Health-related quality of life, psychological distress, and fatigue in metastatic castration-resistant prostate cancer patients treated with radium-223 therapy

Background: Radium-223 is a registered treatment for symptomatic bone metastatic castration-resistant prostate cancer (mCRPC). This multicenter, prospective observational cohort study evaluated health-related quality of life (HR-QoL), psychological distress, and fatigue in mCRPC patients treated with radium-223 in routine practice. Methods: Primary endpoint was cancer-specific and bone metastases-related HR-QoL assessed by EORTC QLQ-C30 and BM-22. Secondary endpoints were psychological distress (HADS) and fatigue (CIS-Fatigue). Outcomes were analyzed for the total cohort and by subgroups receiving 1–3 versus 4–5 versus 6 injections. A trajectory analysis explored HR-QoL patterns over time. Results: 122 patients were analyzed. Baseline HR-QoL, pain intensity, psychological distress, and fatigue were worse in patients who did not complete therapy. Completers showed stabilization of HR-QoL with stable psychological distress and fatigue, whereas those who discontinued experienced clinically meaningful and statistically significant deterioration across HR-QoL, psychological distress, and fatigue over time. Trajectory analysis associated HR-QoL deterioration with baseline opioid use, low hemoglobin, and high alkaline phosphatase. Conclusions: Discontinuation of radium-223 was associated with worse baseline and worsening longitudinal HR-QoL, psychological distress, and fatigue versus completion. Patients with baseline opioid use, low hemoglobin, and high ALP warrant specific attention during follow-up to preserve HR-QoL. Clinical trial registration: NCT04995614.

Maarten J. van der Doelen, Irma M. Oving, Dirk N. J. Wyndaele, Jean-Paul van Basten, Frederik Terheggen, Addy C. M. van de Luijtgaarden, Wim J. G. Oyen, W. Dick van Schelven, Franchette van den Berkmortel, Niven Mehra, Marcel J. R. Janssen, Judith B. Prins, Winald R. Gerritsen, José A. E. Custers, Inge M. van Oort