CoRPS Center of Excellence

Research of the Department Medical and Clinical Psychology is embedded in CoRPS.

Projects Cancer

Current projects

KWF Fellowship project

KWF Fellowship project: Cardiovascular co-morbidity in cancer patients
  • Researcher: Dounya Schoormans
  • Funding Organization: Dutch Cancer Society
  • Start project: 2013

Supporting breast cancer patients in coping with chemotherapy

Supporting breast cancer patients in coping with chemotherapy *

  • Researcher: Floor Mols
  • Funding Organization: Pink Ribbon (subsidie naar IKZ)
  • Start project: 2012
  • Summary:
  • 'Als het je overkomt is het zó confronterend, ineens ben je ziek.'
    Borstkankerpatiënten worden steeds vaker behandeld met chemotherapie. Tussen 2000-2008 was er sprake van een toename in chemotherapiegebruik van 40%2. Patiënten krijgen daardoor vaker te maken met haaruitval (alopecia) door chemotherapie. Deze chemotherapie-geïnduceerde alopecia (CIA) is een van de meest gevreesde bijwerkingen van chemotherapie3-5. 'Ik vond haaruitval veel emotioneler dan de amputatie van mijn borst'1 is geen zeldzame uitspraak. CIA is stigmatiserend6 7, het veroorzaakt stress8, 9, kan traumatiserend zijn4, 10, 11 en kan leiden tot een lagere kwaliteit van leven12. Ook heeft het een negatieve invloed op het lichaamsbeeld en zelfvertrouwen10, 13
    Mede dankzij de inspanningen van het IKZ bieden 65 Nederlandse ziekenhuislocaties inmiddels hoofdhuidkoeling aan om CIA te voorkomen14. Bij 50% van de patiënten wordt een goed resultaat bereikt9. Dat resultaat is van meerdere (on)bekende factoren afhankelijk. Dit veroorzaakt onzekerheid bij patiënten, mede door een gebrek aan goede informatie over CIA en hoofdhuidkoeling. Bovendien zijn hulpverleners vaak niet goed op de hoogte van CIA en hoofdhuidkoeling en is het vanwege tijdsdruk onmogelijk om tijdens een chemotherapie-informatiegesprek volledige informatie te bieden. Adequate informatievoorziening is voor patiënten echter essentieel om met CIA om te kunnen gaan.
    Met dit project willen we borstkankerpatiënten ondersteuning bieden in het omgaan met CIA en de keuze voor hoofdhuidkoeling. Daarvoor is betere informatie en begeleiding nodig. Het kennisplatform hoofdhuidkoeling van het IKZ zal daarom samen met (ex-)borstkankerpatiënten een web-based tool ontwikkelen waarin wetenschappelijke informatie en praktische tips over CIA en hoofdhuidkoeling gebundeld zijn zoals;
    - Waarom valt mijn haar uit?
    - Wat te doen wanneer mijn haar uitvalt?
    - Welke verschillende hoofdbedekkingen bestaan er?
    - Hoe ga ik om met reacties uit mijn omgeving?
    - Hoe beslis ik of ik hoofdhuidkoeling wil of niet?
    - Hoe groot is de kans dat hoofdhuidkoeling bij mij werkt?
    De tool zal patiënten informeren en ondersteunen in de omgang met CIA en de behandelkeuze rondom hoofdhuidkoeling.
    Het kennisplatform zal de deskundigheid van verpleegkundigen vergroten door informatie over CIA en hoofdhuidkoeling aan te bieden via een website en landelijke en regionale bijeenkomsten. Bovendien is het kennisplatform telefonisch bereikbaar voor vragen van verpleegkundigen.

Identifying symptom clusters in cancer patients

Identifying symptom clusters in cancer patients

  • Researcher:  Melissa Thong
  • Funding Organization: Dutch Cancer Society
  • Start project: 2011
  • Summary:
    According to the symptom clustering concept, symptoms (physical or psychological) that occur at the same time could be interrelated. However, symptom assessment research tend to focus on individual symptoms. This might not assess the symptom experience of cancer patients adequately as they are more likely to have multiple symptom complaints.

    Having a better understanding of symptom clusters could have implications on clinical symptom management and the psychosocial well-being of the patient. Furthermore, if we can improve in identifying patients at risk of developing symptom burden, this could help in developing strategies tailored to patients' needs to assist in symptom self-management.

