Quality of Life Research

, 16:509 | Cite as

Responsiveness of disease-specific and generic utility instruments in prostate cancer patients

  • Murray Krahn
  • Karen E. Bremner
  • George Tomlinson
  • Paul Ritvo
  • Jane Irvine
  • Gary Naglie



Preferences (utilities) for health outcomes have an important role in decisions about prostate cancer screening and treatment. The responsiveness of utility instruments has not been evaluated.


Prostate cancer outpatients from the Princess Margaret Hospital, Toronto (n = 248) were allocated into three cohorts: N — newly diagnosed and treated; M — metastatic disease; O — all others.


We measured quality of life at 3 points within 12 months using 3 disease-specific utility instruments (Patient Oriented Prostate Utility Scales), 3 generic utility instruments (Health Utilities Index, EQ-5D, Quality of Well-Being Scale), and 3 profile scales (PORPUS-P profile, Prostate Cancer Index, QLQ-C-30). Responsiveness was assessed using measures of internal responsiveness (standardized effect size, standardized response mean) and external responsiveness (receiver operator curve analysis, mixed model regression).


Cohort N patients showed post-treatment declines followed by improvement in global health and functional status. Disease specific instruments detected moderate (0.4–1.3) decrements followed by small increments (0.1–0.4) in standardized effect size and standardized response mean. Most instruments detected change using external responsiveness measures (all cohorts).


Disease-specific utility instruments appeared to be more responsive than generic instruments. Use of generic instruments should be supplemented with a responsive disease-specific instrument, particularly for applications in early prostate cancer.


Measurement Psychometrics Urologic diseases Utility measurement 



area under the receiver operator curve


EuroQol 5 dimension quality of life instrument


health related quality of life


Health Utilities Index


Prostate Cancer Index


Patient Oriented Prostate Utility Scales


health index version of PORPUS


health profile version of PORPUS


direct utility elicitation version of the PORPUS, using rating scale scaling


direct utility elicitation version of the PORPUS, using standard gamble scaling


European Organisation for the Research and Treatment of Cancer quality of life questionnaire, core module


Quality of Well Being Scale


rating scale


standardized effect size


standard gamble


standardized response mean



Support was provided by the Canadian Institutes for Health Research (CIHR), (Grant #006169), Zeneca Canada Inc., an Investigator Award from the Canadian Institutes for Health Research (Dr.␣Krahn), the F. Norman Hughes Chair in Pharmacoeconomics (Dr. Krahn) and the Mary Trimmer Chair in Geriatric Medicine Research (Dr. Naglie).


