| A variety of factors such as the patient's clinical and socio-demographic characteristics, level of function prior to treatment, type, and side-effect of treatment could influence survival over the course of disease. While sufficient evidence exists on differences in survival based on clinical and sociodemographic characteristics, lesser is known about quality of life measures, factors influencing physical function and impact of treatment on comorbid conditions.;Data from CaPSURE (longitudinal observational registry for men with biopsy proven prostate cancer) was utilized in this dissertation.;In first analysis, Cox proportional hazards models with sequential bootstrap resampling and addition of time-dependent covariates were used to estimate association between HRQOL and survival (defined by all-cause mortality) at various points during the course of disease, Higher levels of baseline physical functioning and general health perception were significantly associated with better survival. Furthermore, HRQOL measured after definitive treatment, dynamically, and as a change in scores, demonstrated similar results with higher levels of physical functioning, role limitation due to physical problems, general health perception, energy/fatigue, and social functioning being significantly associated with better survival (HR ranging from 0.57 to 0.65).;In the second analysis, individual contributions of various demographic, clinical, psychosocial, and behavioral factors to changes in Physical Function were assessed. Linear regression using generalized estimating equation method was utilized. Vitality, bodily pain, mental health, and social function were independently associated with changes in physical function over time. Age was negatively associated with changes in physical function with varied responses among different treatment modalities. In addition, severity of disease, lower income, and non-White race were associated with decrease in physical function over time.;In the final analysis, impact of treatment on pre-existing conditions measured by Total Illness Burden Index (TIBI-CaP) was assessed. The odds ratios (OR) of the probability of being in a more severe category of TIBI-CaP for each type of treatment were derived using ordinal logistic regression, Adjusted odds ratio demonstrated a strong association between type of treatment and TIBI-CaP severity category. Compared to patients treated with Radical Prostatectomy, patients managed with Brachytherapy, External Beam Radiation, Hormonal Treatment and Watchful Waiting demonstrated an increase probability of being in more severe TIBI-CaP category with odd ratios ranging from 1.23 to 2.33. |
