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Hoffman RM, Van Den Eeden SK, Davis KM, Lobo T, Luta G, Shan J, Aaronson D, Penson DF, Leimpeter AD, Taylor KL. Decision-making processes among men with low-risk prostate cancer: A survey study. Psychooncology 2017; 27:325-332. [PMID: 28612468 DOI: 10.1002/pon.4469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 04/17/2017] [Accepted: 06/02/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To characterize decision-making processes and outcomes among men expressing early-treatment preferences for low-risk prostate cancer. METHODS We conducted telephone surveys of men newly diagnosed with low-risk prostate cancer in 2012 to 2014. We analyzed subjects who had discussed prostate cancer treatment with a clinician and expressed a treatment preference. We asked about decision-making processes, including physician discussions, prostate-cancer knowledge, decision-making styles, treatment preference, and decisional conflict. We compared the responses across treatment groups with χ2 or ANOVA. RESULTS Participants (n = 761) had a median age of 62; 82% were white, 45% had a college education, and 35% had no comorbidities. Surveys were conducted at a median of 25 days (range 9-100) post diagnosis. Overall, 55% preferred active surveillance (AS), 26% preferred surgery, and 19% preferred radiotherapy. Participants reported routinely considering surgery, radiotherapy, and AS. Most were aware of their low-risk status (97%) and the option for AS (96%). However, men preferring active treatment (AT) were often unaware of treatment complications, including sexual dysfunction (23%) and urinary complications (41%). Most men (63%) wanted to make their own decision after considering the doctor's opinion, and about 90% reported being sufficiently involved in the treatment discussion. Men preferring AS had slightly more uncertainty about their decisions than those preferring AT. CONCLUSIONS Subjects were actively engaged in decision making and considered a range of treatments. However, we found knowledge gaps about treatment complications among those preferring AT and slightly more decisional uncertainty among those preferring AS, suggesting the need for early decision support.
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Affiliation(s)
- Richard M Hoffman
- Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | | | - Kimberly M Davis
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tania Lobo
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jun Shan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - David Aaronson
- Department of Urology, Kaiser Permanente East Bay, Oakland, CA, USA
| | - David F Penson
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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52
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Weiner AB, Matulewicz RS, Schaeffer EM, Liauw SL, Feinglass JM, Eggener SE. Contemporary management of men with high-risk localized prostate cancer in the United States. Prostate Cancer Prostatic Dis 2017. [DOI: 10.1038/pcan.2017.5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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53
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Shirk JD, Crespi CM, Saucedo JD, Lambrechts S, Dahan E, Kaplan R, Saigal C. Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017. [DOI: 10.1007/s40271-017-0255-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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54
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Radhakrishnan A, Grande D, Ross M, Mitra N, Bekelman J, Stillson C, Pollack CE. When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. J Am Board Fam Med 2017; 30:298-307. [PMID: 28484062 PMCID: PMC5870832 DOI: 10.3122/jabfm.2017.03.160359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The role of primary care providers (PCPs) in decision making around cancer care remains largely unknown. We evaluated how frequently men with localized prostate cancer report receiving help from their PCP about their treatment, and whether those men who do are less likely to receive definitive treatment. METHODS We mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. Participants were asked whether their PCP helped decide how to treat their cancer. The outcome was receipt of definitive treatment (either radical prostatectomy or radiotherapy). RESULTS A total of 2386 men responded (adjusted response rate, 51.1%). Among these men, 38.2% reported receiving help from their PCP regarding choosing a treatment, and 79.6% received definitive treatment. In adjusted analyses, non-Hispanic black men (odds ratio, 1.76; 95% confidence interval, 1.37-2.27) were more likely than non-Hispanic white men to report receiving help from their PCP. However, men who did receive help were not more likely to forgo definitive treatment overall (P = .58) or in the subgroups of men who may be least likely to benefit from definitive treatment. CONCLUSIONS Though a substantial proportion of men reported receiving help from their PCP about prostate cancer treatment, these discussions were not associated with different treatment patterns. Further effort is needed to determine how to optimize the role of PCPs in supporting patients to make preference-sensitive cancer decisions.
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Affiliation(s)
- Archana Radhakrishnan
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP).
| | - David Grande
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Michelle Ross
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Nandita Mitra
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Justin Bekelman
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Christian Stillson
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
| | - Craig Evan Pollack
- From the Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (AR, CEP); the Division of General Internal Medicine, Hospital of the University of Pennsylvania Philadelphia (DG, CS); the Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania (MR, NM); the Department of Radiation Oncology, Hospital of the University of Pennsylvania (JB); and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore (CEP)
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D'Agostino TA, Shuk E, Maloney EK, Zeuren R, Tuttle RM, Bylund CL. Treatment decision making in early-stage papillary thyroid cancer. Psychooncology 2017; 27:61-68. [PMID: 28124394 DOI: 10.1002/pon.4383] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to develop an in-depth understanding of papillary microcarcinoma (PMC) patients' decision-making process when offered options of surgery and active surveillance. METHODS Fifteen PMC patients and 6 caregivers participated in either a focus group or individual interview. Focus groups were segmented by patients' treatment choice. Primary themes were identified in transcripts using thematic text analysis. RESULTS Four themes emerged from the surgery subsample: (1) Decision to undergo thyroidectomy quickly and with a sense of urgency; (2) Perception of PMC as a potentially life-threatening disease; (3) Fear of disease progression and unremitting uncertainty with active surveillance; and (4) Surgery as a means of control and potential cure. Three themes emerged from the active surveillance subsample: (1) View of PMC as a common, indolent, and low-risk disease; (2) Concerns about adjusting to life without a thyroid and becoming reliant on hormone replacement medication; and (3) Openness to reconsidering surgery over the long run. Two themes were identified that were shared by participants from both subsamples: (1) Deep level of trust and confidence in physician and cancer center; and (2) Use of physician and internet as primary sources of disease and treatment-related information. CONCLUSIONS Several factors influenced participants' treatment choice, with similarities and differences noted between surgery and active surveillance subsamples. Many of the emergent themes are consistent with research on decision making among localized prostate cancer patients. Findings suggest that participants from both PMC treatment subsamples are motivated to reduce illness and treatment-related uncertainty.
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Affiliation(s)
| | - Elyse Shuk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rebecca Zeuren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Hamad Medical Corporation, Doha, Qatar
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56
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Kinlock BL, Parker LJ, Bowie JV, Howard DL, LaVeist TA, Thorpe RJ. High Levels of Medical Mistrust Are Associated With Low Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control 2017; 24:72-77. [PMID: 28178717 DOI: 10.1177/107327481702400112] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with prostate cancer. METHODS A total of 877 men (415 black, 462 white) with prostate cancer between the ages of 40 to 81 years who entered the North Carolina Central Cancer Registry during the years 2007 and 2008 were retrospectively recruited. The dependent variable was overall QOL measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The primary independent variable was medical mistrust. Multivariate regression analysis was used to assess the association between medical mistrust and overall QOL. RESULTS Compared with white men, black men reported a higher level of medical mistrust (black = 2.7, white = 2.4; P < .001) and lower QOL (black = 134.4, white = 139.5; P < 0.001). After controlling for demographical and clinical variables, higher levels of medical mistrust were associated with a reduction in overall QOL among men with prostate cancer (beta = -7.73; standard error = 1.54) CONCLUSIONS: Higher levels of medical mistrust are associated with reduced overall QOL among black and white men with prostate cancer. Interventions targeted to reduce medical mistrust may be effective in increasing the overall QOL of men with prostate cancer.
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Affiliation(s)
- Ballington L Kinlock
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Lauren J Parker
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Janice V Bowie
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Daniel L Howard
- Public Policy Research Institute and Department of Sociology, Texas A&M University, College Station, TX
| | - Thomas A LaVeist
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Roland J Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Departments of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Mallapareddi A, Ruterbusch J, Reamer E, Eggly S, Xu J. Active surveillance for low-risk localized prostate cancer: what do men and their partners think? Fam Pract 2017; 34:90-97. [PMID: 28034917 PMCID: PMC6916739 DOI: 10.1093/fampra/cmw123] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is recognized as a reasonable treatment option for low-risk localized prostate cancer (LPC) but continues to be chosen by a minority of men. To date, limited data are available regarding reasons why men with low-risk LPC adopt AS. PURPOSE The aim of this study is to better understand conceptualizations, experiences and reasons why men with low-risk LPC and their partners adopt AS. METHODS We conducted five focus groups (FGs), three among men with low-risk LPC who had chosen AS and two with their partners. FGs were video/audio recorded, transcribed and analysed using qualitative thematic analysis. RESULTS A total of 12 men and 6 partners (all women) participated in FG discussions. The most common reasons for choosing AS were seeing the LPC as 'small' or 'low grade' without need for immediate treatment and trusting their physician's AS recommendation. The most common concerns about AS were perceived unreliability of prostate specific antigen, pain associated with prostate biopsies and potential cancer progression. Partners saw themselves as very involved in their husbands' treatment decision-making process, more than men acknowledged them to be. Multiple terms including 'watchful waiting' were used interchangeably with AS. There appeared to be a lack of understanding that AS is not simply 'doing nothing' but is actually a recognized management option for low-risk LPC. CONCLUSIONS Emphasizing the low risk of a man's LPC and enhancing physician trust may increase acceptability of AS. Standardizing terminology and presenting AS as a reasonable and recognized management option may also help increase its adoption.
