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Interpretation of Domain Scores on the EPIC-How Does the Domain Score Translate into Functional Outcomes?

Authors
  • Laviana, Aaron A1
  • Hernandez, Agustin1
  • Huang, Li-Ching2
  • Zhao, Zhiguo2
  • Koyama, Tatsuki2
  • Conwill, Ralph3
  • Hoffman, Karen4
  • Feurer, Irene D2, 5
  • Goodman, Michael6
  • Hamilton, Ann S7
  • Wu, Xiao-Cheng8
  • Paddock, Lisa E9
  • Stroup, Antoinette9
  • Cooperberg, Matthew R10
  • Hashibe, Mia11
  • O'Neil, Brock B12
  • Kaplan, Sherrie H13
  • Greenfield, Sheldon13
  • Penson, David F1
  • Barocas, Daniel A1
  • 1 Department of Urology, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 2 Department of Biostatistics, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 3 Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 4 Department of Radiation Oncology, University of Texas MD Anderson Center, Houston, Texas.
  • 5 Department of Surgery, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 6 Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia. , (Georgia)
  • 7 Department of Preventive Medicine, Keck School of Medicine at University of Southern California, Los Angeles, California.
  • 8 Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, Louisiana.
  • 9 Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, New Jersey. , (Jersey)
  • 10 Department of Urology, University of California-San Francisco, San Francisco, California.
  • 11 Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
  • 12 Department of Urology, University of Utah Health, Salt Lake City, Utah.
  • 13 Department of Medicine, University of California-Irvine, Irvine, California.
Type
Published Article
Journal
The Journal of urology
Publication Date
Dec 01, 2019
Volume
202
Issue
6
Pages
1150–1158
Identifiers
DOI: 10.1097/JU.0000000000000392
PMID: 31216252
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The EPIC-26 (Expanded Prostate Cancer Index Composite-Short Form) is a validated questionnaire for measuring health related quality of life. However, the relationship between domain scores and functional outcomes remains unclear, leading to potential confusion about expectations after treatment. For instance, does a sexual function domain score of 80 mean that a patient can achieve erection sufficient for intercourse? Consequently we sought to determine the relationship between the domain score and the response to obtaining the best possible outcome for each question. Using data from the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study, a multicenter, prospective study of men diagnosed with localized prostate cancer, we analyzed 11,464 EPIC-26 questionnaires from a total of 2,563 men at baseline through 60 months of followup who were treated with robotic prostatectomy, radiotherapy or active surveillance. We dichotomized every item into its best possible outcome and assessed the percent of men at each domain score who achieved the best result. For every EPIC-26 item the frequency of the best possible outcome was reported by domain score category. For example, a score of 80 to 100 on sexual function corresponded to 97% of men reporting erections sufficient for intercourse while at a score of 40 to 60 only 28% reported adequate erections. Also, at a score of 80 to 100 on the urinary incontinence domain 93% of men reported rarely or never leaking vs 6% at a score of 61 to 80. Our findings indicate a novel way to interpret EPIC-26 domain scores, demonstrating large variations in the percent of respondents reporting the best possible outcomes over narrow domain score differences. This information may be valuable when counseling men on treatment options.

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