Development of a set of EORTC measures

Development of a set of EORTC measures to assess QoL in lymphoproliferative disorders

  • Researcher:  Lonneke Van de Poll-Franse
  • Funding Organization: European Organisation for Research and Treatment of Cancer-Quality of Life Group
  • Start project: 2011
  • Summary:
    In contrast to the large number of quality of life (QOL) studies in patients with solid tumors, relatively few QOL studies have been conducted in patients with hematological malignancies. There is still much to be done to understand patients' morbidity in many areas of hematological malignancies. The American Society of Hematology (ASH) has recently voiced concern about the lack of data in this area, advocating urgent efforts to raise the standards of QOL research. International recommendations for various hematologic diseases are paying greater attention to QOL issues and are advocating more research into this area. Studies investigating effects and complications after hematological cancer treatment (some using patient-reported outcome measures) have identified problems in several domains, including eye, oral, endocrine, neurosensory, and cardiopulmonary impairments. The most commonly used QOL questionnaires in studies of haematological cancer survivors are the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Short Form-36. In addition to these more generic questionnaires, hematological cancer specific questionnaires should be used to detect, with more sensitivity, side-effects and symptoms particularly relevant to HL, NHL, and CLL patients. However, these instruments are lacking. The aim of this research is therefore to develop a set of questionnaire modules to assess the health-related quality of life (HRQoL) of patients suffering from Chronic Lymphocytic Leukemia (CLL), non-Hodgkins Lymphoma (NHL) or Hodgkins Lymphoma (HL). The modules will be a supplement for the EORTC QLQ-C30 core questionnaire.

Cancer and diabetes

Patient reported outcomes

  • Researcher: Pauline Vissers
  • Start project: 2011
  • Summary:
    Due to the increased aging of the population and better treatment and detection of diseases, the number of cancer survivors with concurrent chronic diseases is increasing. Nowadays approximately one in five cancer patients also suffers from concurrent diabetes. It has previously been shown that having both cancer and diabetes negatively impacts survival. In addition, previous studies indicate that diabetes patients might have an increased risk to develop cancer. Although numerous studies focus on mortality and cancer incidence after diabetes, considerably less attention has been paid to the potential consequences the combination of both cancer and diabetes can have on Patient-Reported Outcomes (PROs) such as quality of life, anxiety and depression. PROs are important outcome measures to help improve the quality of care for elderly living with chronic diseases. This thesis provides insight in the effect of both cancer and diabetes on PROs.

The impact of a cancer Survivorship Care Plan

The impact of a cancer Survivorship Care Plan on patient reported outcomes and health care providers. A pragmatic cluster randomized controlled trial (ROGY care)
  • Researcher:  Lonneke Van de Poll-Franse
  • Funding organization: Dutch Cancer Society (KWF Kankerbestrijding)
  • Start project: 2010
  • Summary:
    Evidence on effects of implementing Survivorship Care Plans (SCPs), recommended by the IOM and Dutch Health Council, is limited. Aim of this pragmatic cluster randomized trial is to assess the impact of SCPs in routine clinical practice. Primary outcomes are patient satisfaction with information and care. Secondary outcomes include illness perceptions, quality of life, and health care use.
    We built an SCP-application in the web-based 'Registrationsystem Oncological GYnecology' (ROGY), used by gynecologists in our area since 2006. By clicking the SCP-icon in ROGY, a personalized SCP is automatically generated with ROGY-information. Twelve hospitals are randomized to 'usual care' or 'SCP-care'. In 'usual care', gynecologists provide care as usual, without access to the SCP-icon. In 'SCP-care', SCPs are personally discussed and handed to patients. All newly diagnosed endometrial and ovarian cancer patients are asked to complete a questionnaire after primary treatment and after 6, 12, 18 and 24 months. Health care providers' (i.e., gynecologists, oncology nurses and primary care physicians) evaluation of the SCP is also assessed.
    The results of this trial will help to gain insight into the impact of SCPs on patient reported outcomes and health care providers, and contribute to improvement of quality of care for cancer survivors.