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Affiliation(s)
- Arun Mallapareddi
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA and
| | - Julie Ruterbusch
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Elyse Reamer
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA and
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Jinping Xu
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA and
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Leapman M, Jazayeri SB, Katsigeorgis M, Hobbs A, Samadi DB. Patient-perceived Causes of Prostate Cancer: Result of an Internet-based Survey. Urology 2017; 99:69-75. [DOI: 10.1016/j.urology.2016.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/31/2016] [Accepted: 09/03/2016] [Indexed: 11/15/2022]
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Moses KA, Orom H, Brasel A, Gaddy J, Underwood W. Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter? Urology 2016; 99:76-83. [PMID: 27667157 DOI: 10.1016/j.urology.2016.07.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/07/2016] [Accepted: 07/23/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer (PCa) among the various racial groups in the United States exist, which may be a source of potential disparity in outcome. METHODS Utilizing Surveillance, Epidemiology and End Results 17, we identified 327,636 men diagnosed with PCa from 2004 to 2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity. RESULTS African American (AA) and Hispanic men were less likely to receive treatment compared to White men (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.71, 0.75, and OR 0.95, 95% CI 0.92, 0.98, respectively). AA men had significantly lower OR of receiving definitive treatment within each D'Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (low-risk OR 0.81, 95% CI 0.78, 0.85; intermediate-risk OR 0.74, 95% CI 0.71, 0.77; and high-risk OR 0.62, 95% CI 0.58, 0.66). Hispanic men with intermediate-risk (OR 0.89, 95% CI 0.84, 0.94) or high-risk (OR 0.79, 95% CI 0.72, 0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D'Amico classification. CONCLUSION There is a significant disparity in the receipt of treatment for PCa among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer PCa-related outcomes in these populations.
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Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Alicia Brasel
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Jacquelyne Gaddy
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL
| | - Willie Underwood
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
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Walker DM, McAlearney AS, Sova LN, Lin JJ, Abramson S, Bickell NA. Comparing Prostate Cancer Treatment Decision Making in a Resource-rich and a Resource-poor Environment: A Tale of two Hospitals. J Natl Med Assoc 2016; 108:211-219. [PMID: 27979006 DOI: 10.1016/j.jnma.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Black men with prostate cancer are diagnosed later, have poorer treatment outcomes, and higher mortality from the disease than all other racial groups. While existing literature has explored differences in the treatment decision making process between black and white men with localized prostate cancer, little is known about how environmental factors may affect the treatment decision process for men with clinically significant disease for whom treatment improves survival. The aim of this study was to compare and contrast the treatment decision process, from both patients' and treating physicians' perspectives, in a resource-rich and a resource-poor hospital. METHODS Qualitative interviews and focus groups were conducted with patients and their treating physicians from two urban hospitals. Patients were identified through retrospective review of pathology and tumor registries; their charts abstracted to ascertain treatments. Treating physicians were identified and contacted to discuss the treatment decision process. Physicians were also asked to discuss patients who did not receive definitive treatment. Transcripts were analyzed deductively using themes from the Health Belief Model, and inductively to explore emergent themes. RESULTS Overall, patients and physicians discussed similar factors that influenced the decision making process at both hospitals. However, a few important differences were found: providers at the resource-poor hospital discussed cost as a barrier, highlighted having limited treatment options for their patients, and noted issues with follow-up as external factors affecting treatment decisions. Patients at the resource-poor hospital expressed greater fear and anxiety, and less self-efficacy and motivation in comparison to patients treated at the hospital with greater resources. Importantly, patients at both hospitals described significant trust in their physician, yet only at the resource-poor hospital did patients suggest that they lacked knowledge regarding treatment side-effects, despite physicians at both hospitals describing their attempt to disclose all side-effects. CONCLUSION These findings identify both medical-system factors, and practice-level factors that can help guide the development of interventions to reduce prostate cancer treatment disparities.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA; Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Lindsey N Sova
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Jenny J Lin
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Health Equity & Community Engaged Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place; Box 1077, New York, NY 10029, USA
| | - Sarah Abramson
- Center for Health Equity & Community Engaged Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place; Box 1077, New York, NY 10029, USA
| | - Nina A Bickell
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Health Equity & Community Engaged Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place; Box 1077, New York, NY 10029, USA
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Mollica MA, Underwood W, Homish GG, Homish DL, Orom H. Spirituality is associated with less treatment regret in men with localized prostate cancer. Psychooncology 2016; 26:1839-1845. [PMID: 27530290 DOI: 10.1002/pon.4248] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/26/2016] [Accepted: 08/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Some patients with prostate cancer regret their treatment choice. Treatment regret is associated with lower physical and mental quality of life. We investigated whether, in men with prostate cancer, spirituality is associated with lower decisional regret 6 months after treatment and whether this is, in part, because men with stronger spiritual beliefs experience lower decisional conflict when they are deciding how to treat their cancer. METHODS One thousand ninety three patients with prostate cancer (84% white, 10% black, and 6% Hispanic; mean age = 63.18; SD = 7.75) completed measures of spiritual beliefs and decisional conflict after diagnosis and decisional regret 6 months after treatment. We used multivariable linear regression to test whether there is an association between spirituality and decisional regret and structural equation modeling to test whether decisional conflict mediated this relationship. RESULTS Stronger spiritual beliefs were associated with less decisional regret (b = -0.39, 95% CI = -0.53, -0.26, P < .001, partial η2 = 0.024, confidence interval = -0.55, 39%, P < .001, partial η2 = 0.03), after controlling for covariates. Decisional conflict partially (38%) mediated the effect of spirituality on regret (indirect effect: b = -0.16, 95% CI = -0.21, -0.12, P < .001). CONCLUSIONS Spirituality may help men feel less conflicted about their cancer treatment decisions and ultimately experience less decisional regret. Psychosocial support post-diagnosis could include clarification of spiritual values and opportunities to reappraise the treatment decision-making challenge in light of these beliefs.
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Affiliation(s)
- Michelle A Mollica
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Gregory G Homish
- Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Symes Y, Song L, Heineman RG, Barbosa BD, Tatum K, Greene G, Weaver M, Chen RC. Involvement in Decision Making and Satisfaction With Treatment Among Partners of Patients With Newly Diagnosed Localized Prostate Cancer. Oncol Nurs Forum 2016; 42:672-9. [PMID: 26488835 DOI: 10.1188/15.onf.672-679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine partner involvement in treatment decision making for localized prostate cancer, congruence between partner involvement and patient preference, reasons for partner noninvolvement, and partner satisfaction with patient treatment
. DESIGN Cross-sectional exploratory study. SETTING 100 counties in North Carolina. SAMPLE 281 partners of men with newly diagnosed localized prostate cancer. METHODS Participants completed a phone survey. Logistic regression analyses were used. MAIN RESEARCH VARIABLES Partners' involvement in treatment decision making, partner satisfaction with treatment, activities of partner involvement, and reasons for noninvolvement. FINDINGS Of the 228 partners (81%) related to decision making, 205 (73%) were very satisfied with the treatment the patients received, and partner involvement was congruent with patient preference in 242 partners (86%). Partners reported several reasons for noninvolvement. CONCLUSIONS Most partners engaged in multiple activities during treatment decision making for localized prostate cancer and were satisfied with the patient's treatment. Partner involvement was mostly congruent with patient preference. IMPLICATIONS FOR NURSING Partners' active involvement in treatment decision making for localized prostate cancer (e.g., being involved in patients' conversations with doctors) should be encouraged and facilitated for those who prefer this type of decision making.
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Affiliation(s)
- Yael Symes
- University of North Carolina at Chapel Hill
| | - Lixin Song
- School of Nursing, University of North Carolina, Chapel Hill, NC
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Orom H, Underwood W, Biddle C. Emotional Distress Increases the Likelihood of Undergoing Surgery among Men with Localized Prostate Cancer. J Urol 2016; 197:350-355. [PMID: 27506694 DOI: 10.1016/j.juro.2016.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE We determined whether among men with clinically localized prostate cancer, particularly men with low risk disease, greater emotional distress increases the likelihood of undergoing surgery vs radiation or active surveillance. MATERIALS AND METHODS Participants were 1,531 patients recruited from 2 academic and 3 community facilities (nonHispanic white 83%, nonHispanic black 11% and Hispanic 6%; low risk 36%, intermediate risk 49% and high risk 15%; choice of active surveillance 24%, radiation 27% and surgery 48%). Emotional distress was assessed shortly after diagnosis and after men made a treatment decision with the Distress Thermometer. We used multinomial logistic regression with robust standard errors to test if emotional distress at either point predicted treatment choice in the sample as a whole and after stratifying by D'Amico risk score. RESULTS In the sample as a whole the participants who were more emotionally distressed at diagnosis were more likely to choose surgery over active surveillance (RRR 1.07; 95% CI 1.01, 1.14; p=0.02). Men who were more distressed close to the time they made a treatment choice were more likely to have chosen surgery over active surveillance (RRR 1.16; 95% CI 1.09, 1.24; p <0.001) or surgery over radiation (RRR 1.12; 95% CI 1.05, 1.19; p=0.001). This pattern was also found in men with low risk disease. CONCLUSIONS Emotional distress may motivate men with low risk prostate cancer to choose more aggressive treatment. Addressing emotional distress before and during treatment decision making may reduce a barrier to the uptake of active surveillance.
