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Christopher S Saigal

Publications and source records attributed to Christopher S Saigal.

7 recordsLinked to original sources
PubMed2005

Predictors of fatigue after treatment for prostate cancer.

OBJECTIVES: To investigate whether post-treatment fatigue among men treated for prostate cancer varies by treatment, demographics, or pretreatment general and disease-specific health-related quality of life. We also sought to describe the baseline characteristics of men who were fatigued at follow-up to allow for interventions in those at greatest risk. METHODS: We conducted a secondary analysis on data gathered from men with prostate cancer at biopsy and after treatment by examining factors that predicted for post-treatment fatigue. RESULTS: Univariate and multivariate analysis results demonstrated that post-treatment fatigue was associated with baseline fatigue, role limitations due to emotional problems, treatment type, and treatment location. RESULTS: Univariate analysis showed that those who were fatigued at follow-up were more likely to have been treated at a public facility (P = 0.0017), be nonwhite (Latino, African American, or Asian Pacific-Islander; P = 0.0362), be married (P = 0.0413), be not employed at least part-time (P = 0.0327), to have one or more comorbidities (P = 0.0005), and to have scored lower in all domains of the RAND 36-Item Health Survey and UCLA Prostate Cancer Index at baseline (all P < or = 0.05) than those not fatigued at follow-up. Those who declined from baseline energy levels were more likely to have had lower baseline energy scores (P < 0.0001), to have been treated in a public facility (P = 0.0578), and to have had a baseline prostate-specific antigen level of 10 ng/mL or greater (P = 0.059) than those who remained at their baseline energy level. Lower baseline role-emotional scores were associated with both fatigue at follow-up and a decline from baseline at follow-up. CONCLUSIONS: Men with lower pretreatment quality-of-life measures may be at increased risk of fatigue after prostate cancer treatment.

Adenocarcinoma↗
PubMed2003

Regret in men treated for localized prostate cancer.

PURPOSE: We identify the predictors of medical regret in men treated for localized prostate cancer. MATERIALS AND METHODS: Patients previously treated for early stage prostate cancer were assessed for treatment regret using validated items. Univariate and multivariate analyses identified associations between regret and demographic characteristics, clinical outcomes, medical knowledge, and general and disease specific health related quality of life as measured by the general health perceptions domain of the RAND 36-Item Health Survey and a validated short form of the University of California, Los Angeles Prostate Cancer Index. RESULTS: Of 96 respondents (mean age 64 years, mean followup 2.8 years) 16% expressed regret with treatment decisions. Regretful men were almost twice as likely as nonregretful men to have less than a college education (60% versus 33%, p = 0.05) and worse current health related quality of life (p <0.05). In addition, regretful men tended to be unable to recall the most recent prostate specific antigen accurately (p = 0.06). Men with and without regret did not differ in other demographic characteristics, treatment choice or clinical outcomes. Regretful men were more likely to say they would choose a different treatment if they could. In multivariate analyses worse quality of life predicted regret but decline in quality of life with time was not associated with regret. CONCLUSIONS: Men expressing regret over treatment choice for localized prostate cancer have poorer health related quality of life. Further study is needed to identify factors that predict posttreatment regret. Such information will allow patients and physicians to individualize treatment decisions, optimize quality of life and avoid medical regret.

Aged↗
PubMed2003

Variation in continence and potency by definition.

PURPOSE: The reporting of quality of life outcomes after prostate cancer treatment has improved with the use of validated instruments and third party data collection, and yet widely disparate continence and potency rates persist among providers. We assessed how well various definitions of these outcomes correspond with each other in the same patients. MATERIALS AND METHODS: A longitudinal cohort of 269 men undergoing radical prostatectomy for early stage prostate cancer completed quality of life questionnaires, including the University of California-Los Angeles Prostate Cancer Index. Six definitions of urinary continence and 6 definitions of potency represented by individual or aggregated items in the survey were analyzed. Using 2,506 questionnaires patients meeting the criteria for continence or potency by each definition were compared. RESULTS: Correspondence among continence definitions varied widely. Of the men who reported using no pads only 42% leaked urine not at all. Other definitions had higher rates of concordance with 98% of patients who reported total control also claiming no pads. Correspondence among potency definitions was even more disparate. Only 5% of men with erections firm enough for intercourse reported having morning erection very often, while 61% rated their ability to function sexually as good or very good. CONCLUSIONS: Variations in outcomes from items intended to measure the same domain reflect the idiosyncrasy of patient definitions of urinary and erectile function. Disease targeted, health related quality of life outcomes vary greatly depending on the specific definition used.

