced Adult & Pediatric Urology, Bronx, NY), Patrick P. Daily, MD (Mississippi Urology, Jackson, MS), Glen Wells, MD (Alabama Urology, Birmingham, AL), Richard J. Kahnoski, MD (Michigan Medical, Grand Rapids, MI), Sheldon J. Freedman, MD (Las Vegas, NV), Randil Clark, MD (North Idaho Urology, Coeur D'Alene, ID), Daniel W. Lin, M.D (Veterans Administration Puget Sound HCS, Seattle, WA), Mark Austenfeld, MD (Kansas City Urology Care, Kansas City, MO), Henri P. Lanctin, MD (Adult & Pediatric Urology, Sartell, MN), J. Brantley Thrasher, MD (University of Kansas, Adult Urology and Urologic Oncology, Kansas City, KS), and David W. Bowyer, MD (Snake River Urology, Twin Falls, ID). Former CaPSURE investigators are: John Forrest, MD (1995-99, Urologic Specialists of Oklahoma, Tulsa, OK), William Schmeid, MD (1995-99, Metro Urology, Jeffersonville, IN), Glen Brunk, MD (1995-99, Urology of Indiana, Indianapolis, IN), Jay Young, MD (1995-2001, South Orange County Medical Research Center, Laguna Woods, CA), Gary Katz, MD (1996-2000, Medical College of Virginia and Veterans Administration Medical Center, Richmond, VA), Stacy J. Childs, MD (1999-2000, Cheyenne Urological, Cheyenne, WY), Kevin Tomera, MD (1999-2001, Alaska Urological Associates, Anchorage, AK), Clayton Hudnall, MD (1995-2002, Urology San Antonio Research, San Antonio, TX), David Penson, MD, MPH (2000-2003, Veterans Administration Puget Sound HCS, Seattle, WA); W. Lamar Weems, MD (1996-2005, Mississippi Urology, Jackson, MS); Joseph N. Macaluso, Jr., MD (1995-2005, Urologic Institute of New Orleans, Gretna, LA).


  • The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Veterans Affairs.

  • From the Mental Health and Urology Services and the Interdisciplinary Research Program to Improve Care for Older Veterans, a Research Enhancement Award Program of the Health Services Research & Development, Department of Veteran Affairs, San Francisco Veterans Affairs Medical Center, and the Department of Psychiatry and Urology, University of California at San Francisco, San Francisco, California

Abstract

BACKGROUND.

Previous findings have suggested that patient educational attainment is related to cancer stage at presentation and treatment for localized prostate cancer, but there is little information on education and quality of life outcomes. Patient education level and quality of life were examined among men diagnosed with prostate cancer and cared for within an equal-access health care system, the Department of Veterans Affairs Veterans Health Administration (VA).

METHODS.

Participants were 248 men with prostate cancer cared for in the VA and enrolled in CaPSURE. Repeated-measures analysis of variance was used to examine quality of life over time according to education level, controlling for age, ethnicity, income, site of clinical care, and year of diagnosis.

RESULTS.

Patients with lower levels of education tended to be younger, nonwhite, and have lower incomes. Controlling for age, ethnicity, income, year of diagnosis, and site, men with less formal education, compared with those with more, had worse functioning in the physical (P = .0248), role physical (P = .0048), role emotional (P = .0089), vitality (P = .0034), mental health (P = .0054), social function (P = .0056), and general health (P = .0002) domains and worse urinary (P = .003) and sexual (P = .0467) side effects.

CONCLUSIONS.

Men with less education experienced worse health-related quality of life across a wide range of domains and greater urinary and sexual symptoms than their peers who had more education. Clinicians should be aware that, even within an equal access to health care system, men with less education are vulnerable, having greater difficulty functioning in their daily lives after their prostate cancer treatment. Cancer 2007. © 2007 American Cancer Society.

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