Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer
Abstract
Objectives Health-related quality of life (HRQOL) is an increasingly important endpoint in prostate cancer care. However, pivotal issues that are not fully assessed in existing HRQOL instruments include irritative urinary symptoms, hormonal symptoms, and multi-item scores quantifying bother between urinary, sexual, bowel, and hormonal domains. We sought to develop a novel instrument to facilitate more comprehensive assessment of prostate cancer-related HRQOL. Methods Instrument development was based on advice from an expert panel and prostate cancer patients, which led to expanding the 20-item University of California-Los Angeles Prostate Cancer Index (UCLA-PCI) to the 50-item Expanded Prostate Index Composite (EPIC). Summary and subscale scores were derived by content and factor analyses. Reliability and validity were assessed by test-retest correlation, Cronbach's alpha coefficient, interscale correlation, and EPIC correlation with other validated instruments. Results Test-retest reliability and internal consistency were high for EPIC urinary, bowel, sexual, and hormonal domain summary scores (each r >/=0.80 and Cronbach's alpha >/=0.82) and for most domain-specific subscales. Correlations between function and bother subscales within domains were high (r >0.60). Correlations between different primary domains were consistently lower, indicating that these domains assess distinct HRQOL components. EPIC domains had weak to modest correlations with the Medical Outcomes Study 12…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Included RCTs were assessed for risk of bias using a modified EPOC tool across selection, detection, performance, attrition and reporting domains.
“A modified version of the Effective Practice and Organisation of Care (EPOC) 31 risk of bias (RoB) tool for randomised trials was used for quality assessment of RCTs.”
From Mindfulness-based interventions for psychological wellbeing and quality of life in men with prostate cancer: A systematic review and meta-analysis (2021) · cites this paper as [31]
Cites
The functional assessment of cancer therapy scale: development and validation of the general measure
Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., Silberman, M., Yellen, S. B., Winicour, P., & Brannon, J. (1993) · Journal of Clinical Oncology · doi:10.1200/jco.1993.11.3.570 · Cited by 6,020 · see citing works
McHorney, C. A., Ware, J. E., Rachel Lu, J. F., & Sherbourne, C. D. (1994) · Medical Care · doi:10.1097/00005650-199401000-00004 · Cited by 4,458 · see citing works
Quality-of-life outcomes in men treated for localized prostate cancer
Litwin, M. S., Hays, R. D., Fink, A., Ganz, P. A., Leake, B., Leach, G. E., & Brook, R. H. (1995) · JAMA · doi:10.1001/jama.1995.03520260051032 · Cited by 1,020 · see citing works
Self-citationEsper, P., Mo, F., Chodak, G., Sinner, M., Cella, D., & Pienta, K. J. (1997) · Urology · doi:10.1016/s0090-4295(97)00459-7 · Cited by 696 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Patient-reported outcome measures: the importance of patient satisfaction in surgery
Chow, A., Mayer, E. K., Darzi, A. W., & Athanasiou, T. (2009) · Surgery · doi:10.1016/j.surg.2009.03.019 · Cited by 356 · see citing works
Randomized clinical trial of a family intervention for prostate cancer patients and their spouses
Northouse, L. L., Mood, D. W., Schafenacker, A., Montie, J. E., Sandler, H. M., Forman, J. D., Hussain, M., Pienta, K. J., Smith, D. C., & Kershaw, T. (2007) · Cancer · doi:10.1002/cncr.23114 · Cited by 335 · see citing works
Self-citationBokhour, B. G., Clark, J. A., Inui, T. S., Silliman, R. A., & Talcott, J. A. (2001) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2001.00832.x · Cited by 247 · see citing works
Penedo, F. J., Molton, I., Dahn, J. R., Shen, B.-J., Kinsinger, D., Traeger, L., Siegel, S., Schneiderman, N., & Antoni, M. (2006) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3103_8 · Cited by 223 · see citing works
Management of Complications of Prostate Cancer Treatment
Michaelson, M. D., Cotter, S. E., Gargollo, P. C., Zietman, A. L., Dahl, D. M., & Smith, M. R. (2008) · CA: A Cancer Journal for Clinicians · doi:10.3322/ca.2008.0002 · Cited by 196 · see citing works
Campbell, L. C., Keefe, F. J., Scipio, C., McKee, D. C., Edwards, C. L., Herman, S. H., Johnson, L. E., Colvin, O. M., McBride, C. M., & Donatucci, C. (2007) · Cancer · doi:10.1002/cncr.22355 · Cited by 169 · see citing works
Hart, T. L., Coon, D. W., Kowalkowski, M. A., Zhang, K., Hersom, J. I., Goltz, H. H., Wittmann, D. A., & Latini, D. M. (2014) · The Journal of Sexual Medicine · doi:10.1111/jsm.12598 · Cited by 118 · see citing works