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Affiliation(s)
- Heather Orom
- University at Buffalo (CB), Buffalo, New York; Roswell Park Cancer Institute, Buffalo, New York.
| | - Willie Underwood
- University at Buffalo (CB), Buffalo, New York; Roswell Park Cancer Institute, Buffalo, New York
| | - Caitlin Biddle
- University at Buffalo (CB), Buffalo, New York; Roswell Park Cancer Institute, Buffalo, New York
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Does where you live influence how your vestibular schwannoma is managed? Examining geographical differences in vestibular schwannoma treatment across the United States. J Neurooncol 2016; 129:269-79. [DOI: 10.1007/s11060-016-2170-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
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Effect of physician disclosure of specialty bias on patient trust and treatment choice. Proc Natl Acad Sci U S A 2016; 113:7465-9. [PMID: 27325783 DOI: 10.1073/pnas.1604908113] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This paper explores the impact of disclosures of bias on advisees. Disclosure-informing advisees of a potential bias-is a popular solution for managing conflicts of interest. Prior research has focused almost exclusively on disclosures of financial conflicts of interest but little is known about how disclosures of other types of biases could impact advisees. In medicine, for example, physicians often recommend the treatment they specialize in; e.g., surgeons are more likely to recommend surgery than nonsurgeons. In recognition of this bias, some physicians inform patients about their specialty bias when other similarly effective treatment options exist. Using field data (recorded transcripts of surgeon-patient consultations) from Veteran Affairs hospitals and a randomized controlled laboratory experiment, we examine and find that disclosures of specialty bias increase patients' trust and their likelihood of choosing a treatment in accordance with the physicians' specialty. Physicians in the field also increased the strength of their recommendation to have the specialty treatment when they disclosed their bias or discussed the opportunity for the patient to seek a consultation with a physician from another specialty. These findings have important implications for handling advisor bias, shared advisor-advisee decision-making, and disclosure policies.
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Moschini M, Fossati N, Sood A, Lee JK, Sammon J, Sun M, Pucheril D, Dalela D, Montorsi F, Karnes RJ, Briganti A, Trinh QD, Menon M, Abdollah F. Contemporary Management of Prostate Cancer Patients Suitable for Active Surveillance: A North American Population-based Study. Eur Urol Focus 2016; 4:68-74. [PMID: 28753764 DOI: 10.1016/j.euf.2016.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 05/21/2016] [Accepted: 06/02/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Active surveillance (AS) is increasingly recognized as a recommended treatment option for prostate cancer (PCa) patients with clinically localized, low-risk disease; however, previous studies suggested that its utilization is uncommon in the United States. OBJECTIVE We evaluated the nationwide utilization rate of AS in the contemporary era. DESIGN, SETTING, AND PARTICIPANTS We relied on the 2010-2011 Surveillance Epidemiology and End Results (SEER) database using all 18 SEER-based registries. We identified 9049 patients that fulfilled the University of California, San Francisco AS criteria (prostate-specific antigen level <10ng/ml, clinical T stage ≤2a, Gleason score ≤6 [no pattern 4 or 5], and percentage of positive biopsy cores <33%). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression analysis tested the relationship between receiving local treatment and all available predictors. RESULTS AND LIMITATIONS Only 32% of AS candidates did not receive any active local treatment. This proportion varied widely among the SEER-based registries, ranging from 13% to 49% (p<0.001). In multivariable analyses, clinical stage T2a (odds ratio [OR]: 1.23; p=0.04) and percentage of positive cores (OR: 1.10 for each 2% increase; p<0.001) were associated with a higher probability of receiving local treatment. Conversely, older age (OR: 0.89 for each 2-yr increase; p<0.001), not being married (OR: 0.64; p<0.001), and uninsured status (OR: 0.55; p=0.008) were associated with a lower probability of receiving active local treatment. The study is limited by the fact that SEER does not distinguish among patients undergoing observation, AS, watchful waiting, or initial hormonal therapy. CONCLUSIONS In the United States, a considerable proportion of patients suitable for AS receive local treatment for PCa. Proportions differ significantly among SEER registries. PATIENT SUMMARY Having more extensive and palpable disease, having medical insurance, being married, and being younger are associated with an increased probability of receiving local treatment for low-risk prostate cancer.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Nicola Fossati
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akshay Sood
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Justin K Lee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jesse Sammon
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Dan Pucheril
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Deepansh Dalela
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | | | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA
| | - Firas Abdollah
- Vattikuti Urology Institute (VUI) and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, Detroit, MI, USA.
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Hurwitz LM, Cullen J, Elsamanoudi S, Kim DJ, Hudak J, Colston M, Travis J, Kuo HC, Porter CR, Rosner IL. A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic. Urol Oncol 2016; 34:233.e17-25. [DOI: 10.1016/j.urolonc.2015.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/25/2015] [Accepted: 11/14/2015] [Indexed: 01/22/2023]
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Xu J, Janisse J, Ruterbusch JJ, Ager J, Liu J, Holmes-Rovner M, Schwartz KL. Patients' Survival Expectations With and Without Their Chosen Treatment for Prostate Cancer. Ann Fam Med 2016; 14:208-14. [PMID: 27184990 PMCID: PMC4868558 DOI: 10.1370/afm.1926] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/28/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Overtreatment of screen-detected localized prostate cancer (LPC) is an important public health concern, since the survival benefit of aggressive treatment (surgery or radiation) has not been well established. We investigated the survival expectations of patients who had LPC with and without their chosen treatment. METHODS A population-based sample of 260 men (132 black, 128 white) 75 years old or younger with newly diagnosed LPC completed a self-administered survey. How long the patients expected to live with their chosen treatment, how long they would expect to live with no treatment, and factors associated with the difference in perceived life expectancy were assessed using multivariable analysis. RESULTS Without any treatment, 33% of patients expected that they would live less than 5 years, 41% 5 to 10 years, 21% 10 to 20 years, and 5% more than 20 years. With their chosen treatment, 3% of patients expected to live less than 5 years, 9% 5 to 10 years, 33% 10 to 20 years, and 55% more than 20 years. Treatment chosen, age, general health perception, and perceived cancer seriousness predicted the differences in perceived life expectancy, while race and actual tumor risk did not. After adjustment for other covariates, men who choose surgery or radiation expected greater gain in survival than men who chose watchful waiting or active surveillance. CONCLUSIONS Most patients with LPC underestimated their life expectancy without treatment and overestimated the gain in life expectancy with surgery or radiation. These unrealistic expectations may compromise patients' ability to make informed treatment decisions and may contribute to overtreatment of LPC. Primary care physicians, when included in the decision process, should focus on helping patients develop realistic expectations and choices that support their treatment goals.
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Affiliation(s)
- Jinping Xu
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - James Janisse
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | | | - Joel Ager
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Joe Liu
- Department of Anesthesiology, Wayne State University, Detroit, Michigan
| | | | - Kendra L Schwartz
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
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Sidani S, Fox M, Epstein DR, Miranda J. Challenges in Using the Randomized Trial Design to Examine the Influence of Treatment Preferences. Can J Nurs Res 2016; 48:7-13. [PMID: 28841070 DOI: 10.1177/0844562116665274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The overall purpose of this methodological study was to investigate the strengths and limitations of the randomized clinical trial design in examining the influence of treatment preferences on outcomes. The study was a secondary analysis of data obtained in two randomized clinical trials that evaluated behavioral therapies for insomnia. In both trials, the same design and methods were used to assess participants' treatment preferences and outcomes, however, the treatments differed. The results illustrated the challenges encountered in using the randomized clinical trial design. The challenges were related to the unbalanced distribution of participants with preferences for the study treatments, non-comparability of the subgroups with treatments matched or mismatched to their preferences, differential attrition, which compromised the sample size and composition of the subgroups and limited the use of the planned statistical analyses. Whether these challenges occur in trials of other types of treatments and target populations should be explored in future research. Some strategies were proposed and should be evaluated for their utility in addressing these challenges.
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Affiliation(s)
- Souraya Sidani
- 1 School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Mary Fox
- 2 School of Nursing, York University, Toronto, ON, Canada
| | - Dana R Epstein
- 3 Phoenix VA Health Care System, Arizona State University College of Nursing and Health Innovation, Phoenix, AZ, USA
| | - Joyal Miranda
- 1 School of Nursing, Ryerson University, Toronto, ON, Canada
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70
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Prostate cancer radiation therapy: A physician’s perspective. Phys Med 2016; 32:438-45. [DOI: 10.1016/j.ejmp.2016.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/27/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023] Open
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Abstract
PURPOSE OF REVIEW Treatment decisions for low-risk prostate cancer are arguably some of the most challenging in oncology. Active surveillance has emerged as an important option for many men with tumors estimated to have a low metastatic potential. Multiple complex patient and physician factors affect the recommendation, selection, and adherence to active surveillance. While baseline clinical criteria are used to identify candidates for this approach, it is important to identify and understand other forces that may influence the management of prostate cancer with active surveillance. RECENT FINDINGS Patient perceptions and acceptance of active surveillance have improved over time. Treatment decisions for prostate cancer are strongly associated with physician recommendations, and a high-quality relationship between the patient and his healthcare system is critical to successful active surveillance. Patient understanding of prostate cancer and consistency of information received from separate physicians can affect a decision to pursue active surveillance. Psychological symptoms, most notably regarding anxiety and distress, can affect adherence to active surveillance over time. In general, anxiety for men on active surveillance is low, and lifestyle interventions and self-management strategies may be helpful for increasing quality of life and limiting abandonment of active surveillance in the absence of disease progression. SUMMARY Multiple factors may affect the decision for and adherence to active surveillance for prostate cancer. It is important for both physicians and patients to be aware of these issues and work towards individualized approaches and interventions as needed to increase adoption of active surveillance in the future.
