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Cowan BA, Olivier K, Tombal B, Wefel JS. Treatment-Related Cognitive Impairment in Patients with Prostate Cancer: Patients' Real-World Insights for Optimizing Outcomes. Adv Ther 2024; 41:476-491. [PMID: 37979089 PMCID: PMC10838823 DOI: 10.1007/s12325-023-02721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
Cognitive impairment (CI) is an issue that needs to be at the forefront of unmet healthcare needs in patients with prostate cancer (PCa) as it can negatively impact quality of life during long-term care. CI in patients with prostate cancer is thought to be influenced by treatment, androgen deprivation therapy (ADT), and novel androgen receptor (AR) pathway inhibitors in particular; however, current understanding is limited on how treatment affects cognition. Additionally, the experience of patients with CI who are receiving PCa treatment is not well understood or represented in clinical literature, which is a barrier to optimal patient outcomes in managing prostate cancer treatment-related cognitive impairment (PCa-TRCI). To help understand the patient journey and elucidate management gaps in PCa-TRCI, an international roundtable of healthcare provider and patient panelists was convened. The panelists focused on four key topic areas: (1) the patient experience when afflicted with, or at risk of, PCa-TRCI, (2) the physical, emotional, and social impact of CI on patients' quality of life (QoL), (3) the challenges that patients with PCa-TRCI face, and their impact on clinical decision-making, and (4) ways in which managing PCa-TRCI should evolve to improve patient outcomes. The purpose of the roundtable was to include patients in a direct discussion with healthcare providers (HCPs) regarding the patient journey and highlight real-world evidence of areas where patient outcomes could be improved in the absence of clinical evidence. The resulting discussion highlighted important healthcare gaps for patients with, and at risk of, PCa-TRCI and offered potential solutions as a roadmap to effective medicine.
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Affiliation(s)
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Bertrand Tombal
- Division of Urology at the Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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2
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Schmitz RSJM, Engelhardt EG, Gerritsma MA, Sondermeijer CMT, Verschuur E, Houtzager J, Griffioen R, Retèl V, Bijker N, Mann RM, van Duijnhoven F, Wesseling J, Bleiker EMA. Active surveillance versus treatment in low-risk DCIS: Women's preferences in the LORD-trial. Eur J Cancer 2023; 192:113276. [PMID: 37657228 PMCID: PMC10632767 DOI: 10.1016/j.ejca.2023.113276] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) can progress to invasive breast cancer (IBC), but most DCIS lesions remain indolent. However, guidelines recommend surgery, often supplemented by radiotherapy. This implies overtreatment of indolent DCIS. The non-randomised patient preference LORD-trial tests whether active surveillance (AS) for low-risk DCIS is safe, by giving women with low-risk DCIS a choice between AS and conventional treatment (CT). Here, we aim to describe how participants are distributed among both trial arms, identify their motives for their preference, and assess factors associated with their choice. METHODS Data were extracted from baseline questionnaires. Descriptive statistics were used to assess the distribution and characteristics of participants; thematic analyses to extract self-reported reasons for the choice of trial arm, and multivariable logistic regression analyses to investigate associations between patient characteristics and chosen trial arm. RESULTS Of 377 women included, 76% chose AS and 24% CT. Most frequently cited reasons for AS were "treatment is not (yet) necessary" (59%) and trust in the AS-plan (39%). Reasons for CT were cancer worry (51%) and perceived certainty (29%). Women opting for AS more often had lower educational levels (OR 0.45; 95% confidence interval [CI], 0.22-0.93) and more often reported experiencing shared decision making (OR 2.71; 95% CI, 1.37-5.37) than women choosing CT. CONCLUSION The LORD-trial is the first to offer women with low-risk DCIS a choice between CT and AS. Most women opted for AS and reported high levels of trust in the safety of AS. Their preferences highlight the necessity to establish the safety of AS for low-risk DCIS.