Towards a healthy cancer survivorship

Towards a healthy cancer survivorship: Investigating the role of Type D personality in colorectal cancer patients’. VENI - Innovational Research Incentive

  • Researcher: Floor Mols
  • Funding organization: Netherlands Organisation for Scientific research
  • Start project: 2010
  • Summary:
    Cancer survivorship is an important research topic nowadays, mainly because survivors often face continuing physical and psychological problems due to cancer and its treatment. Most studies focus on the impact of diagnosis and treatment on general quality of life. However, less attention has been paid to broader aspects like patient-reported outcomes (e.g. health-related quality of life, late side-effects, fatigue, impact of cancer, anxiety, and depression) and health care utilisation in cancer survivors. There is also a need for more personalized care of survivors as a function of individual differences in psychological functioning.
    Regarding this issue, Type D personality has become an important research topic in the cardiovascular field. Type D is defined by the combination of two personality traits; the tendency to experience negative emotions (negative affectivity) and to inhibit self-expression of these emotions in social interaction (social inhibition). Type D has much explanatory power (above and beyond clinical characteristics) to select cardiovascular patients at risk for adverse patient-reported outcomes and a decrease in health care utilisation.
    Preliminary evidence suggests that cancer survivors with a Type D personality report a worse health status compared to non-Type D survivors. This needs to be confirmed and investigated more in-depth in a larger prospective population-based study, in order to evaluate its potentially negative long-term consequences on cancer patients' lives.
    I will investigate the degree to which patient-reported outcomes and health care utilisation can be explained by Type D personality, while controlling for clinical characteristics (e.g. treatment, comorbidity), in order to predict which cancer patients will experience a self-reported healthy cancer survivorship. This study will focus on colorectal cancer, the second most prevalent cancer in the Netherlands. Insights from this population-based prospective study may help to tailor clinical care towards the individual needs of colorectal cancer patients as a function of their personality profile.

Testing biologic interaction

Testing biologic interaction between diabetes and cancer on mortality and patient reported outcome*

The impact of a cancer Survivorship Care Plan

The impact of a cancer Survivorship Care Plan on patient reported outcomes and health care providers. A pragmatic cluster randomized controlled trial

  • Researcher: Kim Nicolaije
  • Start project: 2010

Sexual Dysfunctioning and the Quality of...

Sexual Dysfunction and the Quality of Sexual Life in Patients With Colorectal Cancer and Their Partners
  • Researcher:  Marjan Traa
  • Start project: 2010
  • Summary:
    In this project the main focus is on assessing sexual functioning and the quality of sexual life after the treatment of colorectal cancer in patients and their partners.
    Patients and their partners complete questionnaires concerning sexual functioning, relational issues, quality of life, body image, fatigue, anxiety, depressive symptoms, personality factors, and demographic factors. Questionnaires are completed before surgical treatment and 3, 6, and 12 months after surgical teatment.
    The results of this prospective study will give insight in 1) the incidence of sexual problems and the extent patients with colorectal cancer and their partners are bothered by these problems across time, 2) the effect of different treatment modalities on sexual functioning, 3) the relation between sexual problems and quality of life, 4) the determinants of sexual problems and the quality of sexual life adopting the biopsychosocial approach of patients with colorectal cancer who have been treated with surgery, radiation and/or chemotherapy, and more specifically to the role of personality and patient factors and sexual functioning/the quality of sexual life.

Cancer Research Award

Cancer Research Award ‘Information disclosure and cancer survivorship care planning’

Sexual functioning after treatment

Sexual functioning after treatment of colorectal cancer patients and their partners

  • Researchers: Brenda Den Oudste
  • Funding organization: Dutch Cancer Society
  • Start project: 2009

PROFILES

PROFILES (Patient Reported Outcomes Following Initial treatment and Long term Survivorship)  *

PHAROS

PHAROS: Impact of new systemic treatments of patients with hematological malignancies in the Netherlands: population-based cohort studies  *

  • Researcher: Lonneke Van de Poll-Franse
  • Funding organization: The Netherlands Organization for Health Research and Development
  • Start project: 2008
  • Summary:
    PHAROS (Population-based Haematological Registry for Observational Studies) is a registry to study the effectiveness of targeted therapies that are given to patients with hematological malignancies in a population-based setting. In addition to the effectiveness of these new expensive therapies in response to treatment, survival, side effects and cost-effectiveness, the consequences of these therapies on the health-related quality of life of patients are studied. For more information and publications see http://www.pharosregistry.nl/