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Hall IJ, Lee Smith J. Evolution of a CDC Public Health Research Agenda for Low-Risk Prostate Cancer. Am J Prev Med 2015; 49:S483-8. [PMID: 26590643 PMCID: PMC4733621 DOI: 10.1016/j.amepre.2015.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 11/03/2022]
Abstract
Men with prostate cancer face difficult choices when selecting a therapy for localized prostate cancer. Comparative data from controlled studies are lacking and clinical opinions diverge about the benefits and harms of treatment options. Consequently, there is limited guidance for patients regarding the impact of treatment decisions on quality of life. There are opportunities for public health to intervene at several decision-making points. Information on typical quality of life outcomes associated with specific prostate cancer treatments could help patients select treatment options. From 2003 to present, the Division of Cancer Prevention and Control at CDC has supported projects to explore patient information-seeking behavior post-diagnosis, caregiver and provider involvement in treatment decision making, and patient quality of life following prostate cancer treatment. CDC's work also includes research that explores barriers and facilitators to the presentation of active surveillance as a viable treatment option and promotes equal access to information for men and their caregivers. This article provides an overview of the literature and considerations that initiated establishing a prospective public health research agenda around treatment decision making. Insights gathered from CDC-supported studies are poised to enhance understanding of the process of shared decision making and the influence of patient, caregiver, and provider preferences on the selection of treatment choices. These findings provide guidance about attributes that maximize patient experiences in survivorship, including optimal quality of life and patient and caregiver satisfaction with information, treatment decisions, and subsequent care.
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Affiliation(s)
- Ingrid J Hall
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Judith Lee Smith
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Daniels CP, Millar JL, Spelman T, Sengupta S, Evans SM. Predictors and rate of adjuvant radiation therapy following radical prostatectomy: A report from the Prostate Cancer Registry. J Med Imaging Radiat Oncol 2015; 60:247-54. [PMID: 26548940 DOI: 10.1111/1754-9485.12407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Long-term data from three randomized trials have demonstrated that adjuvant radiation therapy (ART) reduces the rate of biochemical failure in high-risk men following radical prostatectomy (RP). One of these trials has shown a survival advantage. We investigated the rate of ART in Victoria and the predictors for this treatment. METHODS We analysed data from eligible patients who were notified to the Victorian Prostate Cancer Registry (PCR) by 37 Victorian hospitals between 1 August 2008 and 31 October 2011. We defined ART as radiation therapy (RT) delivered within 6 months of RP. Predictors of ART receipt were modelled using adjusted and unadjusted logistic regression. RESULTS There were 4626 eligible cases from which 2018 underwent RP with recorded date of surgery. Of these eligible prostatectomy cases, a total of 89 received ART. A subgroup of 833 men had an adverse pathologic feature, of whom 78 received ART. In a multivariate model, pathologic tumour stage pT3a (odds ratio (OR) 2.64; 95% confidence interval (CI) 1.4-5.00; P = 0.003), pT3b (OR 4.58; 95% CI 2.12-9.89; P = 0.000), a positive surgical margin (OR 8.91; 95% CI 4.61-17.2; P = 0.000) and pathologic Gleason grade >7 (OR 7.18; 95% CI 1.54-33.6; P = 0.012) predicted receipt of ART. CONCLUSION Adverse pathologic features and high pathologic Gleason score predict for receiving ART in Victorian men after RP, but overall, ART is not commonly prescribed. This finding is consistent with other published series and may reflect clinician scepticism regarding the benefit of ART over salvage RT and concern about toxicity and the risk of over treatment.
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Affiliation(s)
| | - Jeremy L Millar
- Department of Radiation Oncology, Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tim Spelman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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74
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Martin NE. Improving What Matters. Eur Urol 2015; 68:384-5. [DOI: 10.1016/j.eururo.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
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Peltier A, Aoun F, Ameye F, Andrianne R, De Meerleer G, Denis L, Joniau S, Lambrecht A, Billiet I, Vanderdonck F, Roumeguère T, Van Velthoven R. Does Multimedia Education with 3D Animation Impact Quality and Duration of Urologists' Interactions with their Prostate Cancer Patients? Adv Ther 2015; 32:863-73. [PMID: 26407808 DOI: 10.1007/s12325-015-0248-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This large multicenter study aimed to assess the impact of the use of multimedia tools on the duration and the quality of the conversation between healthcare providers (urologists, radiotherapists and nurses) and their patients. METHODS 30 urological centers in Belgium used either videos or other instructive tools in their consultation with prostate cancer patients. Each consultation was evaluated for duration and quality using a visual analog scale. RESULTS In total, 905 patient visits were evaluated: 447 without and 458 with video support. During consultations with video support, an average of 2.3 videos was shown. Video support was judged to be practical and to improve the quality of consultations, without loss of time, regardless of patient age or stage of disease management (p > 0.05). CONCLUSION Healthcare providers indicate that the use of videos improved patient comprehension about prostate cancer, as well as the quality information exchange, without increasing consultation time. The use of video material was feasible in daily practice, and was easy to understand, relevant and culturally appropriate, even for the most elderly men. Multimedia education also helped to empower men to actively participate in their healthcare and treatment discussions. FUNDING Ipsen NV.
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Affiliation(s)
- Alexandre Peltier
- Department of Urology, Institut Jules Bordet, 1000, Brussels, Belgium.
| | - Fouad Aoun
- Department of Urology, Institut Jules Bordet, 1000, Brussels, Belgium
| | - Filip Ameye
- Department of Urology, AZ Maria Middelares, 9000, Ghent, Belgium
| | | | | | - Louis Denis
- Oncology Center Antwerp, 2000, Antwerp, Belgium
| | - Steven Joniau
- Department of Urology, UZ Leuven Gasthuisberg, 3000, Louvain, Belgium
| | - Antoon Lambrecht
- Department of Radiotherapy, AZ Groeninge, 8500, Kortrijk, Belgium
| | - Ignace Billiet
- Department of Urology, AZ Groeninge, 8500, Kortrijk, Belgium
| | | | - Thierry Roumeguère
- Department of Urology, University Clinics of Brussels, Erasme Hospital-ULB, 1070, Brussels, Belgium
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Mollica MA, Underwood W, Homish GG, Homish DL, Orom H. Spirituality is associated with better prostate cancer treatment decision making experiences. J Behav Med 2015; 39:161-9. [PMID: 26243642 DOI: 10.1007/s10865-015-9662-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/17/2015] [Indexed: 12/12/2022]
Abstract
This study examined whether spiritual beliefs are associated with greater decision-making satisfaction, lower decisional conflict and decision-making difficulty with the decision-making process in newly diagnosed men with prostate cancer. Participants were 1114 men diagnosed with localized prostate cancer who had recently made their treatment decision, but had not yet been treated. We used multivariable linear regression to analyze relationships between spirituality and decision-making satisfaction, decisional conflict, and decision-making difficulty, controlling for optimism and resilience, and clinical and sociodemographic factors. Results indicated that greater spirituality was associated with greater decision-making satisfaction (B = 0.02; p < 0.001), less decisional conflict (B = -0.42; p < 0.001), and less decision-making difficulty (B = -0.08; p < 0.001). These results confirm that spiritual beliefs may be a coping resource during the treatment decision-making process. Providing opportunities for patients to integrate their spiritual beliefs and their perceptions of their cancer diagnosis and trajectory could help reduce patient uncertainty and stress during this important phase of cancer care continuum.
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Affiliation(s)
- Michelle A Mollica
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA. .,Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA.
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA.
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA.
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77
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Devos J, Van Praet C, Decaestecker K, Claeys T, Fonteyne V, Decalf V, De Meerleer G, Ost P, Lumen N. Cognitive factors influencing treatment decision-making in patients with localised prostate cancer: development of a standardised questionnaire. Acta Clin Belg 2015; 70:272-9. [PMID: 25816107 DOI: 10.1179/2295333715y.0000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Men diagnosed with localised prostate cancer have to make a well-informed treatment choice between (robot-assisted) radical prostatectomy, external beam radiotherapy and, in selected cases, brachytherapy and active surveillance. We developed and validated a questionnaire to determine the cognitive reasons motivating this choice. MATERIALS AND METHODS The Prostate Cancer Decision-Making Questionnaire (PC-DMQ) was designed in-house and validated through the Delphi method. Finally, we tested the questionnaire in a cohort of 24 men, recently diagnosed with localised PC, before undergoing RARP (n = 16), EBRT (n = 6), brachytherapy (n = 1) or active surveillance (n = 1). RESULTS The experts reached consensus after three rounds. In the patient cohort, 75% of men undergoing RARP chose this treatment because 'it provides the best chance of cure'. Reasons to choose EBRT were not as explicit: 33.3% chose this treatment because 'it provides the best chance of cure' and 33.3% because 'the maintenance of potency is important to them'. CONCLUSIONS The PC-DMQ is a comprehensive and standardised tool that allows further research into cognitive factors that influence treatment decision-making in patients with localised PC.