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Affiliation(s)
- Renée S J M Schmitz
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen G Engelhardt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda A Gerritsma
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Ellen Verschuur
- Dutch Breast Cancer Society ('Borstkanker Vereniging Nederland'), Utrecht, the Netherlands
| | - Julia Houtzager
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rosalie Griffioen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Valesca Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ritse M Mann
- Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frederieke van Duijnhoven
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Family Cancer Clinic, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands.
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3
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Agochukwu-Mmonu N, Qin Y, Kaufman S, Oerline M, Vince R, Makarov D, Caram MV, Chapman C, Ravenell J, Hollenbeck BK, Skolarus TA. Understanding the Role of Urology Practice Organization and Racial Composition in Prostate Cancer Treatment Disparities. JCO Oncol Pract 2023; 19:e763-e772. [PMID: 36657098 PMCID: PMC10414720 DOI: 10.1200/op.22.00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/13/2022] [Accepted: 11/07/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Black men have a higher risk of prostate cancer diagnosis and mortality but are less likely to receive definitive treatment. The impact of structural aspects on treatment is unknown but may lead to actionable insights to mitigate disparities. We sought to examine the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. METHODS Using a 20% sample of national Medicare data, we identified beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. We linked urologists to their practices with tax identification numbers. We then linked patients to practices on the basis of their primary urologist. We grouped practices into quartiles on the basis of their proportion of Black patients. We used multilevel mixed-effects models to identify treatment associations. RESULTS We identified 54,443 patients with incident prostate cancer associated with 4,194 practices. Most patients were White (87%), and 9% were Black. We found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years; P < .01). Black patients had lower odds of definitive therapy (adjusted odds ratio, 0.87; 95% CI, 0.81 to 0.93) and underwent less treatment than White patients in every practice context. Black patients in practices with higher proportions of Black patients had higher treatment rates than Black patients in practices with lower proportions. Black patients had lower predicted probability of treatment (66%) than White patients (69%; P < .05). CONCLUSION Despite Medicare coverage, we found less definitive treatment among Black beneficiaries consistent with ongoing prostate cancer treatment disparities. Our findings are reflective of the adverse effects of practice segregation and structural racism, highlighting the need for multilevel interventions.
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Affiliation(s)
- Nnenaya Agochukwu-Mmonu
- Department of Urology, New York University Medical Center, New York, NY
- Department of Population Health, New York University Medical Center, New York, NY
| | - Yongmei Qin
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Samuel Kaufman
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mary Oerline
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Danil Makarov
- Department of Urology, New York University Medical Center, New York, NY
- Department of Population Health, New York University Medical Center, New York, NY
| | - Megan V. Caram
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI
- Department of Medicine, New York University Medical Center, New York, NY
| | - Christina Chapman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Joseph Ravenell
- Department of Population Health, New York University Medical Center, New York, NY
- Department of Medicine, New York University Medical Center, New York, NY
| | - Brent K. Hollenbeck
- Department of Urology, University of Michigan, Ann Arbor, MI
- Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI
| | - Ted A. Skolarus
- Department of Urology, University of Michigan, Ann Arbor, MI
- Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Mellqvist UH, Steinmetz HT, Perrot A, Aerts E, Williams P, Vallejo A, Morgan K, Plate A, Rodríguez-Leboeuf AM, Desgraz R, Franck EH, De Costa L, Brescianini A, Ludwig H. Patient Confidence and Information Preferences during the Treatment Decision-making Process: Results from a Large Multiple Myeloma Patient Survey Across 12 Countries in Europe and Israel. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023; 23:e240-e251.e12. [PMID: 36967243 DOI: 10.1016/j.clml.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/31/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The relapsing nature of multiple myeloma (MM) means that patients typically receive different and multiple lines of therapy, requiring many treatment decisions over the disease course. The aim of this study was to explore patient confidence and information preferences during the treatment decision-making process. PATIENTS AND METHODS A multinational, cross-sectional survey enrolled patients with MM. It was co-developed and distributed by Myeloma Patients Europe across 12 countries in Europe and Israel from May 2019 to March 2020. Eligibility criteria included a self-reported diagnosis of MM and being able to recall the decision-making process at the start of their latest treatment line. RESULTS A total of 1559 patients were included, with complete responses received from 1081 (69%) patients. The median age range was 54 to 64 years; there was an equal gender split and 57% had their latest treatment decision made within the past year. Overall, 54% of patients felt "very confident" in the latest treatment decision. Patients deemed the most important information to be safety/tolerability and treatment effectiveness, but the latter was among the least frequently received. Most patients reported that their primary physician treating MM was their main source for all types of information (range, 62%-94%), with 87% of patients reporting a "very good" or "good" relationship with them. CONCLUSION Over half of patients felt very confident in their latest treatment decision; however, patients reported not routinely receiving important treatment effectiveness information. Addressing the discrepancies between information that patients receive and consider important may enhance confidence in decision-making.