Penedo, F. J., Traeger, L., Dahn, J., Molton, I., Gonzalez, J. S., Schneiderman, N., & Antoni, M. H. (2007) · International Journal of Behavioral Medicine · doi:10.1007/bf03000188 · Cited by 115 · see citing works
Chambers, S. K., Foley, E., Galt, E., Ferguson, M., & Clutton, S. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-011-1195-8 · Cited by 74 · see citing works
Quality of life after treatment for prostate cancer
Penson, D. F., & Litwin, M. S. (2003) · Current Urology Reports · doi:10.1007/s11934-003-0068-1 · Cited by 71 · see citing works
Self-citationClinical and epidemiological observations on individual radiation sensitivity and susceptibility
Seibold, P., Auvinen, A., Averbeck, D., Bourguignon, M., Hartikainen, J. M., Hoeschen, C., Laurent, O., Noël, G., Sabatier, L., Salomaa, S., et al. (2020) · International Journal of Radiation Biology · doi:10.1080/09553002.2019.1665209 · Cited by 56 · see citing works
Darwish-Yassine, M., Berenji, M., Wing, D., Copeland, G., Demers, R. Y., Garlinghouse, C., Fagerlin, A., Newth, G. E., Northouse, L., Holmes-Rovner, M., et al. (2014) · Journal of Cancer Survivorship · doi:10.1007/s11764-013-0312-8 · Cited by 55 · see citing works
Self-citationA systematic review of sexual distress measures
Santos-Iglesias, P., Mohamed, B., & Walker, L. M. (2018) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2018.02.020 · Cited by 51 · see citing works
Donovan, K. A., Gonzalez, B. D., Nelson, A. M., Fishman, M. N., Zachariah, B., & Jacobsen, P. B. (2018) · Psycho-Oncology · doi:10.1002/pon.4463 · Cited by 46 · see citing works
Quality of life of patients with cancer during the COVID-19 pandemic
BAFFERT, K.-A., DARBAS, T., LEBRUN-LY, V., PESTRE-MUNIER, J., PEYRAMAURE, C., DESCOURS, C., MONDOLY, M., LATROUITE, S., BIGNON, E., NICOULEAU, S., et al. (2021) · In Vivo · doi:10.21873/invivo.12306 · Cited by 45 · see citing works
Does “normal” aging imply urinary, bowel, and erectile dysfunction? A general population survey
Korfage, I. J., Roobol, M., de Koning, H. J., Kirkels, W. J., Schröder, F. H., & Essink-Bot, M.-L. (2008) · Urology · doi:10.1016/j.urology.2008.01.058 · Cited by 45 · see citing works
Phillips, S. M., Stampfer, M. J., Chan, J. M., Giovannucci, E. L., & Kenfield, S. A. (2015) · Journal of Cancer Survivorship · doi:10.1007/s11764-015-0426-2 · Cited by 42 · see citing works
Schofield, P., Gough, K., Lotfi-Jam, K., Bergin, R., Ugalde, A., Dudgeon, P., Crellin, W., Schubach, K., Foroudi, F., Tai, K. H., et al. (2016) · BMC Cancer · doi:10.1186/s12885-016-2687-1 · Cited by 30 · see citing works
Cormie, P., Chambers, S. K., Newton, R. U., Gardiner, R. A., Spry, N., Taaffe, D. R., Joseph, D., Hamid, M. A., Chong, P., Hughes, D., et al. (2014) · BMC Cancer · doi:10.1186/1471-2407-14-199 · Cited by 30 · see citing works
Samuel, C. A., Smith, A. B., Elkins, W., Richmond, J., Mahbooba, Z., Basch, E., Bennett, A. V., Chung, A. E., Jonsson, M., Chen, R. C., et al. (2021) · Quality of Life Research · doi:10.1007/s11136-020-02442-4 · Cited by 27 · see citing works
Nnate, D. A., Anyachukwu, C. C., Igwe, S. E., & Abaraogu, U. O. (2021) · Psycho-Oncology · doi:10.1002/pon.5749 · Cited by 24 · see citing works
Wittmann, D., & Koontz, B. F. (2017) · Current Sexual Health Reports · doi:10.1007/s11930-017-0095-4 · Cited by 16 · see citing works
- Authors
- Wei, J. T., Dunn, R. L., Litwin, M. S., Sandler, H. M., & Sanda, M. G.
- Affiliations
- Ann Arbor VA Medical Center (US)
- University of Michigan (US)
- University of California, Los Angeles (US)
- Corresponding author
- Sanda, Martin G
- Venue
- Urology
- Publisher
- Elsevier BV
- Published
- 2000-12
- Volume
- 56
- Issue
- 6
- Pages
- 899-905
- ISSN
- 0090-4295 (ISSN-L)
- OpenAlex
- W2137282952
- Cited by
- 1,520
- References
- 4
- Citations by year
- 2026: 41 · 2025: 48 · 2024: 57 · 2023: 69 · 2022: 87 · 2021: 87 · 2020: 99 · 2019: 68 · 2018: 90 · 2017: 90 · 2016: 89 · 2015: 91 · 2014: 83 · 2013: 70 · 2012: 81
- FWCI
- 6.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Urology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (1 P50 CA 69568, 5P30CA46598, P50CA069568)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Social Sciences › Education › Health Education and Validation
- Keywords
- Expanded Prostate Cancer Index Composite, health-related quality of life, prostate cancer, instrument development, irritative urinary symptoms, hormonal symptoms, sexual dysfunction, bowel symptoms, bother, UCLA Prostate Cancer Index, test-retest reliability, factor analysis, criterion validity, SF-12, FACT-P, AUA Symptom Index
- MeSH terms
- Aged, Brachytherapy, Factor Analysis, Statistical, Health Status Indicators, Humans, Male, Middle Aged, Prostatectomy, Prostatic Neoplasms, Quality of Life, Sampling Studies, Reproducibility of Results, Cohort Studies, Radiotherapy, Adjuvant, Radiotherapy, Conformal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