  1. 1.
    Krahn MD, Mahoney JE, Eckman MH, Trachtenberg J, Pauker SG, Detsky AS (1994) Screening for prostate cancer: A decision analytic view JAMA 272:781–86CrossRefGoogle Scholar
  2. 2.
    Schwartz KL, Alibhai SM, Tomlinson G, Naglie G, Krahn MD (2003) Continued undertreatment of older men with localized prostate cancer Urology 62(5):860–65CrossRefPubMedGoogle Scholar
  3. 3.
    Alibhai SM, Naglie G, Nam R, Trachtenberg J, Krahn MD (2003) Do older men benefit from curative therapy of localized prostate cancer? J Clin Oncol 21(17):3318–327CrossRefPubMedGoogle Scholar
  4. 4.
    Krahn MD, Bremner KE, Asaria J, et al. (2002) The ten-year rule revisited: Accuracy of clinicians’ estimates of life expectancy in patients with localized prostate cancer Urology 60(2):258–63CrossRefPubMedGoogle Scholar
  5. 5.
    Torrance GW (1987) Utility approach to measuring health-related quality of life J Chron Dis 40:593–00CrossRefPubMedGoogle Scholar
  6. 6.
    Froberg DG, Kane RL (1989) Methodology for measuring health-state preferences-I: Measurement strategies J Clin Epidemiol 42:345–54CrossRefPubMedGoogle Scholar
  7. 7.
    Gold MR, Patrick DL, Torrance GW, et al. (1996) Identifying and valuing outcomes. In: Gold MR, Siegel JE, Russell LB, Weinstein MC (Eds) Cost Effectiveness in Health and Medicine Oxford University Press New YorkGoogle Scholar
  8. 8.
    Froberg DG, Kane RL (1989) Methodology for measuring health-state preferences-II: Scaling methods J Clin Epidemiol 42:459–71CrossRefPubMedGoogle Scholar
  9. 9.
    Krahn M, Ritvo P, Irvine J, et al. (2000) Construction of the Patient-Oriented Prostate Utility Scale (PORPUS): A multiattribute health state classification system for prostate cancer J Clin Epidemiol 53(9):920–30CrossRefPubMedGoogle Scholar
  10. 10.
    Krahn M, Ritvo P, Irvine J, et al. (2003) Patient and community preferences for outcomes in prostate cancer: Implications for clinical policy Med Care 41(1):153–64CrossRefPubMedGoogle Scholar
  11. 11.
    Kaplan RM, Anderson JP, Wu AW, Mathews C, Kozin F, Orenstein D (1989) The Quality of Well-Being scale. Applications in AIDS, cystic fibrosis, and arthritis Medical Care 27:S27–s43CrossRefPubMedGoogle Scholar
  12. 12.
    Euroqol-Group. EuroQol: A new facility for the measurement of health related quality of life. Health Policy 1990; 16:199Google Scholar
  13. 13.
    Torrance GW, Furlong W, Feeny D, Boyle M (1995) Multi-attribute preference functions: Health Utilities Index PharmacoEconomics 7:503–20CrossRefPubMedGoogle Scholar
  14. 14.
    Furlong WH, Torrance GW, Feeny D, Boyle MH. McMaster (1994) Health Utilities Index of health-related quality of life Qual Life Res 3:76Google Scholar
  15. 15.
    Feeny D, Furlong W, Boyle M, Torrance GW (1995) Multi-attribute health status classification systems: Health Utilities Index PharmacoEconomics 7:490–02CrossRefPubMedGoogle Scholar
  16. 16.
    Feeny D, Torrance G, Furlong W. Health Utilities Index. In: Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd ed. Philadelphia: Lippincourt-Raven, Publishers, 1996: 239–52Google Scholar
  17. 17.
    van Agt HM, Essink-Bot ML, Krabbe PF, Bonsel GJ (1994) Test-retest reliability of health state valuations collected with the EuroQol questionnaire Soc Sci Med 39(11):1537–544CrossRefPubMedGoogle Scholar
  18. 18.
    Brazier J, Jones N, Kind P (1993) Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire Qual Life Res 2(3):169–80CrossRefPubMedGoogle Scholar
  19. 19.
    Neumann PJ, Goldie SJ, Weinstein MC (2000) Preference-based measures in economic evaluation in health care Annu Rev Public Health 21:587–11CrossRefPubMedGoogle Scholar
  20. 20.
    Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS (1999) Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation J Clin Epidemiol 52(3):187–92CrossRefPubMedGoogle Scholar
  21. 21.
    Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A (1997) Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness, and reliability of EuroQol British J Rheumatol 36:551–59CrossRefGoogle Scholar
  22. 22.
    Stolk EA, Busschbach JJ (2003) Validity and feasibility of the use of condition-specific outcome measures in economic evaluation Qual Life Res 12(4):363–71CrossRefPubMedGoogle Scholar
  23. 23.
    Revicki DA, Leidy NK, Brennan-Diemer F, Thompson C, Togias A (1998) Development and preliminary validation of the multiattribute Rhinitis Symptom Utility Index Qual Life Res 7(8):693–02CrossRefPubMedGoogle Scholar
  24. 24.
    Revicki DA, Leidy NK, Brennan-Diemer F, Sorensen S, Togias A (1998) Integrating patient preferences into health outcomes assessment: The multiattribute Asthma Symptom Utility Index Chest 114(4):998–007CrossRefPubMedGoogle Scholar
  25. 25.
    Tomlinson GA, Bremner KE, Naglie G, Ritvo P, Irvine J, Krahn M (2002) Development and validation of a multi-attribute utility function for a multiattribute health state classification system for prostate cancer Med Decis Making 22(6):560Google Scholar
  26. 26.
    Essink-Bot ML, Korfage IJ, De Koning HJ (2003) Including the quality-of-life effects in the evaluation of prostate cancer screening: Expert opinions revisited? BJU Int 92 Suppl 2:101–05CrossRefGoogle Scholar
  27. 27.
    Kaplan RM, Anderson JP (1988) A general health policy model: Update and applications Health Serv Res 23:203–35PubMedGoogle Scholar
  28. 28.
    Essink-Bot ML, Stouthard ME, Bonsel GJ (1993) Generalizability of valuations on health states collected with the EuroQol questionnaire Health Econ 2:237–46CrossRefPubMedGoogle Scholar
  29. 29.
