Latent profile analysis of adverse effects associated with endocrine therapy in prostate cancer patients based on the theory of unpleasant symptoms

doi:10.3969/j.issn.1674-8115.2023.09.013

Abstract

Abstract:

Objective ·Based on the theory of unpleasant symptoms, to investigate the current status of adverse effects associated with endocrine therapy in prostate cancer patients, and identify the difference of population specificity in each latent category. Methods ·From June 2022 to September 2022, 274 patients with endocrine therapy for prostate cancer in the Urology Department of Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected by convenience sampling method. Adverse reactions associated with endocrine therapy were investigated by basic information questionnaire and simplified Chinese version of the aging male′s symptoms scale. Latent profile analysis was conducted and the differences of population characteristics among categories were assessed based on t-test, variance analysis and multiple Logistic regression. Perform latent profile analysis was performed by using Mplus 8.3 to identify latent classes of endocrine treatment-related adverse events in prostate cancer patients. Results ·Adverse reactions associated with endocrine therapy in patients with prostate cancer could be divided into three groups: mild-symptom group (n=96, 35.0%), moderate-symptom group (n=111, 40.5%) and severe-symptom group (n=67,24.5%). Compared to patients with mild symptoms, those in the moderate-symptom group had significant differences in psychosocial adaptation (OR=1.038, 95%CI 1.018?1.060, P=0.000), and whether genetic detection was performed (OR=0.336, 95%CI 0.129?0.879, P=0.026). Compared to patients with mild symptoms, those in the severe-symptom group had significant differences in psychosocial adaptation (OR=1.027, 95%CI 1.003?1.051, P=0.024), disease uncertainty (OR=1.021, 95%CI 1.005?1.038, P=0.011), M stage (OR=0.354, 95%CI 0.136?0.924, P=0.034), and prostate specific antigen (PSA) (OR=0.142, 95%CI 0.042?0.480, P=0.002; OR=0.275, 95%CI 0.083?0.914, P=0.035). Conclusion ·The incidence of adverse reactions associated with endocrine therapy for prostate cancer is high. Adverse effects associated with endocrine therapy in prostate cancer patients can be classified into three categories. There are significant differences in disease metastasis, PSA levels, genetic testing, disease uncertainty, and psychosocial adaptation among prostate cancer patients receiving endocrine therapy in different categories. Healthcare professionals should assess the diverse sociodemographic background, disease-specific factors, and psychosocial status of prostate cancer patients receiving endocrine therapy, and provide targeted support according to their characteristics to help them acquire self-management skills and cope with adverse treatment effects proactively, in line with the precision medicine framework.

Key words: prostatic neoplasms, endocrine therapy, adverse reaction, theory of unpleasant symptoms, latent profile analysis

CLC Number:

R473.73

ZHU Hanjing, YIN Hongfan, YOU Sijie, YANG Yan. Latent profile analysis of adverse effects associated with endocrine therapy in prostate cancer patients based on the theory of unpleasant symptoms[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(9): 1186-1193.

