The Evolution of Self-Reported Urinary and Sexual Dysfunction over the Last Two Decades: Implications for Comparative Effectiveness Research.

Resnick MJ1, Barocas DA2, Morgans AK3, Phillips SE4, Koyama T4, Albertsen PC5, Cooperberg MR6, Goodman M7, Greenfield S8, Hamilton AS9, Hoffman KE10, Hoffman RM11, Kaplan SH8, McCollum D12, Paddock LE13, Stanford JL14, Stroup AM13, Wu XC15, Penson DF16.

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Abstract

BACKGROUND:

Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time.

OBJECTIVE:

To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart.

DESIGN, SETTING, AND PARTICIPANTS:

Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies.

RESULTS AND LIMITATIONS:

The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39-2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68-3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding.

CONCLUSIONS:

Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations.

PATIENT SUMMARY:

Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research.