    Beaton DE, Bombardier C, Katz JN, Wright JG (2001) A taxonomy for responsiveness J Clin Epidemiol 54(12):1204–217CrossRefPubMedGoogle Scholar
  30. 30.
    Bergman B, Aaronson NK, Ahmedzai S, Kaasa S, Sullivan M (1994) The EORTC QLQ-LC13: A modular supplement to the EORTC Core Quality of Life Questionnaire (QLQ-C30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life Eur J Cancer 30A(5):635–42CrossRefPubMedGoogle Scholar
  31. 31.
    Aaronson NK, Ahmedzai S, Bergman B, et al. (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology J Natl Cancer Inst 85(5):365–76CrossRefPubMedGoogle Scholar
  32. 32.
    Jakobsson L. (2002) Indwelling catheter treatment and health-related quality of life in men with prostate cancer in comparison with men with benign prostatic hyperplasia Scand J Caring Sci 16(3):264–71CrossRefPubMedGoogle Scholar
  33. 33.
    Nygard R, Norum J, Due J (2001) Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis Anticancer Res 21(1B):781–88PubMedGoogle Scholar
  34. 34.
    Litwin MS, Hays RD, Fink A, et al. (1995) Quality-of-life outcomes in men treated for localized prostate cancer JAMA 273:129–35CrossRefPubMedGoogle Scholar
  35. 35.
    Dolan P (1997) Modeling valuations for EuroQol Health States Med Care 35:1095–108CrossRefPubMedGoogle Scholar
  36. 36.
    Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: A critical review and recommendations J Clin Epidemiol 53(5):459–68CrossRefPubMedGoogle Scholar
  37. 37.
    Beaton DE, Hogg-Johnson S, Bombardier C (1997) Evaluating changes in health status: Reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders J Clin Epidemiol 50(1):79–3CrossRefPubMedGoogle Scholar
  38. 38.
    Liang MH (1995) Evaluating measurement responsiveness J Rheumatol 22(6):1191–192PubMedGoogle Scholar
  39. 39.
    Fowler FJ, Barry MJ, Lu-Yao G, Wannson J (1995) Effect of radical prostatectomy for prostate cancer on patient quality of life: Results from a Medicare survey Urology 45:1007–013CrossRefPubMedGoogle Scholar
  40. 40.
    Potosky AL, Legler J, Albertsen PC, et al. (2000) Health outcomes after prostatectomy or radiotherapy for prostate cancer: Results from the Prostate Cancer Outcomes Study J Natl Cancer Inst 92(19):1582–592CrossRefPubMedGoogle Scholar
  41. 41.
    Litwin MS, Flanders SC, Pasta DJ, Stoddard ML, Lubeck DP, Henning JM (1999) Sexual function and bother after radical prostatectomy or radiation for prostate cancer: Multivariate quality-of-life analysis from CaPSURE. Cancer of the Prostate Strategic Urologic Research Endeavor Urology 54(3):503–08CrossRefPubMedGoogle Scholar
  42. 42.
    Grootendorst P, Feeny D, Furlong W (2000) Health Utilities Index Mark 3: Evidence of construct validity for stroke and arthritis in a population health survey Med Care 38(3):290–99CrossRefPubMedGoogle Scholar
  43. 43.
    Horsman J, Furlong W, Feeny D, Torrance G (2003) The Health Utilities Index (HUI(R)): Concepts, measurement properties and applications Health Qual Life Outcomes 1(1):54CrossRefPubMedGoogle Scholar
  44. 44.
    Marra CA, Woolcott JC, Kopec JA, et al. (2005) A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis Soc Sci Med 60(7):1571–582CrossRefPubMedGoogle Scholar
  45. 45.
    King M, Dobson A (2000) Estimating the responsiveness of an instrument using more than two repeated measures Biometrics 56(4):1197–203CrossRefPubMedGoogle Scholar
  46. 46.
    SPSS for Windows. 11.5.0 ed. Chicago: SPSS Inc.; (2002)Google Scholar
  47. 47.
    S+. S+ 6.2 for Windows. Insightful Corporation; (2004)Google Scholar
  48. 48.
    Wiebe S, Guyatt G, Weaver B, Matijevic S, Sidwell C (2003) Comparative responsiveness of generic and specific quality-of-life instruments J Clin Epidemiol 56(1):52–0CrossRefPubMedGoogle Scholar
  49. 49.
    Cantor SB, Spann SJ, Volk RJ, Cardenas MP, Warren MM (1995) Prostate cancer screening: A decision analysis J Fam Pract 41:33–1PubMedGoogle Scholar
  50. 50.
    Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wennberg J (1993) A decision analysis of alternative treatment strategies for clinically localized prostate cancer JAMA 269:2650–659CrossRefPubMedGoogle Scholar
  51. 51.
    Kattan MW, Cowen ME, Miles BJ (1997) A decision analysis for treatment of clinically localized prostate cancer J Gen Internal Med 12:299–05CrossRefGoogle Scholar
  52. 52.
    Essink-Bot ML, de Koning HJ, Nijs HG, Kirkels WJ, van der Maas PJ, Schroder FH (1998) Short-term effects of population-based screening for prostate cancer on health-related quality of life J Natl Cancer Inst 90(12):925–31CrossRefPubMedGoogle Scholar
  53. 53.
    Frosch D, Porzsolt F, Heicappell R, et al (2001) Comparison of German language versions of the QWB-SA and SF-36 evaluating outcomes for patients with prostate disease Qual Life Res 10(2):165–73CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Murray Krahn
    • 1
    • 2
    • 8
  • Karen E. Bremner
    • 1
  • George Tomlinson
    • 1
    • 4
    • 5
  • Paul Ritvo
    • 3
    • 6
  • Jane Irvine
    • 3
    • 7
  • Gary Naglie
    • 1
    • 5
  1. 1.Department of MedicineUniversity of TorontoTorontoCanada
  2. 2.Faculty of Pharmacy University of TorontoTorontoCanada
  3. 3.Department of PsychologyUniversity of TorontoTorontoCanada
  4. 4.Department of Public Health SciencesUniversity of TorontoTorontoCanada
  5. 5.Departments of Health Policy, Management, and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Ontario Cancer InstituteTorontoCanada
  7. 7.York UniversityTorontoCanada
  8. 8.Department ofMedicineUniversity of Toronto, The Toronto General HospitalTorontoCanada

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