UNIVERSITY OF CALGARY

UNIVERSITY OF CALGARY
Quality of Life After Prostate Cancer Diagnosis: A Longitudinal Prospective Cohort Study in
Alberta, Canada
by
Megan Farris
A THESIS
SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
DEGREE OF MASTER OF SCIENCE
GRADUATE PROGRAM IN COMMUNITY HEALTH SCIENCES
CALGARY, ALBERTA
SEPTEMBER, 2016
© Megan Farris 2016

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Abstract
OBJECTIVES: First, we examined the associations of post-diagnosis physical activity
and change in pre-diagnosis physical activity on quality of life (QoL) in prostate cancer
survivors. Then, we identified post-prostate cancer diagnosis QoL trajectories over time
in the population.
METHODS: 830 prostate cancer survivors were derived from a prior case-control study
where information at diagnosis was collected, then survivors were re-consented into a
follow-up study. Three repeated measurements of physical activity and QoL were
undertaken post-diagnosis.
RESULTS: We observed improvements in physical QoL in prostate cancer survivors
who maintained or adopted higher levels of physical activity pre- and post-diagnosis,
according to the cancer prevention physical activity guidelines compared to those who
were non-exercisers. In the trajectory analysis, three physical and three mental trajectory
groups were identified.
CONCLUSION: With additional research, these established trajectory groups may help
healthcare professionals in improving treatment and follow-up for this population of
prostate cancer survivors.

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Acknowledgements
I would like to genuinely thank everyone involved in this Master’s thesis degree.
Specifically, all of the staff in the Department of Cancer Epidemiology and Prevention
Research at Alberta Health Services and the Department of Community Health Sciences
at the University of Calgary. Foremost, I would like to thank my supervisor, Dr. Christine
Friedenreich, for her constant support and mentorship throughout my Master's training.
Without her careful guidance and vote of confidence, this thesis would not be the caliber
it is today. I truly appreciate her time and willingness to help me achieve my goals and I
would not be where I am today without her. In addition, I would like to extend a special
thank you to my committee members: Dr. Karen Kopciuk for her careful guidance and
eagerness to pursue new statistical methods, Dr. Kerry Courneya for his expertise, speedy
reviews and generous praise and Dr. Elizabeth McGregor for her thorough remarks,
epidemiological capabilities and genuine support. I would also like to recognize the
contributions of my co-author, Qinggang Wang, on both manuscripts for his constructive
feedback and interest in my work and data management of the study's datasets.
I would like to thank Dr. Tavis Campbell, Professor, Department of Psychology at the
University of Calgary for agreeing to serve as my internal-external examiner with the
Department of Community Health Sciences.
A special thank you is also necessary to all of the participants in the Prostate Cancer
Cohort Study who generously gave their time to participate in the study making this
project possible. I would like to thank all past and present study staff from the

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Department of Cancer Epidemiology and Prevention Research who made this project
possible. Thank you to my colleagues and peers who supported, mentored and kept me
level-headed through this process: Eileen Shaw, Abbey Poirier, Trisha Kelly, Sarah
MacLaughlin, Pamela Round and Dr. Darren Brenner. A special thanks to my peer
mentor, Eileen Shaw (BB), I could not have done this without you! To my dear
classmates and now friends, Kathryn Wiens, Lauren Hiersch, Amanda Barberio, Chelsea
Doktorchik and my office mates Stephanie Gill and Alexis Mickle, thank you for being
there for all of the ups and downs, for guidance and keeping me grounded, you truly
made this experience wonderful.
On a more personal note, I want to send my utmost thanks and praise to my loving
parents. Without their support, willingness to listen to my problems and for providing
dinner at the end of a long day, this degree would not have been finished on time. I would
also like to thank my dearest boyfriend Troy Bozarth, for his patience and unconditional
support of all my endeavors in every possible way; my two brothers, Mitchell Farris and
Blake Farris for their support and occasional comic relief in times of stress; and my
childhood friend Kathryn Saretsky for always being there for me.

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Table of Contents
Abstract ................................................................................................................................2
Acknowledgements ..............................................................................................................3
Table of Contents .................................................................................................................5
List of Tables .......................................................................................................................8
List of Figures ....................................................................................................................12
List of Symbols, Abbreviations and Nomenclature ...........................................................13
CHAPTER ONE: INTRODUCTION ..................................................................... 15
1.1 Background ..............................................................................................................15
1.1.1 Burden of prostate cancer ................................................................................15
1.1.2 Importance of quality of life in prostate cancer ...............................................16
1.1.2.1 Prevention of quality of life reductions through physical activity .........17
1.1.2.2 High-risk groups for low QoL in prostate cancer populations ..............18
1.2 Aims and hypotheses ...............................................................................................18
1.3 Ethics approval ........................................................................................................20
1.4 References ................................................................................................................21
CHAPTER TWO: LITERATURE REVIEW .......................................................... 25
2.1 Preamble ..................................................................................................................25
2.2 Part 1: Physical activity and prostate cancer ...........................................................25
2.2.1 Physical activity and prostate cancer risk ........................................................26
2.2.2 Physical activity and prostate cancer prognosis and survivorship ..................27
2.2.3 Physical activity and quality of life in prostate cancer survivors ....................28
2.3 Part 2: Change in quality of life after prostate cancer .............................................33
2.3.1 Long-term change in quality of life after prostate cancer: epidemiological
evidence ...........................................................................................................34
2.3.2 Growth modelling and prostate cancer ............................................................37
2.4 References ................................................................................................................40
2.5 Tables .......................................................................................................................50
CHAPTER THREE: ASSOCIATION OF POST-DIAGNOSIS PHYSICAL
ACTIVITY AND CHANGE IN PRE-DIAGNOSIS PHYSICAL ACTIVITY
WITH QUALITY OF LIFE IN PROSTATE CANCER SURVIVORS ............. 62
3.1 Preamble ..................................................................................................................62
3.2 Abstract ....................................................................................................................64
3.3 Introduction ..............................................................................................................66
3.4 Materials and methods .............................................................................................67
3.4.1 Study design ....................................................................................................67