Purpose: Presence of comorbid conditions has consistently been associated with less aggressive treatment and worse overall survival in men with prostate cancer. However, little is known about the impact of comorbidity on health related quality of life outcomes, which may help men and their physicians facing decisions on primary treatment.
Materials and methods: We evaluated patterns of health related quality of life in men with both prostate cancer and cardiovascular disease during 4 years of followup in a cohort of 475 prostate cancer survivors. We measured generic and disease specific health related quality of life at diagnosis and 11 times afterward. Repeated measures analyses with mixed modeling were used to examine changes in health related quality of life in subjects with cardiovascular disease and compare outcomes with those of an age, stage and treatment matched sample without cardiovascular disease.
Results: Men with cardiovascular disease had worse baseline physical health related quality of life (p = 0.003) and showed worse scores over time in this domain than did matched controls (p = 0.003). We found no significant interaction between treatment and cardiovascular disease on physical health related quality of life outcomes, suggesting that cardiovascular disease had the same detrimental effect on health related quality of life in this specific domain for radical prostatectomy, brachytherapy or external beam radiotherapy. The negative effect of cardiovascular disease on physical health related quality of life over time appeared to be stronger for those with worse baseline scores. The presence of cardiovascular disease was also associated with worse baseline sexual function (p = 0.004) and a trend toward worse scores over time (p = 0.07).
Conclusions: Our observations suggest that patients with prostate cancer with cardiovascular disease have worse physical and sexual health related quality of life before and following treatment.