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78
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Hoffman RM, Shi Y, Freedland SJ, Keating NL, Walter LC. Treatment patterns for older veterans with localized prostate cancer. Cancer Epidemiol 2015; 39:769-77. [PMID: 26228494 DOI: 10.1016/j.canep.2015.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/28/2015] [Accepted: 07/13/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Concerns about over-treatment have led to practice guidelines discouraging active treatment of prostate cancer (PCa) in men with limited life expectancies and/or low-risk tumors. We evaluated treatment patterns for older veterans with localized PCa, particularly those with low-risk features. METHODS We used VA Cancer Registry data to identify men aged 65+ diagnosed with clinically localized PCa between January 1st, 2003 and December 31st, 2008. We obtained baseline data on demographics, tumor characteristics, comorbidities, and initial treatment within 6 months of diagnosis: radical prostatectomy, radiotherapy, primary androgen-deprivation therapy (PADT), or no active treatment. National VA surveys provided facility data, including academic affiliation, availability of oncologic specialists, and distance to radiotherapy facilities. Multinomial regression analyses determined associations between patient and facility characteristics and cancer treatment for men with localized (stage<III) and low-risk PCa (stage≤IIa, PSA<10ng/mL, Gleason ≤6). RESULTS 17,206 veterans had localized PCa, 32% age 75+, 12% had comorbidity scores ≥3, and 33% had low-risk tumors. Overall, 39% received radiotherapy, 6% surgery, 20% PADT, and 35% no active treatment. For those with low-risk cancers, older men (RR=0.36, 95% CI 0.30-0.43) and sicker men (RR=0.75, 95% CI 0.62-0.90) were less likely to receive surgery or radiotherapy versus no active treatment. Over time, more of these men received no active treatment (from 41% to 57%, P<0.001) while fewer received PADT (from 11% to 4%, P<0.001). CONCLUSION VA treatment patterns followed evidence-based guidelines against treating older and sicker men with surgery or radiotherapy, for decreasing use of PADT, and for increasingly withholding active treatment, particularly for men with low-risk PCa.
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Affiliation(s)
- Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
| | - Ying Shi
- San Francisco VA Medical Center, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
| | - Stephen J Freedland
- Urology Division, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Louise C Walter
- San Francisco VA Medical Center, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
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Simpkin AJ, Rooshenas L, Wade J, Donovan JL, Lane JA, Martin RM, Metcalfe C, Albertsen PC, Hamdy FC, Holmberg L, Neal DE, Tilling K. Development, validation and evaluation of an instrument for active monitoring of men with clinically localised prostate cancer: systematic review, cohort studies and qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundActive surveillance [(AS), sometimes called active monitoring (AM)],is a National Institute for Health and Care Excellence-recommended management option for men with clinically localised prostate cancer (PCa). It aims to target radical treatment only to those who would benefit most. Little consensus exists nationally or internationally about safe and effective protocols for AM/AS or triggers that indicate if or when men should move to radical treatment.ObjectiveThe aims of this project were to review how prostate-specific antigen (PSA) has been used in AM/AS programmes; to develop and test the validity of a new model for predicting future PSA levels; to develop an instrument, based on PSA, that would be acceptable and effective for men and clinicians to use in clinical practice; and to design a robust study to evaluate the cost-effectiveness of the instrument.MethodsA systematic review was conducted to investigate how PSA is currently used to monitor men in worldwide AM/AS studies. A model for PSA change with age was developed using Prostate testing for cancer and Treatment (ProtecT) data and validated using data from two PSA-era cohorts and two pre-PSA-era cohorts. The model was used to derive 95% PSA reference ranges (PSARRs) across ages. These reference ranges were used to predict the onset of metastases or death from PCa in one of the pre-PSA-era cohorts. PSARRs were incorporated into an active monitoring system (AMS) and demonstrated to 18 clinicians and 20 men with PCa from four NHS trusts. Qualitative interviews investigated patients’ and clinicians’ views about current AM/AS protocols and the acceptability of the AMS within current practice.ResultsThe systematic review found that the most commonly used triggers for clinical review of PCa were PSA doubling time (PSADT) < 3 years or PSA velocity (PSAv) > 1 ng/ml/year. The model for PSA change (developed using ProtecT study data) predicted PSA values in AM/AS cohorts within 2 ng/ml of observed PSA in up to 79% of men. Comparing the three PSA markers, there was no clear optimal approach to alerting men to worsening cancer. The PSARR and PSADT markers improved the modelc-statistic for predicting death from PCa by 0.11 (21%) and 0.13 (25%), respectively, compared with using diagnostic information alone [PSA, age, tumour stage (T-stage)]. Interviews revealed variation in clinical practice regarding eligibility and follow-up protocols. Patients and clinicians perceive current AM/AS practice to be framed by uncertainty, ranging from uncertainty about selection of eligible AM/AS candidates to uncertainty about optimum follow-up protocols and thresholds for clinical review/radical treatment. Patients and clinicians generally responded positively to the AMS. The impact of the AMS on clinicians’ decision-making was limited by a lack of data linking AMS values to long-term outcomes and by current clinical practice, which viewed PSA measures as one of several tools guiding clinical decisions in AM/AS. Patients reported that they would look to clinicians, rather than to a tool, to direct decision-making.LimitationsThe quantitative findings were severely hampered by a lack of clinical outcomes or events (such as metastases). The qualitative findings were limited through reliance on participants’ reports of practices and recollections of events rather than observations of actual interactions.ConclusionsPatients and clinicians found that the instrument provided additional, potentially helpful, information but were uncertain about the current usefulness of the risk model we developed for routine management. Comparison of the model with other monitoring strategies will require clinical outcomes from ongoing AM/AS studies.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Julia Wade
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, CT, USA
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lars Holmberg
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
- Regional Cancer Centre, Uppsala/Örebro Region, Uppsala, Sweden
| | - David E Neal
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Bratt O, Folkvaljon Y, Hjälm Eriksson M, Akre O, Carlsson S, Drevin L, Franck Lissbrant I, Makarov D, Loeb S, Stattin P. Undertreatment of Men in Their Seventies with High-risk Nonmetastatic Prostate Cancer. Eur Urol 2015; 68:53-8. [DOI: 10.1016/j.eururo.2014.12.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 12/09/2014] [Indexed: 10/23/2022]
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Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study. J Racial Ethn Health Disparities 2015; 3:35-45. [PMID: 26896103 DOI: 10.1007/s40615-015-0109-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/25/2015] [Accepted: 03/25/2015] [Indexed: 01/28/2023]
Abstract
PURPOSE Racial differences in prostate cancer treatment patterns have motivated concerns about over- and undertreatment. We surveyed black and white patients with localized prostate cancer (LPC) regarding their treatment decision-making processes to gain a better perspective on factors associated with LPC treatment choice. METHODS We conducted a population-based, cross-sectional survey of 260 men (132 black, 128 white) aged ≤75 years, with newly diagnosed LPC. Our primary outcome was treatment choice (either surgery, radiation, or watchful waiting/active surveillance (WW/AS)), and our primary predictors were race and tumor risk level. RESULTS Overall, treatment choice did not differ by race. As cancer risk increased, both black and white patients were more likely to undergo surgery and less likely to receive radiation. However, the pattern of WW/AS was different between white and black men. White men were less likely to select WW/AS as cancer risk increased, while risk level was unrelated to black men undergoing WW/AS. Urologist's recommendation had the greatest impact on men's treatment choice, followed by tumor risk level, age, and personal preferences. CONCLUSIONS Although there were no overall racial differences in treatment choice, when stratified by tumor risk level, the pattern of WW/AS was different between white and black patients, suggesting that over- and undertreatment is a larger concern for black than white men. A risk-stratified approach to understand racial disparities in LPC treatment and better strategies to aid black men in their treatment decision-making are needed to reduce racial disparities in prostate cancer outcomes.
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Camarata AS, Nickleach DC, Jani AB, Rossi PJ. Locoregional prostate cancer treatment pattern variation in independent cancer centers: policy effect, patient preference, or physician incentive? Health Serv Insights 2015; 8:1-8. [PMID: 25922580 PMCID: PMC4401240 DOI: 10.4137/hsi.s24092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/06/2022] Open
Abstract
Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45–64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.
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Affiliation(s)
- Andrew S Camarata
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. ; United States Navy, Medical Corps, USA
| | - Dana C Nickleach
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Peter J Rossi
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Kast RE, Tucker SC, Killian K, Trexler M, Honn KV, Auner GW. Emerging technology: applications of Raman spectroscopy for prostate cancer. Cancer Metastasis Rev 2015; 33:673-93. [PMID: 24510129 DOI: 10.1007/s10555-013-9489-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a need in prostate cancer diagnostics and research for a label-free imaging methodology that is nondestructive, rapid, objective, and uninfluenced by water. Raman spectroscopy provides a molecular signature, which can be scaled from micron-level regions of interest in cells to macroscopic areas of tissue. It can be used for applications ranging from in vivo or in vitro diagnostics to basic science laboratory testing. This work describes the fundamentals of Raman spectroscopy and complementary techniques including surface enhanced Raman scattering, resonance Raman spectroscopy, coherent anti-Stokes Raman spectroscopy, confocal Raman spectroscopy, stimulated Raman scattering, and spatially offset Raman spectroscopy. Clinical applications of Raman spectroscopy to prostate cancer will be discussed, including screening, biopsy, margin assessment, and monitoring of treatment efficacy. Laboratory applications including cell identification, culture monitoring, therapeutics development, and live imaging of cellular processes are discussed. Potential future avenues of research are described, with emphasis on multiplexing Raman spectroscopy with other modalities.
