Bother EXCLUSIVE

Background: The improving efficacy of cancer treatment has resulted in an increasing array of treatment-related symptoms and associated burdens imposed on individuals undergoing aggressive treatment of their disease. Often, clinical trials compare therapies that have different types, and severities, of adverse effects. Whether rated by clinicians or patients themselves, it can be difficult to know which side effect profile is more disruptive or bothersome to patients. A simple summary index of bother can help to adjudicate the variability in adverse effects across treatments being compared with each other.

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Methods: Across 4 studies, a total of 5765 patients enrolled in cooperative group studies and industry-sponsored clinical trials were the subjects of the current study. Patients were diagnosed with a range of primary cancer sites, including bladder, brain, breast, colon/rectum, head/neck, hepatobiliary, kidney, lung, ovary, pancreas, and prostate as well as leukemia and lymphoma. All patients were administered the Functional Assessment of Cancer Therapy-General version (FACT-G). The single item "I am bothered by side effects of treatment" (GP5), rated on a 5-point Likert scale, is part of the FACT-G. To determine its validity as a useful summary measure from the patient perspective, it was correlated with individual and aggregated clinician-rated adverse events and patient reports of their general ability to enjoy life.

Conclusions: The single FACT-G item "I am bothered by side effects of treatment" is significantly associated with clinician-reported adverse events and with patients' ability to enjoy their lives. It has promise as an overall summary measure of the burden of a given set of treatment toxicities compared with another. Future research can identify the contribution of individual side effects compared with one another in terms of how each may contribute to overall bother. Cancer 2018;124:991-7. 2017 American Cancer Society.

Introduction and hypothesis: Pregnancy and delivery are thought to induce urinary incontinence (UI), but its clinical impact is less known. Therefore, we investigated the prevalence of self-reported UI, level of experience of bother, and beliefs to gain a greater understanding of help-seeking behavior in adult pregnant women.

After Cassius gets a job as a telemarketer whose patter includes "sorry to bother you," his finances don't improve much. The company pays so little that Cassius is ready to join a strike planned by professional organizer Squeeze (Steven Yeun).

1718, also bauther, bather, bodder, "to bewilder, confuse;" 1745 as "give trouble to;" first in Irish writers (Sheridan, Swift, Sterne), hence probably from Anglo-Irish pother, which is perhaps from Irish bodhairim "I deafen." Related: Bothered; bothering. As a noun from 1803.

Men are generally hesitant to seek medical treatment for LUTS and typically do so only when symptoms become sufficiently bothersome to impact their quality of life (QOL).9 Most patients with mild symptoms are not sufficiently bothered to accept the risks of even noninvasive therapy.10 For some men the decision to pursue treatment might be driven by moderate or severe genitourinary symptoms, whereas in others, fear of prostate cancer, surgery, or impotence is the factor that drives the decision to seek medical attention.11 Patients with predominantly irritative symptoms of BPH are more likely to report that their QOL is affected than are men with predominantly obstructive symptoms.12

Application of this measurement tool to clinical practice was carried out in 2 validation studies involving more than 300 patients. The results indicated that men with an AUASI score of 7 or less typically rated their urinary condition as not at all bothersome (the mild group), whereas those with scores of 8 to 19 had intermediate ratings (the moderate group), and those with AUASI scores of 20 or greater were bothered some or a lot by their symptoms (the severe group).15

A new study offers independent confirmation that correlations of urinary symptoms with the IPSS bother questions are all significant. Administration of the IPSS along with a new sexuality and prostate health survey showed highly significant correlations between items for both the initial and follow-up values, as shown in Table 2.17 Further confirmation is found for the relationship between the bother question and 3 additional psychometric domains measured in the new sexuality and prostate health survey.5

Data from a number of studies show a correlation between bother-associated scores and symptom parameters. A community-based international study compared the correlation between frequencies of symptoms, bother-associated scores, and interference with daily activities in several thousand men aged 40 to 79 years in the United States and Scotland.20 Results showed that although the Americans had higher overall scores for symptom frequency, symptom bother, and interference with daily activities than the Scottish men (P

The importance of the application of the bother score in the evaluation of LUTS is further illustrated in a study that examined the relationship between the prevalence of symptoms and the degree of bothersomeness caused by LUTS.21 Questionnaire data from 1271 men with LUTS from 12 countries were analyzed. Results of the study showed that the most commonly occurring symptoms were not necessarily the ones that bothered men the most. When symptoms were divided into domains of voiding and storage, symptoms related to voiding (hesitancy, reduced stream, terminal dribble) tended to be more prevalent, whereas symptoms related to storage (frequency, nocturia, incontinence) were embarrassing and disruptive of daily life and tended to be more bothersome.21

A number of valid, reliable, and responsive scales reflecting improvement or deterioration in clinical status have been developed to assess the impact of LUTS on QOL in patients with BPH. These scales have shown that as symptom severity increases, QOL parameters, including bother, interference with daily activities, general health, and sexual satisfaction, are negatively affected.26

In the ALFUS study, a decrease of 2 or more points in the bother score occurred in a significantly greater percentage of patients who received alfuzosin (10 mg once daily and 15 mg once daily) than in controls (a decrease of approximately 21% for both groups vs 12% for placebo; P = .004 for the alfuzosin 10-mg group and P = .003 for the alfuzosin 15-mg group).30 Similarly, the ALFORTI study showed significant improvements in QOL scores in alfuzosin-treated patients compared with controls.29 These results demonstrate the test-retest reliability of the bother question (Table 5).29,30

The degree to which symptoms become bothersome or worrisome to a patient usually provides the basis for his decision to seek medical treatment. Patients who are less bothered by their symptoms are often less likely to seek treatment to relieve those symptoms, but those who are more bothered by their symptoms and seek treatment are more likely to respond to therapy. 041b061a72