Symptom cluster profiles and their impact on quality of life in Chinese patients with prostate cancer undergoing ADT: a cross-sectional study

Yingchao Xiao, Huichao Chen, Zhiqiang Chen, Juan Chen, Zi Wang, Aihua Ou, Li Li, Junwei He, Zunguang Bai, Lihong Wan

Background Despite the growing burden of prostate cancer in China and the widespread use of androgen deprivation therapy (ADT), no validated disease-specific instrument has been used to systematically characterize symptom clusters and their impact on quality of life (QoL) in this population. This exploratory application of the newly developed Prostate Cancer Endocrine Therapy Symptom Cluster Assessment Scale (PCET-SCAS) addresses this gap. Objective To characterize symptom cluster profiles and QoL in Chinese patients with prostate cancer undergoing ADT, examine their correlations, and identify independent predictors of QoL using a disease-specific assessment instrument. Methods This cross-sectional study consecutively enrolled 188 patients receiving ADT at one tertiary hospital in Guangzhou, China. Symptom clusters were assessed using the PCET-SCAS, and QoL was evaluated with the EORTC QLQ-C30 and QLQ-PR25. Spearman correlation and multiple linear regression were performed for statistical analysis. This exploratory application of the PCET-SCAS aimed to characterize symptom cluster profiles and their impact on QoL in this cohort. Results Five distinct symptom clusters were identified, including the urological-sleep, pain-digestive-nutritional, emotional-energy, endocrine therapy-related, and sexual function clusters. The sexual function cluster had the highest severity (median 2.50, IQR 2.25–3.00). Cognitive function was the lowest-scoring functional domain (median 50.00). All five clusters were significantly negatively correlated with functional domains and overall health status (r = −0.167 to −0.630, all P < 0.01), and positively correlated with symptom domains (r = 0.156 to 0.636, all P < 0.05). Univariate analysis identified age, cohabitation status, physical activity level, Karnofsky Performance Status (KPS) score, disease progression, bone metastasis, and all five symptom cluster scores as significant correlates of QoL (all P < 0.05). Multivariate regression (16 separate models, adjusted R² range: 0.139–0.541) identified symptom cluster severity as the most consistent independent predictor of QoL across domains. KPS score predicted physical, role, and social functioning but not emotional or cognitive outcomes (sexual outcomes were not analyzed in regression due to insufficient data). The emotional-energy cluster was the dominant predictor of emotional function, and the urological-sleep cluster was the strongest predictor of urinary symptoms. Conclusion Chinese patients with prostate cancer undergoing ADT experience a multidimensional, co-occurring symptom burden across five distinct clusters, all significantly associated with impaired QoL. KPS predicted physical, role, and social functioning but not emotional or cognitive outcomes (sexual outcomes were not analyzed in regression due to insufficient data), underscoring its role as a physical performance measure rather than a global QoL indicator. These findings support the development of cluster-targeted supportive care interventions to optimize QoL in this population.