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Affiliation(s)
- Rachel E Kast
- Smart Sensors and Integrated Microsystems Laboratories, Department of Electrical and Computer Engineering, Wayne State University, 5050 Anthony Wayne Drive, Room 3100, Detroit, MI, 48202, USA
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Sidani S, Fox M, Epstein D. Conducting a two-stage preference trial: utility and challenges. Int J Nurs Stud 2015; 52:1017-24. [PMID: 25736207 DOI: 10.1016/j.ijnurstu.2015.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/25/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
Abstract
Treatment preferences reflect individuals' choice of therapy and influence their adherence to treatment and achievement of outcomes. The two-stage partially randomized clinical or preference trial (two-stage PRCT) is an appropriate design for examining the contribution of treatment preferences. It involves a two-stage process for assigning participants to treatments, which is useful to dismantle the effects of the treatments from those of treatment preferences. In this paper, we explain the role of treatment preferences in intervention evaluation research, describe the protocol for implementing the two-stage PRCT, and discuss issues in its application. The issues are encountered in the selection of treatments, assignment of participants and assessment of treatment preferences. Lastly, we propose ways to address the issues.
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Affiliation(s)
- Souraya Sidani
- School of Nursing, Ryerson University, Toronto, ON, Canada.
| | - Mary Fox
- School of Nursing, York University, Toronto, ON, Canada.
| | - Dana Epstein
- Phoenix Veterans Affairs Health Care System Phoenix, AZ, U.S.A.
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MacLennan S, Bekema HJ, Williamson PR, Campbell MK, Stewart F, MacLennan SJ, N'Dow JMO, Lam TBL. A core outcome set for localised prostate cancer effectiveness trials: protocol for a systematic review of the literature and stakeholder involvement through interviews and a Delphi survey. Trials 2015; 16:76. [PMID: 25887437 PMCID: PMC4355995 DOI: 10.1186/s13063-015-0598-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/10/2015] [Indexed: 12/29/2022] Open
Abstract
Background Prostate cancer is a growing health problem worldwide. The management of localised prostate cancer is controversial. It is unclear which of several surgical, radiotherapeutic, ablative, and surveillance treatments is the most effective. All have cost, process and recovery, and morbidity implications which add to treatment decision-making complexity for patients and healthcare professionals. Evidence from randomised controlled trials (RCTs) is not optimal because of uncertainty as to what constitutes important outcomes. Another issue hampering evidence synthesis is heterogeneity of outcome definition, measurement, and reporting. This project aims to determine which outcomes are the most important to patients and healthcare professionals, and use these findings to recommend a standardised core outcome set for comparative effectiveness trials of treatments for localised prostate cancer, to optimise decision-making. Methods/Design The range of potentially important outcomes and measures will be identified through systematic reviews of the literature and semi-structured interviews with patients. A consultation exercise involving representatives from two key stakeholder groups (patients and healthcare professionals) will ratify the list of outcomes to be entered into a three round Delphi study. The Delphi process will refine and prioritise the list of identified outcomes. A methodological substudy (nested RCT design) will also be undertaken. Participants will be randomised after round one of the Delphi study to one of three feedback groups, based on different feedback strategies, in order to explore the potential impact of feedback strategies on participant responses. This may assist the design of a future core outcome set and Delphi studies. Following the Delphi study, a final consensus meeting attended by representatives from both stakeholder groups will determine the final recommended core outcome set. Discussion This study will inform clinical practice and future trials of interventions of localised prostate cancer by standardising a core outcome set which should be considered in comparative effectiveness studies for localised prostate cancer. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0598-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven MacLennan
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - Hendrika J Bekema
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzleplein, Groningen, The Netherlands, 9700 RB.
| | - Paula R Williamson
- Department of Biostatistics, University of Liverpool, Crown Street, Liverpool, UK, L69 3BX.
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - Fiona Stewart
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - Sara J MacLennan
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD.
| | - James M O N'Dow
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD. .,Department of Urology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK, AB25 2ZD.
| | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Cornhill Road, Aberdeen, UK, AB25 2ZD. .,Department of Urology, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, UK, AB25 2ZD.
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Martin NE, Massey L, Stowell C, Bangma C, Briganti A, Bill-Axelson A, Blute M, Catto J, Chen RC, D'Amico AV, Feick G, Fitzpatrick JM, Frank SJ, Froehner M, Frydenberg M, Glaser A, Graefen M, Hamstra D, Kibel A, Mendenhall N, Moretti K, Ramon J, Roos I, Sandler H, Sullivan FJ, Swanson D, Tewari A, Vickers A, Wiegel T, Huland H. Defining a standard set of patient-centered outcomes for men with localized prostate cancer. Eur Urol 2015; 67:460-7. [PMID: 25234359 DOI: 10.1016/j.eururo.2014.08.075] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/29/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Value-based health care has been proposed as a unifying force to drive improved outcomes and cost containment. OBJECTIVE To develop a standard set of multidimensional patient-centered health outcomes for tracking, comparing, and improving localized prostate cancer (PCa) treatment value. DESIGN, SETTING, AND PARTICIPANTS We convened an international working group of patients, registry experts, urologists, and radiation oncologists to review existing data and practices. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The group defined a recommended standard set representing who should be tracked, what should be measured and at what time points, and what data are necessary to make meaningful comparisons. Using a modified Delphi method over a series of teleconferences, the group reached consensus for the Standard Set. RESULTS AND LIMITATIONS We recommend that the Standard Set apply to men with newly diagnosed localized PCa treated with active surveillance, surgery, radiation, or other methods. The Standard Set includes acute toxicities occurring within 6 mo of treatment as well as patient-reported outcomes tracked regularly out to 10 yr. Patient-reported domains of urinary incontinence and irritation, bowel symptoms, sexual symptoms, and hormonal symptoms are included, and the recommended measurement tool is the Expanded Prostate Cancer Index Composite Short Form. Disease control outcomes include overall, cause-specific, metastasis-free, and biochemical relapse-free survival. Baseline clinical, pathologic, and comorbidity information is included to improve the interpretability of comparisons. CONCLUSIONS We have defined a simple, easily implemented set of outcomes that we believe should be measured in all men with localized PCa as a crucial first step in improving the value of care. PATIENT SUMMARY Measuring, reporting, and comparing identical outcomes across treatments and treatment centers will provide patients and providers with information to make informed treatment decisions. We defined a set of outcomes that we recommend being tracked for every man being treated for localized prostate cancer.
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Affiliation(s)
- Neil E Martin
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA; Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Laura Massey
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
| | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Cambridge, MA, USA
| | - Chris Bangma
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alberto Briganti
- Prostate Cancer Research Programme at the Urological Research Institute, Department of Urology, Vita-Salute San Raffaele University Hospital, Milan, Italy
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Department of Urology, Uppsala University Hospital and National Prostate Cancer Register of Sweden, Uppsala, Sweden
| | - Michael Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Catto
- University of Sheffield Academic Urology Unit and Academic Unit of Molecular Oncology, CR-UK/YCR, Sheffield Cancer Research Centre, University of Sheffield Medical School, Sheffield, UK
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Günter Feick
- Bundesverband Prostatakrebs Selbsthilfe, Pohlheim, Germany
| | | | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mark Frydenberg
- Department of Surgery, Monash University, Victoria, Australia
| | - Adam Glaser
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Markus Graefen
- Martini-Klinik at University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Hamstra
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Adam Kibel
- Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nancy Mendenhall
- University of Florida Proton Therapy Institute, Jacksonville, FL, USA
| | - Kim Moretti
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Jacob Ramon
- Department of Urology and Uro-Oncology, Chaim Sheba Medical Center at Tel Hashomer, Tel Hashomer, Israel
| | - Ian Roos
- Cancer Voices Australia, Melbourne, Victoria, Australia
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - David Swanson
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Hartwig Huland
- Martini-Klinik at University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Showalter TN, Mishra MV, Bridges JFP. Factors that influence patient preferences for prostate cancer management options: A systematic review. Patient Prefer Adherence 2015; 9:899-911. [PMID: 26170640 PMCID: PMC4494611 DOI: 10.2147/ppa.s83333] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE We performed a systematic review to evaluate evidence regarding factors that influence patient preferences for management options for localized prostate cancer. METHODS We followed a prespecified search protocol (PROSPERO identifier CRD42014009173) to identify studies that evaluated patient preferences for prostate cancer management options for localized prostate cancer. We queried PubMed, the Cochrane Database of Systematic Reviews, Embase, Cumulative Index to Nursing & Allied Health Literature (CINAHL) Plus, and Econ-Lit databases. Two separate reviewers completed the article selection process and review, including coding of study characteristics. Study quality was scored according to the PREFS checklist, which consists of five criteria: Purpose, Respondents, Explanation, Findings, and Significance. Reviewers summarized the primary findings of each article included in the analysis. RESULTS Of the 606 citations identified in the literature search, there were a total of 21 articles that met all selection criteria, reporting results for a total of 4,131 subjects. Themes identified in the studies included: the importance of patient perceptions of treatment efficacy and side effects; the influence of physician recommendations on patient decision-making; and the prioritization of concerns regarding treatment side effects among those men who prefer radiation therapy or active surveillance. The articles had an average PREFS score of 3.4 (standard deviation [SD] 1.0), which is similar to a recent study for breast cancer treatment preferences. CONCLUSION This systematic review of factors that influence patient preferences for prostate cancer management options identified a small, but high quality, group of articles that satisfied the selection criteria. The available evidence suggests that interventions aimed at informing patients regarding the comparative effectiveness of prostate cancer management alternatives should include the influence of physician recommendations and family members' desires on patient decision-making.