Health-related quality of life among lymphoma survivors

Health-related quality of life among lymphoma survivors: a longitudinal population-based study *
  • Researcher: Lonneke Van de Poll-Franse
  • Funding organization: Jonker-Driessen Stichting
  • Start project: 2008
  • Summary:
    The number of long-term survivors is increasing rapidly due to the increasing incidence of cancer in general, the aging of the population, and the effective treatment of cancer. All in all, this has led to increasing numbers of individuals who are either cured of their cancer or are living with it as a chronic disease. The increasing number of long-term lymphoma survivors urges the examination of the long-term effects of lymphoma and its specific treatments. The latter may need to be adapted in case of severe long-term side effects. In addition, the effects of the new targeted therapies on quality of life need to be studied. Besides quality of life, we will focus on the impact of cancer, anxiety, depression, and fatigue on these cancer survivors and the role of disease perception and personality in this matter. For more information and publication see http://www.profilesregistry.nl/

*Acquired grants for participating centers

Completed projects

Anxiety in (benign) breast disease

Anxiety in (benign) breast disease

  • Researcher: Van Esch
  • Start project: 2012
  • Summary:
    Women referred by the national breast cancer (BC) screening program or their general practitioner to a cooperating hospital were asked to participate in this study. When women agreed to participate in the study, they directly completed an informed consent and a set of questionnaires, so before they were informed about the diagnosis of their breast problem. All participants subsequently received questionnaires at one, three, six, 12, and 24 months after surgical treatment (BC patients) or diagnosis (benign breast problem group (BBP)) on quality of life (QOL), depressive symptoms, fatigue, state and trait anxiety, neuroticism, and type D personality. BC patients also completed questionnaires on their health status. In addition, a diagnostic interview was administered at 12 months to assess lifetime clinical anxiety and depressive disorders. Demographic data and health care utilization were assessed by self-report questionnaires. Medical information was retrieved from patients' medical files. The study was approved by the Dutch Medical Ethical Committee (ccMo NL15659.008.06) and registered at the Dutch Trial Register (NTR1555).
    About 150 BC patients and 300 BBP patients were included in this study. Some of the results are presented here.
    • Women who scored high on trait anxiety had significantly worse outcomes on several health status (HS) scales. Furthermore, trait anxiety was the only significant predictor of those HS scales.
    • BC patients had combined anxiety and depressive symptoms (CADS) before diagnosis their state anxiety score, depressive symptoms, and CADS scores were about three times as high 24 months after surgery as the scores of patients without CADS at baseline.
    • Women with a false positive diagnosis of screen-detected BC had a low QOL and experienced feelings of anxiety, especially when they scored high on trait anxiety. This effect lasted for at least one year after diagnosis.
    • An abnormal screening mammogram evoked more anxiety and depressive symptoms prior to diagnosis with an ongoing impairment of QOL compared with women referred with a benign palpable lump in the breast, especially in women not prone to anxiety.

Implementation Fellow

Implementation Fellow
  • Researcher:  Brenda Den Oudsten
  • Funding Organization: The Netherlands Organisation for Health Research and Development
  • Start project: 2010

Information provision

Information provision and patient reported outcomes in cancer survivors: with a special focus on thyroid cancer

Summary:

The PhD thesis describes the results of studies on the information provision to different groups of cancer survivors in different phases of their disease. Several areas of informationprovision were experienced as insufficient by the cancer survivors. The perceived level of, and satisfaction with, information received by cancer survivors was related to other patient reported outcomes like health-related quality of life, illness perceptions and levels of anxiety and depression. In addition, the thesis showed that thyroid cancer survivors reported lower levels of physical and psychosocial functioning, and more problems (fatigue, dyspnea, insomnia and financial) compared to an age- and gender matched normative population. Thyroid cancer specific neuromuscular, concentration, sympathetic and psychological problems explained a large part (41-58%) of the variance in health-related quality of life.