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Hochstenbach LM, Determann D, Fijten RR, Bloemen-van Gurp EJ, Verwey R. Taking shared decision making for prostate cancer to the next level: Requirements for a Dutch treatment decision aid with personalized risks on side effects. Internet Interv 2023; 31:100606. [PMID: 36844795 PMCID: PMC9945792 DOI: 10.1016/j.invent.2023.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 12/16/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Different curative treatment modalities need to be considered in case of localized prostate cancer, all comparable in terms of survival and recurrence though different in side effects. To better inform patients and support shared decision making, the development of a web-based patient decision aid including personalized risk information was proposed. This paper reports on requirements in terms of content of information, visualization of risk profiles, and use in practice. METHODS Based on a Dutch 10-step guide about the setup of a decision aid next to a practice guideline, an iterative and co-creative design process was followed. In collaboration with various groups of experts (health professionals, usability and linguistic experts, patients and the general public), research and development activities were continuously alternated. RESULTS Content requirements focused on presenting information only about conventional treatments and main side effects; based on risk group; and including clear explanations about personalized risks. Visual requirements involved presenting general and personalized risks separately; through bar charts or icon arrays; and along with numbers or words, and legends. Organizational requirements included integration into local clinical pathways; agreement about information input and output; and focus on patients' numeracy and graph literacy skills. CONCLUSIONS The iterative and co-creative development process was challenging, though extremely valuable. The translation of requirements resulted in a decision aid about four conventional treatment options, including general or personalized risks for erection, urinary and intestinal problems that are communicated with icon arrays and numbers. Future implementation and validation studies need to inform about use and value in practice.
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Affiliation(s)
- Laura M.J. Hochstenbach
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands,Corresponding author at: Maastricht University, Department of Health Services Research, P.O. Box 616, 6200 MD, the Netherlands.
| | | | - Rianne R.R. Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Esther J. Bloemen-van Gurp
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands,Expertise Center Empowering Healthy Behavior, Fontys University of Applied Sciences, P.O. Box 347, 5600 AH Eindhoven, the Netherlands
| | - Renée Verwey
- Center of Expertise for Innovative Care and Technology (EIZT), School of Nursing, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, the Netherlands
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6
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Husted M, Gray D, Golding SE, Hindley R. Reaching a Tipping Point: A Qualitative Exploration of Quality of Life and Treatment Decision-Making in People Living With Benign Prostatic Hyperplasia. QUALITATIVE HEALTH RESEARCH 2022; 32:1979-1992. [PMID: 36154347 PMCID: PMC9629511 DOI: 10.1177/10497323221129262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Benign prostatic hyperplasia (BPH) is a common condition amongst older men and is associated with lower urinary tract symptoms and erectile dysfunction; these symptoms can be burdensome and negatively affect quality of life. Various surgical and pharmaceutical treatment options exist but there is a paucity of qualitative research exploring men's decision-making when seeking BPH treatment. This study qualitatively explored men's experience of living with BPH and seeking treatment for BPH. Twenty men (aged 52-75) were recruited from outpatient urology clinics at a hospital trust in Southern England. Data were collected using semi-structured interviews (via video or telephone call) and were audio-recorded; transcripts were analysed using thematic analysis. Four themes were generated: 'Impacts are about more than just physical symptoms', 'The path towards treatment', 'The process of information gathering' and 'Navigating hopes, fears and uncertainty'. Results indicate most men appear to seek treatment for BPH following a gradual, and sometimes lengthy, period of deterioration in symptoms; for some men, however, treatment seeking follows an acute episode of sudden or severe symptoms. The decision to proceed with surgical or minimally invasive treatment options appears to be dependent on men reaching a tipping point; they no longer perceive their symptoms as tolerable and feel their ability to cope with symptoms is reduced. Men each bring their own set of concerns and preferences about side effects and risk-benefit profiles of different treatments. Clinicians need to be sensitive to these individual differences and incorporate them into shared decision-making for choosing between treatment options for BPH.