Erectile Dysfunction↗
PubMed2002

Variations in use of imaging in a national sample of men with early-stage prostate cancer.

OBJECTIVES: To measure the national practice variations in imaging studies performed for men newly diagnosed with clinically localized prostate cancer. METHODS: We created an analytic file from 1991 to 1996 Medicare claims data using files for a random sample of 5% of all Medicare beneficiaries. Among men with newly diagnosed clinically localized prostate cancer, we identified those undergoing staging bone scans, staging computed tomography (CT), or staging magnetic resonance imaging (MRI) at the time of diagnosis. We conducted univariate and multivariate analyses adjusting for Charlson index score, age group, race, geographic region, and year of diagnosis. RESULTS: In all geographic regions, men receiving radiation therapy (RT) were more likely than those receiving radical prostatectomy (RP) to undergo CT. In the South, RT patients were significantly more likely than RP patients to undergo MRI and bone scans. In the West, RT patients were significantly more likely than RP patients to have bone scans. In multivariate analyses that controlled for all significant univariate findings, treatment with RT significantly predicted for the use of bone scans (odds ratio 1.24, 95% confidence interval 1.17 to 1.31), CT scans (odds ratio 3.26, 95% confidence interval 3.18 to 3.34), and MRI scans (odds ratio 1.47, 95% confidence interval 1.23 to 1.72). Regional differences in the use of imaging technologies for staging persisted in the multivariate analysis. CONCLUSIONS: Patients undergoing RT for clinically localized prostate cancer undergo more bone, CT, and MRI scans than do patients undergoing RP, regardless of comorbidity, age, or race. In addition, a significant geographic variation was found in the use of these diagnostic tests. These variations suggest that evidence-based staging guidelines have not been met with broad physician acceptance.

Aged↗
PubMed2002

Stability of time trade-off utilities for health states associated with the treatment of prostate cancer.

BACKGROUND: Patients diagnosed with localized prostate cancer face several treatment options. Patient preferences for treatment side effects often dominate the decision making process. We proposed to learn more about the nature of patient preferences, or utilities, for these side effects. METHODS: Two hundred and fifteen men were consecutively enrolled from three institutions for assessment after prostate needle biopsy. Baseline and 6 month follow-up assessments were done using the University of California, Los Angeles Prostate Cancer Index (UCLA PCI), and a laptop utility assessment application, U-Titer II. Patient utility was assessed for current pelvic functions as well as hypothetical pelvic dysfunctions. We calculated stability of utility scores and correlations between utility scores and UCLA PCI scores. RESULTS: Utility scores for current pelvic functions exhibited a significant 'ceiling effect.' Utility scores for current pelvic functions and hypothetical impaired states were stable after 6 months in patients with negative biopsies. In patients who underwent treatment, utility for current sexual function decreased by 0.13 units (p < 0.00) and utility for current urinary function decreased by 0.09 units (p < 0.01). Utility for hypothetical stress urinary incontinence rose in men with a >25-point drop in UCLA PCI score. CONCLUSION: Utilities for some 'current' pelvic functions decreased in tandem with UCLA PCI scores in men who experienced >25-point changes in these scores. Utilities for some 'hypothetical' pelvic dysfunctions rose as men began to actually experience functional changes in those areas.

Adult↗
PubMed2002

The economic costs of early stage prostate cancer.

The economic costs of early stage prostate cancer are significant, and will likely increase as the proportion of older men grows in the population of industrialised nations. In the US, total costs have been estimated to range from US dollars 1.72 billion to US dollars 4.75 billion annually (1990 costs). Costs related to early stage prostate cancer arise from screening, staging and treatment. Cost-effectiveness models of population-based prostate cancer screening indicate that such screening could result in as much as US dollars 27.9 billion (1988 values) in charges to the US healthcare system. Evidence-based cancer-staging strategies would result in significant reduction of wasted expense. Rational allocation of healthcare dollars for prostate cancer screening and treatment may ultimately depend on data from randomised controlled trials.

Humans↗