THE USE OF GENERIC MEASURES OF HEALTH-RELATED QUALITY-OF-LIFE IN THE ASSESSMENT OF OUTCOME FROM TRANSURETHRAL RESECTION OF THE PROSTATE

Objectives To investigate the performance of the EuroQol (EQ) quality- of-life measure and the Nottingham Health Profile (NHP) in assessing t he outcome of transurethral resection of the prostate (TURF) for lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruct ion (BPO), and to determine which men experience the greatest increase in health-related quality of life (HRQL) after TURF. Patients and met hods A prospective cohort study was undertaken over 12 months from Apr il 1992 of 314 men who completed the EQ, the NHP and a symptom invento ry before undergoing elective TURF for probable BPO (Group 1). Identic al postal questionnaires were used to follow up this group at 6 weeks, 6 months and 12 months post-operatively, with response rates of 79%, 74% and 69%, respectively, Overall, 92% of patients responded at eithe r 6 or 12 months after surgery, A group of 51 men who had not undergon e operation, also with LUTS and probable BPO, were similarly followed over 6 months, before eventually undergoing TURF (Group 2). These pati ents differed from Group 1 in being younger, less symptomatic and havi ng a higher baseline quality-of-life score, but the inclusion of this group from a broadly similar diagnostic category allowed outcome to be assessed over time in the absence of surgery. Results There was a sig nificant improvement in all LUTS 6 weeks after TURF; post-micturition dribbling and storage symptoms continued to improve for up to one year . The NHP revealed pre-operative morbidity in all dimensions of the pr ofile, At 12 months after surgery there were significant improvements in the domains of social interaction, energy, pain, emotional reaction s and sleep. The EQ profile also showed morbidity in all dimensions be fore surgery, with significant improvement at 12 months in usual activ ities, mood and pain/discomfort. The EQ self-rated health and composit e quality-of-life score also showed improvement with TURF which contin ued for 12 months after surgery, The patients in Group 2 tended to det eriorate over the 6 months of follow-up using all measures, but the ch anges were not significant. The EQ composite quality-of-life score als o discriminated between patients on the basis of age, number of sympto ms and ASA grade, suggesting that these subgroups experienced differin g amounts of benefit from surgery. Conclusion TURF led to significant improvement in the indices of generic HRQL as measured using the NHP a nd EQ; this improvement continued for 12 months after surgery and mirr ored the symptomatic improvement. The EQ confirmed clinical experience , in that men who were younger, fitter and most symptomatic experience d the greatest benefit from surgery, This has not been shown previousl y using a quality-of-life measure. Generic HRQL measures can be incorp orated easily into clinical trials and both the measures used in this study have sufficient sensitivity to be used in this population, The E Q has the advantage of generating a composite quality-of-life score wh ich is easy to interpret and can be used in cost-utility analysis. The addition of HRQL measures leads to a more robust appraisal of the res ults of surgical intervention, Ultimately, patient-based outcome from TURF will be assessed using a combination of psychometrically tested d isease-specific and generic measures, together with symptom scoring.