Figures/Tables 6

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References 33

1	SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2020[J]. CA A Cancer J Clin, 2020, 70(1): 7-30.
2	LIU X, YU C, BI Y, et al. Trends and age-period-cohort effect on incidence and mortality of prostate cancer from 1990 to 2017 in China[J]. Public Health, 2019, 172: 70-80.
3	赵劲歌, 曾浩. 2020年欧洲泌尿外科学会(EAU)前列腺癌指南更新荟萃与解读[J]. 现代泌尿外科杂志, 2020, 25(9): 832-836, 841.
	ZHAO J G, ZENG H. Update of the European Association of Urology (EAU) guidelines for prostate cancer in 2020[J]. J Mod Urol, 2020, 25(9):832-836,841.
4	GAVIN A T, DRUMMOND F J, DONNELLY C, et al. Patient-reported ‘ever had’ and ‘current’ long-term physical symptoms after prostate cancer treatments[J]. BJU Int, 2015, 116(3): 397-406.
5	OCCHIPINTI S, ZAJDLEWICZ L, COUGHLIN G D, et al. A prospective study of psychological distress after prostate cancer surgery[J]. Psycho-oncology, 2019, 28(12): 2389-2395.
6	SHARPLEY C F, CHRISTIE D R H, BITSIKA V. Depression and prostate cancer: implications for urologists and oncologists[J]. Nat Rev Urol, 2020, 17(10): 571-585.
7	ZHAO X X, SUN M, YANG Y. Effects of social support, hope and resilience on depressive symptoms within 18 months after diagnosis of prostate cancer[J]. Health Qual Life Outcomes, 2021, 19(1): 1-10.
8	LENZ E R, PUGH L C, MILLIGAN R A, et al. The middle-range theory of unpleasant symptoms: an update[J]. ANS Adv Nurs Sci, 1997, 19(3): 14-27.
9	邵聪聪. 基于不悦症状理论肺癌患者的癌因性疲乏现状及相关因素[D]. 济南: 山东大学, 2021.
	SHAO C C. Current status of cancer-caused fatigue and related factors in lung cancer patients based on unpleasant symptom theory[D]. Jinan: Shandong University, 2021.
10	朱涵菁, 袁秀群, 杨艳. 生理-心理-社会模式下前列腺癌患者护理的研究进展[J]. 上海护理, 2022, 22(2): 46-49.
	ZHU H J, YUAN X Q, YANG Y. Research progress of prostate cancer patient care under physiological-psychological-social model[J]. Shanghai Nursing Journal, 2022, 22(2): 46-49.
11	仲艳. 前列腺癌内分泌治疗患者生活质量现状及影响因素研究[D]. 沈阳: 中国医科大学, 2021.
	ZHONG Y. Quality of life and its influencing factors in prostate cancer patients undergoing endocrine therapy[D]. Shenyang: China Medical University, 2021.
12	尹奎, 彭坚, 张君. 潜在剖面分析在组织行为领域中的应用[J]. 心理科学进展, 2020, 28(7): 1056-1070.
	YIN K, PENG J, ZHANG J. The application of latent profile analysis in the field of organizational behavior[J]. Adv Psychol Sci,2020, 28(7): 1056-1070.
13	李峥, 刘宇. 护理学研究方法[M]. 2版. 北京: 人民卫生出版社, 2018.
	LI Z, LIU Y. Research methods in nursing[M]. 2nd edition. Beijing: People′s Medical Publishing House, 2018.
14	HEINEMANN L A J, SAAD F, ZIMMERMANN T, et al. The Aging Males′ Symptoms (AMS) scale: update and compilation of international versions[J]. Health Qual Life Outcomes, 2003, 1: 15.
15	杨锐, 陆箴琦, 顾晓锋. 简体中文版老年男性症状量表的信效度检验[J]. 护理学杂志, 2020, 35(5): 31-34.
	YANG R, LU Z Q, GU X F. Reliability testing of the Simplified Chinese version of the Geriatric Male Symptom Scale [J]. Journal of Nursing Science, 2020, 35(5): 31-34.
16	HILTON B A. The Uncertainty Stress Scale: its development and psychometric properties[J]. Can J Nurs Res, 1994, 26(3): 15-30.
17	汪向东, 王希林, 马弘. 心理卫生评定量表手册[M]. 增订版. 北京: 中国心理卫生杂志社, 1999.
	WANG X D, WANG X L, MA H. Rating scales for mental health (updated edition) [M]. Beijing: Chinese Mental Health Journal, 1999.
18	姚静静. 癌症患者适应水平的横断面调查及其预测因素分析[D]. 上海: 第二军医大学, 2013.
	YAO J J. A cross-sectional survey of cancer patients′ adjustment levels and analysis of their predictors [D]. Shanghai: Second Military Medical University, 2013.
19	NORIEGA ESQUIVES B, LEE T K, MORENO P I, et al. Symptom burden profiles in men with advanced prostate cancer undergoing androgen deprivation therapy[J]. J Behav Med, 2022, 45(3): 366-377.
20	朱晓丹, 陆箴琦, 顾晓锋. 前列腺癌患者症状负担及影响因素分析[J]. 中国实用护理杂志, 2019, 35(15): 1168-1172.
	ZHU X D, LU Z Q, GU X F. Analysis of symptom burden and influencing factors in patients with prostate cancer[J]. Chin J Prac Nurs, 2019, 35(15): 1168-1172.
21	HIGANO C S. Sexuality and intimacy after definitive treatment and subsequent androgen deprivation therapy for prostate cancer[J]. J Clin Oncol, 2012, 30(30): 3720-3725.
22	ARAP W. Quality of life and satisfaction with outcome among prostate-cancer survivors[J]. N Engl J Med, 2008, 359(2): 200-201.
23	WEI Y, WU J L, GU W J, et al. Prognostic value of germline DNA repair gene mutations in de novo metastatic and castration-sensitive prostate cancer[J]. Oncologist, 2020, 25(7): e1042-e1050.
24	LI J, XU C L, LEE H J, et al. A genomic and epigenomic atlas of prostate cancer in Asian populations[J]. Nature, 2020, 580(7801): 93-99.
25	PITUSKIN E, FAIRCHILD A. Prostate cancer with bone metastases: addressing chronic pain from the perspective of the radiation oncology nurse practitioner[J]. Semin Oncol Nurs, 2021, 37(4): 151175.
26	FERNANDEZ-ARAQUE A, GOMEZ-CASTRO J, GIAQUINTA-ARANDA A, et al. Mishel′s model of uncertainty describing categories and subcategories in fibromyalgia patients, a scoping review[J]. Int J Environ Res Public Health, 2020, 17(11): 3756.
27	ZHANG Y Z. Uncertainty in illness: theory review, application, and extension[J]. Oncol Nurs Forum, 2017, 44(6): 645-649.
28	LILJA H, ULMERT D, VICKERS A J. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring[J]. Nat Rev Cancer, 2008, 8(4): 268-278.
29	HAN S, WOO S, KIM Y I, et al. Concordance between response assessment using prostate-specific membrane antigen PET and serum prostate-specific antigen levels after systemic treatment in patients with metastatic castration resistant prostate cancer: a systematic review and meta-analysis[J]. Diagnostics (Basel), 2021, 11(4): 663.
30	DAVID M K, LESLIE S W. Prostate Specific Antigen [M]. Treasure Island (FL): StatPearls Publishing LLC, 2022.
31	CHAMBERS S K, NG S K, BAADE P, et al. Trajectories of quality of life, life satisfaction, and psychological adjustment after prostate cancer[J]. Psycho-oncology, 2017, 26(10): 1576-1585.
32	刘莹莹, 李惠艳, 苑冬鹤. 老年前列腺癌病人支持性照顾需求与生活质量的纵向研究 [J]. 安徽医药, 2019, 23(10): 1987-1990.
	LIU Y Y, LI H Y, YUAN D H. A longitudinal study of supportive care needs and quality of life in elderly prostate cancer patients[J]. Anhui Med Pharm J, 2019, 23(10): 1987-1990.
33	WALSH E A, ANTONI M H, POPOK P J, et al. Effects of a randomized-controlled trial of cognitive behavioral stress management: psychosocial adaptation and immune status in men with early-stage prostate cancer[J]. Gen Hosp Psychiatry, 2022, 79: 128-134.