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Affiliation(s)
- Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
- Correspondence: Timothy N Showalter, Department of Radiation Oncology, University of Virginia, 1240 Lee Street, Box 800383, Charlottesville, VA 22908-0383, USA, Tel +1 434 982 6278, Fax +1 434 243 9789, Email
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John FP Bridges
- Department of Health Care Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Entwicklung von Aufklärungsmaterialien für die „Deutsche Prostatakrebsstudie PREFERE“. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:28-39. [DOI: 10.1016/j.zefq.2015.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
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African-American Men with Low-Risk Prostate Cancer: Modern Treatment and Outcome Trends. J Racial Ethn Health Disparities 2014; 2:295-302. [PMID: 26863460 DOI: 10.1007/s40615-014-0071-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/27/2014] [Accepted: 10/24/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics and treatment patterns for African-American (AA) men with low-risk prostate cancer (PCa) using a national, population-based dataset. METHODS We conducted a retrospective review of the Surveillance Epidemiology and End Results database 2004-2008. AA men aged ≥40 years with low-risk PCa were identified. For comparison, white men were selected using the same selection criteria. We reviewed all recorded treatment modalities. Definitive treatment (DT) was defined as undergoing radiotherapy or prostatectomy. RESULTS Overall, 7246 AA men and 47,154 white men met the criteria. Most of the patients had PSA level between 4.1 and 6.9 ng/mL (56.2 %) and received DT (76 %). Black men were younger (mean age: 62(±8) vs. 65(±10) years), less likely to receive DT (adjusted odds ratio (AOR), 0.71 [0.67-0.76]), and of those receiving DT, less likely to undergo prostatectomy (AOR, 0.58 [0.54-0.62]). Patients receiving DT had lower crude cancer-specific and overall mortality (0.17 vs. 0.41 % and 2.9 vs. 7.8 %, p value < 0.001, respectively, among blacks). The difference in overall mortality was largest among ≥ 75 years (5.6 vs. 18.2 %). Across age groups, blacks had higher all-cause mortality (AOR, 1.45 [1.13-1.87] and 1.56[1.31-1.86] for <65 and ≥ 65 years, respectively). CONCLUSION Our study of a large modern cohort of men with low-risk PCa demonstrates significant lower receipt of DT, lower receipt of prostatectomy among those receiving DT, and lower survival for black men compared to their white counterparts. Older men were less likely to receive DT. Patients who received DT had better survival. The survival difference was most striking among the elderly.
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Moses KA, Chen LY, Sjoberg DD, Bernstein M, Touijer KA. Black and White men younger than 50 years of age demonstrate similar outcomes after radical prostatectomy. BMC Urol 2014; 14:98. [PMID: 25495177 PMCID: PMC4269868 DOI: 10.1186/1471-2490-14-98] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/01/2014] [Indexed: 12/02/2022] Open
Abstract
Background Black men with prostate cancer are diagnosed at a younger age, present with more aggressive disease, and experience higher mortality. We sought to assess pathological features and biochemical recurrence (BCR) in young men undergoing radical prostatectomy (RP) to determine if there is a difference between black and white men closer to the time of disease initiation. Methods We identified 551 white and 99 black men at a tertiary cancer center who underwent RP at ≤50 years of age. Baseline and pathological features were compared between the two groups. Cox proportional hazards models were utilized to examine the association of race and BCR, and Kaplan-Meier curves were generated to determine biochemical recurrence-free survival (bRFS). Results There were no differences in median age at surgery, biopsy Gleason score, or comorbidity. Black men had higher preoperative PSA (6.1 ng/ml vs 4.7 ng/ml, p = 0.004), but a greater percentage were cT1c (78% vs 63%), compared to white men. On multivariate analysis, black men demonstrated significantly lower odds of non-organ confined disease (OR 0.39; 95% CI: 0.18, 0.81; p = 0.01) and extracapsular extension (ECE) (OR 0.38; 95% CI: 0.18, 0.81, p = 0.01), and had no difference in Gleason score upgrading and seminal vesicle invasion compared to white men. There was no significant difference in bRFS in men with organ-confined disease; however, among men with locally advanced disease black men trended towards greater BCR (p = 0.052). Black men had 2-year bRFS of 56% vs 75% in white men. Conclusions In this single institution study, there does not appear to be a racial disparity in outcomes among younger men who receive RP for prostate cancer. Black and white men in our cohort demonstrate similar bRFS with pathologically confirmed organ-confined disease. There may be greater risk of BCR among black men locally advanced disease compared to white men, suggesting that locally advanced disease is biologically more aggressive in black men.
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Affiliation(s)
- Kelvin A Moses
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
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91
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Kerns SL, West CML, Andreassen CN, Barnett GC, Bentzen SM, Burnet NG, Dekker A, De Ruysscher D, Dunning A, Parliament M, Talbot C, Vega A, Rosenstein BS. Radiogenomics: the search for genetic predictors of radiotherapy response. Future Oncol 2014; 10:2391-406. [PMID: 25525847 DOI: 10.2217/fon.14.173] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
'Radiogenomics' is the study of genetic variation associated with response to radiotherapy. Radiogenomics aims to uncover the genes and biologic pathways responsible for radiotherapy toxicity that could be targeted with radioprotective agents and; identify genetic markers that can be used in risk prediction models in the clinic. The long-term goal of the field is to develop single nucleotide polymorphism-based risk models that can be used to stratify patients to more precisely tailored radiotherapy protocols. The field has evolved over the last two decades in parallel with advances in genomics, moving from narrowly focused candidate gene studies to large, collaborative genome-wide association studies. Several confirmed genetic variants have been identified and the field is making progress toward clinical translation.
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Affiliation(s)
- Sarah L Kerns
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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92
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Goepfert RP, Yom SS, Ryan WR, Cheung SW. Development of a chemoradiation therapy toxicity staging system for oropharyngeal carcinoma. Laryngoscope 2014; 125:869-76. [PMID: 25388529 DOI: 10.1002/lary.25023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Develop an innovative tool to standardize representation of treatment toxicity and enable shared decision making by mapping provider-based outcome descriptions to four overall stages of toxicity from chemoradiation therapy for oropharyngeal carcinoma. STUDY DESIGN Cross-sectional, provider-based questionnaire. METHODS Five short-term and five long-term treatment outcomes of cisplatin and intensity-modulated radiation therapy for oropharyngeal carcinoma were chosen by a focus group of head and neck oncologists. A pilot survey was developed in an online platform, and feedback from extramural head and neck oncologists was used to refine it for institutional review board submission and formal deployment. Respondents were surgical, radiation, and medical oncologists with experience in treating oropharyngeal carcinoma. One hundred five responses were analyzed, of which 67% were from providers with >10 years in practice and 79% were from providers who treat >15 new oropharyngeal carcinoma patients per year. RESULTS A particular overall chemoradiation toxicity class is accounted for by two adjoining distress levels (>90% occurrence) for both short-term and long-term outcomes. Providers deemed mucositis and nausea, and pain and xerostomia the most distressing short-term and long-term toxicities, respectively. Providers were split as to their impression of the relative importance that patients place on short-term versus long-term outcomes when considering treatment options. CONCLUSIONS A clinical tool to represent overall chemoradiation toxicity considering short-term and long-term outcomes has been developed by analyzing provider-centric responses to a realistic clinical scenario. Results from this pilot study enhance patient counseling and shared decision making, and serve as foundational information for a prospective, longitudinal patient-centric observational study.
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Affiliation(s)
- Ryan P Goepfert
- Departments of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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93
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Martin NE, D'Amico AV. Progress and controversies: Radiation therapy for prostate cancer. CA Cancer J Clin 2014; 64:389-407. [PMID: 25234700 DOI: 10.3322/caac.21250] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/14/2014] [Accepted: 08/15/2014] [Indexed: 12/14/2022] Open
Abstract
Radiation therapy remains a standard treatment option for men with localized prostate cancer. Alone or in combination with androgen-deprivation therapy, it represents a curative treatment and has been shown to prolong survival in selected populations. In this article, the authors review recent advances in prostate radiation-treatment techniques, photon versus proton radiation, modification of treatment fractionation, and brachytherapy-all focusing on disease control and the impact on morbidity. Also discussed are refinements in the risk stratification of men with prostate cancer and how these are better for matching patients to appropriate treatment, particularly around combined androgen-deprivation therapy. Many of these advances have cost and treatment burden implications, which have significant repercussions given the prevalence of prostate cancer. The discussion includes approaches to improve value and future directions for research.
