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Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP): Development and Validation of a Practical Health-Related Quality of Life Instrument for Use in the Routine Clinical Care of Prostate Cancer Patients
Peter Chang1, Konrad M Szymanski2, Jonathan J Chipman3, Mark S Litwin4, Paul L Nguyen5, Robert Cook6, Andrew A Wagner7, William C DeWolf7, John T Wei8, Martin G Sanda7
1Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Boston, MA;2McGill University Health Centre, Montreal, QC, Canada3Dana-Farber Cancer Institute, Boston, MA;4David Geffen School of Medicine and School of Public Health, University of California-Los Angeles, Los Angeles, CA;5Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA;6Seven Hills Urology, Centra Health, Lynchburg, VA;7Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;8University of Michigan School of Medicine, Ann Arbor, MI
Introduction:
Measuring prostate cancer patient HRQOL in routine clinical practice is hindered by lack of instruments enabling efficient real-time, point-of-care scoring of multiple HRQOL domains. We sought to develop an instrument for this purpose.
Materials & Methods:
The EPIC for Clinical Practice (EPIC-CP) is a one-page, 16-item questionnaire to measure urinary incontinence, urinary irritation, bowel, sexual, and hormonal HRQOL domains that we constructed by eliminating conceptually overlapping items from the 3 page EPIC-26, and revising the questionnaire format to mirror the AUA Symptom Index, thereby enabling practitioners to calculate HRQOL scores at point of care. We administered EPIC-CP to a new cohort of PCa patients in community-based and academic oncology, radiation, and urology practices to evaluate the instrument's validity and ease of use for clinical practice.
Results:
175 treated and 132 untreated PCa subjects completed EPIC-CP (N = 307). EPIC-CP domain scores correlated highly with respective domain scores from longer versions of EPIC (r > 0.92 for all domains). EPIC-CP showed high internal consistency (Cronbach's alpha = 0.64-0.84) and sensitivity to PCa treatment-related effects (p < 0.05 in each of 5 HRQOL domains). Patients completed EPIC-CP efficiently (96% in <10 minutes, and 11% missing items). It was deemed ‘very convenient' by clinicians in 87% of routine clinical encounters, and clinicians accurately scored completed questionnaires 94% of the time.
Conclusions:
EPIC-CP is a valid instrument that enables patient-reported HRQOL to be measured efficiently and accurately at the point of care, and can thereby facilitate improved emphasis and management of patient-reported outcomes.
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