Item	Category of potential profile			χ²/F	P value
Item	Mild symptom (n=96)	Moderate symptom (n=111)	Severe symptom (n=67)	χ²/F	P value
Age/n (%)				10.475	0.033
≤65 year	29 (30.2)	32 (28.8)	22 (32.8)
>65 year and≤75 year	39 (40.6)	63 (56.8)	36 (53.7)
>75 year	28 (29.2)	16 (14.4)	9 (13.6)
Annual treatment cost as a percentage of monthly per capita household income/n (%)				10.175	0.038
≤30%	51 (53.1)	65 (58.6)	27 (40.3)
>30% and ≤60%	24 (25.0)	25 (22.5)	14 (20.9)
>60%	21 (21.9)	21 (18.9)	26 (38.8)
T stage/n (%)				12.175	0.016
T2	22 (22.9)	32 (28.8)	6 (8.9)
T3	45 (46.8)	38 (34.2)	32 (47.8)
T4	29 (30.3)	41 (37.0)	29 (43.3)
N stage/n (%)				9.104	0.011
N0	56 (58.3)	54 (48.6)	23 (34.3)
N1	40 (41.7)	57 (51.4)	44 (65.7)
M stage/n (%)				13.923	0.001
M0	58 (60.4)	59 (53.2)	21 (31.3)
M1	38 (39.6)	52 (46.8)	46 (68.7)
PSA value/n (%)				30.292	0.000
≤0.01 ng·mL^-1	34 (35.4)	37 (33.3)	21 (31.3)
>0.01 ng·mL^-1 and ≤ 0.2 ng·mL^-1	30 (31.2)	41 (36.9)	7 (10.4)
>0.2 ng·mL^-1 and ≤ 2 ng·mL^-1	19 (19.8)	11 (9.9)	10 (14.9)
>2 ng·mL^-1	13 (13.6)	22 (19.9)	29 (43.4)
Gene detection/n (%)				9.719	0.045
Not done	45 (46.9)	59 (53.2)	30 (44.8)
Not mutated	26 (27.1)	14 (12.6)	10 (14.9)
Mutated	25 (26.0)	38 (34.2)	27 (40.3)
Psychosocial adjustment score/score	49.94±27.046	64.5±12.803	65.93±14.506	50.100	0.000
Perceived social support score/score	59.86±21.848	51.00±22.623	46.67±24.319	14.233	0.001
Uncertainty in illness score/score	88.16±31.145	99.67±22.576	110.49±21.970	47.881	0.000