Predictors of recovery after cholecystectomy

Predictors of recovery after cholecystectomy
  • Researcher: Mertens
  • Start project: 2009

Predictors of psychosocial outcomes

Predictors of psychosocial outcomes in women with early stage breast cancer

  • Researcher: Brenda Den Oudsten
  • Start project: 2009
  • Summary:
    The PhD thesis of Brenda den Oudsten entitled "Predictors of psychosocial outcomes in women with early stage breast cancer", describes the results of studies on psychosocial problems and overall quality of life and health. This thesis showed that positive feelings, reflecting the amount of happiness and enjoyment in life, and Personal relationships, reflecting satisfaction with relationships with family and friends consistently contributed to overall QOL over time. In addition, two studies examined the predictors of depressive symptoms and quality of sexual life at 6 and 12 months after surgery. Depressive symptoms at 12 months after surgical treatment were predicted by lower scores on agreeableness, higher scores on neuroticism, depressive symptoms before diagnosis, fatigue before diagnosis, and type of surgery (breast-conserving therapy). Quality of sexual life after surgical treatment was not related to type of surgery or body image. Personality traits, such as higher scores on trait anxiety (6 months after surgical treatment) and lower scores on agreeableness (12 months after surgical treatment) negatively affected quality of sexual life. Moreover, quality of sexual life assessed at baseline predicted quality of sexual life at 6 months and 12 months after surgical treatment. Finally, the hypothesis that additional surgical treatment (re-excisions) may negatively affecting women with early-stage breast cancer was tested. However, this thesis showed that women who had (a) re-excision(s) did not have higher levels of psychosocial problems than women who had one operation.

The influence of personality on quality of life

The influence of personality on quality of life, fatigue prognosis and health care consumption in sarcoidosis
  • Researcher: Jolanda De Vries
  • Funding organization: Sarcoïdose Belangen vereniging Nederland (SBN)
  • Start project: 2008

Chemotherapy and cognitive functioning

Chemotherapy and cognitive functioning in breast cancer patients and the effects on patients’ quality of life and health care consumption

Chemotherapy and cognitive functioning

Chemotherapy and cognitive functioning in breast cancer patients and the effects on patients' quality of life and health care consumption

  • Researcher: Pullens
  • Start project: 2008

Influence of scalp cooling

Influence of scalp cooling on the incidence and prognosis of scalp skin metastasis in breast cancer. Doelmatigheidssubsidie
  • Researcher: Lonneke van de Poll-Franse
  • Funding organization: The Netherlands Organisation for Health Research and Development
  • Start project: 2006

Quality of life in lymphoma survivors

Quality of life in lymphoma survivors

  • Researchers: Lonneke van de Poll-Franse, Floor Mols
  • Funding organization: INTERZOL
  • Start project: 2006
  • Summary:
    The aim of this population-based study was to document the long-term effects (5-15 years post-diagnosis) of non-Hodgkin's lymphoma and its treatment on health-related quality of life (HRQL) and social problems. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with non-Hodgkin's lymphoma from 1989 to 1998. Three hundred sixty patients were invited to complete the SF-36 and the Quality of Life-Cancer Survivors questionnaire, of whom 294 (82%) responded. Patients who received chemotherapy reported significantly worse psychological and social well-being and HRQL than patients not treated with chemotherapy. Radiotherapy and watchful waiting were not associated significantly with HRQL outcomes. Patients diagnosed 10-15 years earlier reported better social well-being than patients diagnosed 5-9 years earlier. In comparison to an age-matched general population normative sample, patients reported significantly worse general health and less vitality, but also less bodily pain. Practical problems were reported with work (41%), obtaining health care insurance (6%), life insurance (15%), and a home mortgage (22%). Five to fifteen years after diagnosis, the general health perceptions and vitality levels of non-Hodgkin's lymphoma survivors remain significantly lower than those of general population peers. Additionally, survivors face practical problems with work and finances that deserve additional attention during the period of rehabilitation.
    In addition, we studied the quality of life (QOL) of long-term Hodgkin's lymphoma survivors and compared it to an age-matched normative sample. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with Hodgkin's lymphoma from 1989 to 1998. Eighty percent of survivors completed the SF-36 and the Quality of Life-Cancer Survivors questionnaire (QOL-CS). QOL was better among patients diagnosed 10-15 years ago compared to patients diagnosed 5-9 years ago. Patients diagnosed 5-9 years ago experienced lower general health, social functioning, mental health and vitality compared to an age-matched normative sample while patients diagnosed 10-15 years earlier reported lower general health but better physical functioning. Most patients reported that their work situation did not change. Problems obtaining health insurance, life insurance and mortgages were high. QOL among Hodgkin's lymphoma survivors is lower compared to an age-matched normative sample. Survivors furthermore experience some (financial) problems in the years after diagnosis