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Affiliation(s)
- Neil E Martin
- Assistant Professor, Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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94
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Kim YJ, Cho KH, Pyo HR, Lee KH, Moon SH, Kim TH, Shin KH, Kim JY, Kim YK, Lee SB. Radical prostatectomy versus external beam radiotherapy for localized prostate cancer: Comparison of treatment outcomes. Strahlenther Onkol 2014; 191:321-9. [PMID: 25339310 DOI: 10.1007/s00066-014-0765-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We retrospectively compared the treatment outcomes of localized prostate cancer between radical prostatectomy (RP) and external beam radiotherapy (EBRT). MATERIALS AND METHODS We retrospectively analyzed 738 patients with localized prostate cancer who underwent either RP (n = 549) or EBRT (n = 189) with curative intent at our institution between March 2001 and December 2011. Biochemical failure was defined as a prostate-specific antigen (PSA) level of ≥ 0.2 ng/ml in the RP group and the nadir of + ≥ 2 ng/ml in the EBRT group. RESULTS The median (range) follow-up duration was 48.8 months (0.7-133.2 months) and 48.7 months (1.0-134.8 months) and the median age was 66 years (45-89 years) and 71 years (51-84 years; p < 0.001) in the RP and EBRT groups, respectively. Overall, 21, 42, and 36 % of patients in the RP group, and 15, 27, and 58 % of patients in the EBRT group were classified as low, intermediate, and high risk, respectively (p < 0.001). Androgen-deprivation therapy was more common in the EBRT group (59 vs. 27 %, respectively; p < 0.001). The 8-year biochemical failure-free survival rates were 44 and 72 % (p < 0.001) and the disease-specific survival rates were 98 % and 97 % (p = 0.543) in the RP and EBRT groups, respectively. CONCLUSIONS Although the EBRT group included more high-risk patients than did the RP group, the outcomes of EBRT were not inferior to those of RP. Our data suggest that EBRT is a viable alternative to RP for treating localized prostate cancer.
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Affiliation(s)
- Yeon-Joo Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
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95
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Elder K, Rice S, Dean C, Piper C. Addressing the differences by race in analgesia use among pediatric patients attending emergency departments. J Pediatr 2014; 165:434-6. [PMID: 25152149 DOI: 10.1016/j.jpeds.2014.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/17/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Keith Elder
- Department of Health Management and Policy, College for Public Health and Social Justice, St Louis University, St Louis, Missouri.
| | - Shahida Rice
- Department of Health Management and Policy, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Caress Dean
- Department of Health Management and Policy, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
| | - Crystal Piper
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina Charlotte, Charlotte, North Carolina
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96
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Jones AL, Chinegwundoh F. Update on prostate cancer in black men within the UK. Ecancermedicalscience 2014; 8:455. [PMID: 25228911 PMCID: PMC4154945 DOI: 10.3332/ecancer.2014.455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Indexed: 11/06/2022] Open
Abstract
There is a wealth of evidence which can be traced back to the African transatlantic slave trade indicating that black men have a higher risk of prostate cancer compared to other ethnic groups. Migration to Westernised countries may have had little effect on the incidence of prostate cancer in this ethnic group; however, current evidence indicates that there are several complex factors that may contribute to this risk. Studies in the UK quote that black men are at 2-3 times the risk of prostate cancer in comparison to their Caucasian counterparts, with a 30% higher mortality rate. Caution should be taken prior to the interpretation of these results due to a paucity of research in this area, limited accurate ethnicity data, and lack of age-specific standardisation for comparison. Cultural attitudes towards prostate cancer and health care in general may have a significant impact on these figures, combined with other clinico-pathological associations. This update summarises new contributory research on this subject, highlighting the need to increase awareness and understanding of prostate cancer amongst high-risk communities and to support further robust research in this area by nominating a lead in cancer and ethnicity studies within the National Health Service.
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Affiliation(s)
- Abeyna Lc Jones
- Department of Urology, Barts NHS Health Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK
| | - Frank Chinegwundoh
- Department of Urology, Barts NHS Health Trust, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK
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97
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Sasahara YI, Narimatsu H, Suzuki S, Fukui T, Sato H, Shirahata N, Yoshioka T. Personalization of chemotherapy for metastatic pancreatic cancer. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2014; 7:59-61. [PMID: 25093005 PMCID: PMC4116360 DOI: 10.4137/ccrep.s14478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
Abstract
Erlotinib is an approved drug for the treatment of advanced pancreatic cancer; however, its survival benefit is small and its cost is high, and the decision to use the drug may often be personalized according to the patient’s background. A 72-year-old Asian man in good general condition chose gemcitabine monotherapy over combination therapy with gemcitabine plus erlotinib because the survival benefit of the latter was small. The cost of the drug did not appear to affect this decision. This report details the process of decision making with respect to whether a patient receives targeted therapy, and suggests that the use of molecular-targeted drugs must be personalized from many perspectives, including the patient’s social situation.
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Affiliation(s)
| | - Hiroto Narimatsu
- Department of Public Health, Yamagata University Graduate School of Medicine, Japan
| | - Syuhei Suzuki
- Department of Clinical Oncology, Yamagata University, Japan
| | - Tadahisa Fukui
- Department of Clinical Oncology, Yamagata University, Japan
| | - Hideyuki Sato
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Japan
| | - Nakao Shirahata
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Japan
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98
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Grover S, Metz JM, Vachani C, Hampshire MK, DiLullo GA, Hill-Kayser C. Patient-reported outcomes after prostate cancer treatment. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814523269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Our aim was to understand patient-reported toxicities resulting from treatment of prostate cancer using various different modalities that have similar oncological endpoints. Methods and materials: An Internet-based survivorship care plan tool was used to collect patient-reported toxicity data for men who had undergone prostate cancer treatment. Results: A total of 127 users of the survivorship care plan tool reported to have been treated for prostate cancer. The median age of the patients at diagnosis in this group was 60 years (range = 25–74 years) and median time since diagnosis was 4 years (range 1–15 years); 61 (48%) received radiation as primary treatment, 44 (35%) received surgery as primary treatment and 22 (17%) received both surgery and radiation (adjuvant or salvage). Hormonal treatment was given to 50 (39%) patients. Some 15% (7/48) in the radiation group versus 50% (21/42) in the surgery group ( p < 0.001) developed urinary incontinence; 61% (33/54) in the radiation group and 86% (37/43) in the surgery group ( p = 0.02) reported having erectile dysfunction since treatment. Most users (84%) had not been offered a survivorship care plan previously. Conclusion: Men with prostate cancer experience significant urinary and sexual sequelae from treatment regardless of the modality used. Patients treated with surgery reported more urinary and sexual side effects than those treated with radiation. The majority of these men are not offered a survivorship care plan to deal with these long-term effects. Survivorship planning tools to assess such side effects and design long-term individualized plans are essential for all prostate cancer patients.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn Vachani
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Margaret K Hampshire
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gloria A DiLullo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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99
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Hoffman RM, Penson DF, Zietman AL, Barry MJ. Comparative effectiveness research in localized prostate cancer treatment. J Comp Eff Res 2014; 2:583-93. [PMID: 24236797 DOI: 10.2217/cer.13.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Prostate-specific antigen testing has dramatically increased the incidence of localized prostate cancer. Most men with localized cancer attempt curative therapy, usually with surgery or radiation. However, there is uncertainty about whether and how to best treat these cancers. No published controlled trials have directly compared surgery against radiation or either treatment against active surveillance. Given the indolent nature of prostate cancer and the substantial risks of treatment-related harms, the effects of cancer and treatment on quality of life are important patient-centered outcomes. Comparative effectiveness research, using observational cohorts, claims data and simulation models, enables comparisons of treatments that have not been studied in controlled trials and captures real-world outcomes data to better support informed decision-making.
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Affiliation(s)
- Richard M Hoffman
- Department of Medicine, University of New Mexico, Albuquerque, NM, USA.
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100
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Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol 2014; 11:317-23. [PMID: 24818853 PMCID: PMC4191828 DOI: 10.1038/nrurol.2014.91] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prostate cancer is considered a disease of older men (aged >65 years), but today over 10% of new diagnoses in the USA occur in young men aged ≤55 years. Early-onset prostate cancer, that is prostate cancer diagnosed at age ≤55 years, differs from prostate cancer diagnosed at an older age in several ways. Firstly, among men with high-grade and advanced-stage prostate cancer, those diagnosed at a young age have a higher cause-specific mortality than men diagnosed at an older age, except those over age 80 years. This finding suggests that important biological differences exist between early-onset prostate cancer and late-onset disease. Secondly, early-onset prostate cancer has a strong genetic component, which indicates that young men with prostate cancer could benefit from evaluation of genetic risk. Furthermore, although the majority of men with early-onset prostate cancer are diagnosed with low-risk disease, the extended life expectancy of these patients exposes them to long-term effects of treatment-related morbidities and to long-term risk of disease progression leading to death from prostate cancer. For these reasons, patients with early-onset prostate cancer pose unique challenges, as well as opportunities, for both research and clinical communities. Current data suggest that early-onset prostate cancer is a distinct phenotype-from both an aetiological and clinical perspective-that deserves further attention.
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Affiliation(s)
- Claudia A. Salinas
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alex Tsodikov
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Miriam Ishak-Howard
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kathleen A. Cooney
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
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