Item	Category of potential profile			χ²/F	P value
Item	Mild symptom (n=96)	Moderate symptom (n=111)	Severe symptom (n=67)	χ²/F	P value
Age/n (%)				10.475	0.033
≤65 year	29 (30.2)	32 (28.8)	22 (32.8)
>65 year and≤75 year	39 (40.6)	63 (56.8)	36 (53.7)
>75 year	28 (29.2)	16 (14.4)	9 (13.6)
Annual treatment cost as a percentage of monthly per capita household income/n (%)				10.175	0.038
≤30%	51 (53.1)	65 (58.6)	27 (40.3)
>30% and ≤60%	24 (25.0)	25 (22.5)	14 (20.9)
>60%	21 (21.9)	21 (18.9)	26 (38.8)
T stage/n (%)				12.175	0.016
T2	22 (22.9)	32 (28.8)	6 (8.9)
T3	45 (46.8)	38 (34.2)	32 (47.8)
T4	29 (30.3)	41 (37.0)	29 (43.3)
N stage/n (%)				9.104	0.011
N0	56 (58.3)	54 (48.6)	23 (34.3)
N1	40 (41.7)	57 (51.4)	44 (65.7)
M stage/n (%)				13.923	0.001
M0	58 (60.4)	59 (53.2)	21 (31.3)
M1	38 (39.6)	52 (46.8)	46 (68.7)
PSA value/n (%)				30.292	0.000
≤0.01 ng·mL^-1	34 (35.4)	37 (33.3)	21 (31.3)
>0.01 ng·mL^-1 and ≤ 0.2 ng·mL^-1	30 (31.2)	41 (36.9)	7 (10.4)
>0.2 ng·mL^-1 and ≤ 2 ng·mL^-1	19 (19.8)	11 (9.9)	10 (14.9)
>2 ng·mL^-1	13 (13.6)	22 (19.9)	29 (43.4)
Gene detection/n (%)				9.719	0.045
Not done	45 (46.9)	59 (53.2)	30 (44.8)
Not mutated	26 (27.1)	14 (12.6)	10 (14.9)
Mutated	25 (26.0)	38 (34.2)	27 (40.3)
Psychosocial adjustment score/score	49.94±27.046	64.5±12.803	65.93±14.506	50.100	0.000
Perceived social support score/score	59.86±21.848	51.00±22.623	46.67±24.319	14.233	0.001
Uncertainty in illness score/score	88.16±31.145	99.67±22.576	110.49±21.970	47.881	0.000

Number of profiles	AIC	BIC	aBIC	IE	P value (LMRT)
1	5 012.070	5 033.749	5 014.724	—	—
2	4 738.516	4 774.648	4 742.940	0.861	0.003 4
3	4 601.870	4 652.454	4 608.063	0.867	0.002 4
4	4 534.848	4 599.884	4 542.810	0.877	0.167 4
5	4 489.916	4 569.404	4 499.647	0.886	0.199 3

Number of profiles	AIC	BIC	aBIC	IE	P value (LMRT)
1	5 012.070	5 033.749	5 014.724	—	—
2	4 738.516	4 774.648	4 742.940	0.861	0.003 4
3	4 601.870	4 652.454	4 608.063	0.867	0.002 4
4	4 534.848	4 599.884	4 542.810	0.877	0.167 4
5	4 489.916	4 569.404	4 499.647	0.886	0.199 3

Category of potential profiles	Probability of belonging to category
Category of potential profiles	Category 1	Category 2	Category 3
Category 1	92.7	3.5	3.8
Category 2	4.5	95.2	3.0
Category 3	5.4	3.0	94.3