Quality of life in cancer survivors

Quality of life in cancer survivors
  • Researcher: Lonneke van de Poll-Franse, Floor Mols
  • Funding organization: Rotary Triborch, Tilburg
  • Start project: 2006
  • Summary:
    This study describes the health-related quality of life (HRQL) of long-term prostate cancer survivors, 5-10 years after diagnosis, and compares it to that of an age-matched normative sample of the general Dutch population. The population-based Eindhoven Cancer Registry was used to select all men diagnosed with prostate cancer from 1994 to 1998. Nine hundred and sixty-four patients received questionnaires (the SF-36 and the Quality of life-Cancer Survivors questionnaire), 780 of whom (81%) responded. Unselected long-term prostate cancer survivors reported comparable HRQL, but worse general health perceptions and better mental health than an age-matched norm population. Patients who underwent radical prostatectomy had the highest physical HRQL, followed by 'watchful waiting' patients and patients who received radiotherapy. Hormonally treated patients, in general, had the lowest physical HRQL. The results suggest that the long-term HRQL of prostate cancer survivors can vary significantly as a function of the type of primary treatment. Because baseline differences between treatment groups cannot be excluded as part of the explanation of the differences, these findings need to be verified in longitudinal studies.
    In addition, it was our aim to obtain more insight into the long-term effects of prostate cancer diagnosis and treatment on bowel, urinary, and sexual function we performed a large population-based study. Prostate-specific function was compared with an age-matched normative population of Dutch screening participants without a history of prostate cancer. Through the population-based Eindhoven Cancer Registry we selected all men diagnosed with prostate cancer between 1994 and 1998 in the southern part of the Netherlands. In total, 964 patients, alive on November first 2004, received a questionnaire (UCLA-EPIC and Sac); 780 (81%) responded. A reference group was used for comparison. Urinary problems were most common after a prostatectomy and bowel problems were most common after radiotherapy. Compared to a reference group with a similar age distribution, both urinary and bowel functioning and bother were significantly worse among survivors. Urinary incontinence was reported by 23-48% of survivors compared to 4% of the normative population. Bowel leakage occurred in 5-14% of patients compared to 2% of norms. Erection problems occurred in 40-74% of patients compared to 18% of norms. The results of this population-based study form an important contribution to the limited information available on prostate-specific problems in the growing group of long-term prostate cancer survivors. Bowel, urinary, and sexual problems occur more often among long-term survivors in comparison to a reference group and cannot merely be explained by age. Since these problems persist for many years, urologists should provide patients with adequate information on this topic before treatment. After treatment, there should be an appropriate focus on these problems.
    Furthermore, a study was performed that focused on the HRQOL of long-term, disease-free prostate cancer survivors and compares it with that of prostate cancer survivors with diabetes mellitus (DM), and a Dutch normative population. The Eindhoven Cancer Registry was used to select all men diagnosed with prostate cancer from 1994 to 1998. Questionnaires on HRQOL (SF-36) and prostate specific problems (UCLA-EPIC and Sac) were send to 964 patients, 780 (81%) responded. Excluding patients with disease progression, the sample consisted of 525 patients with prostate cancer and 65 patients with both prostate cancer and DM. Survivors with DM were more likely to have other comorbid conditions at the time of survey besides DM compared to prostate cancer patients without DM (74% vs. 60%; p=0.05). Five to ten years after diagnosis, patients with DM reported worse General Health Perceptions than patients without DM or the normative population (mean; 52,  61, 63; p<0.001). Patients with DM also reported worse Vitality scores (59 vs. 63; p<0.001) than the normative population. Regression analysis indicated that DM was negatively associated with General Health Perceptions (ß=-0.13; p<0.01) and Vitality (ß=-0.12; p<0.01). Survivors with DM did not report worse urinary and bowel function or bother, nor more sexual problems compared to those without DM. With the exception of general health perceptions and vitality, HRQOL of prostate cancer survivors with or without DM was comparable to a normative population. Survivorship selection can possibly explain, in part, the fact that prostate cancer patients with DM did not report worse generic or disease-specific HRQOL compared to those without DM as had been expected

*Acquired grants for participating centers