'Beyond Treatment': Clinical and psychosocial predictors of health-related quality of life of patients with prostate cancer.

Objective: This study sought to assess the health-related quality of life and its predictors among patients diagnosed with prostate cancer in two municipalities in the Volta Region of Ghana and to compare the scores between patients receiving treatment and those not receiving treatment.

Methods: A cross-sectional hospital-based analytical study was conducted among 205 prostate cancer patients attending 2 hospitals in the Volta Region. Health-related quality of life was measured using the functional assessment of cancer therapy-prostate instrument, comprising subscales for physical, emotional, social and functional well-being. Group differences were assessed using Kruskal-Wallis H tests, and multiple linear regression was used to identify predictors of overall health-related quality of life.

Results: The performance under the individual domains or subscales was 14.8 ± 8.7, 14.1 ± 5.6, 13.7 ± 6.6, 9.6 ± 7.7, and 20.1 ± 9.9 for the physical well-being, social/family well-being, emotional well-being, functional well-being and PC subscales, respectively. The functional assessment of cancer therapy-trial outcome index was 44.6 (standard deviation ±16.2). The Functional Assessment of Cancer Therapy-General (FACT-G) total score among the study participants was 52.2 (standard deviation ±15.5). The participants in this study had an overall functional assessment of cancer therapy-prostate total score of 72 (standard deviation ±22), an indication of a lower health-related quality of life performance. Contrary to expectations, untreated patients reported slightly better scores in physical and emotional well-being and higher overall health-related quality of life scores compared to those who received treatment. Emotional well-being was significantly lower among treated patients (mean = 12.6) compared to untreated patients (mean = 16.9). Treated patients showed marginally better social and functional well-being. While differences in total scores between the groups were not statistically significant (p = 0.27), clinical variables such as urinary incontinence, pain, anxiety, erectile dysfunction and bowel problems were significantly associated with lower quality of life (all p < 0.001). Regression analysis identified older age (β = -0.12, p = 0.03), erectile dysfunction (β = -0.47, p < 0.001), bowel problems (β = -0.19, p < 0.001) and anxiety (β = -0.18, p < 0.001) as independent predictors of poorer scores, whereas being married was associated with higher performance on the scale (β = 0.13, p = 0.01).

Conclusion: The functional assessment of cancer therapy-prostate scale revealed notably low health-related quality of life scores among men with prostate cancer in the two municipalities of Ghana's Volta Region. Untreated patients reported better emotional and physical well-being, while treated patients had slightly better social and functional well-being. Overall scores were higher in untreated patients. Erectile dysfunction, bowel issues, anxiety and older age significantly reduced performance on the scale. Marriage positively predicted better quality of life outcomes. Clinical or symptom burden and psychosocial factors had a greater impact on overall quality of life than treatment status, emphasising the need for comprehensive care.