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Affiliation(s)
- Margaret Husted
- Department of Psychology, University of Winchester, Winchester, UK
| | - Debra Gray
- Department of Psychology, University of Winchester, Winchester, UK
| | - Sarah E. Golding
- Department of Psychology, University of Winchester, Winchester, UK
| | - Richard Hindley
- Department of Psychology, University of Winchester, Winchester, UK
- Urology Department, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
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7
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Brown A, Yim J, Jones S, Tan A, Callander E, Watt K, De Abreu Lourenco R, Pain T. Men's perceptions and preferences regarding prostate cancer radiation therapy: A systematic scoping review. Clin Transl Radiat Oncol 2022; 38:28-42. [PMID: 36345391 PMCID: PMC9636414 DOI: 10.1016/j.ctro.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the literature on men's preferences and perceptions regarding prostate cancer radiation therapy. METHODS A scoping review was undertaken as per JBI guidelines. Searches were conducted in PubMed, CINAHL, Scopus and Science Direct with search terms including "prostate cancer," "radiotherapy," "radiation therapy," "radiation oncology," "patient preferences," "patient perceptions" and "patient experience." The resultant studies were mapped and grouped according to the emergent themes and pathway stages. RESULTS A total of 779 titles and abstracts were screened by two independent reviewers. Fifty-two full-text studies were reviewed, with 27 eligible for inclusion. There were 4 pre-treatment, 13 during treatment and 10 post-treatment studies covering broad themes of information needs (n = 3), preferences and decisions (n = 6), general experiences (n = 8), side effects (n = 6), and support (n = 4). There were a mix of methodologies, including 11 qualitative, 14 quantitative (including four preference studies), one mixed methods and one narrative review. CONCLUSION There were only four preference studies, with the remaining 23 reporting on perceptions. Overall, there is a paucity of literature regarding patient preferences and perceptions of prostate cancer radiation therapy, particularly when considering how many clinical and technical studies are published in the area. This highlights opportunities for future research.
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Affiliation(s)
- Amy Brown
- Townsville University Hospital, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia,Corresponding author at: Townsville University Hospital, PO Box 670, Queensland 4815, Australia.
| | - Jackie Yim
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Scott Jones
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Alex Tan
- James Cook University, Townsville, Queensland, Australia,Radiation Oncology, Genesis Cancer Care, Nambour, Queensland, Australia
| | | | - Kerrianne Watt
- James Cook University, Townsville, Queensland, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tilley Pain
- Townsville University Hospital, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia
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8
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Mitchell JM, Gresenz CR. The Influence of Practice Structure on Urologists' Treatment of Men With Low-Risk Prostate Cancer. Med Care 2022; 60:665-672. [PMID: 35880758 PMCID: PMC9378464 DOI: 10.1097/mlr.0000000000001746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vertical and horizontal integration among health care providers has transformed the practice arrangements under which many physicians work. OBJECTIVE To examine the influence of type of practice structure, and by implication the financial incentives associated with each structure, on treatment received among men newly diagnosed with low-risk prostate cancer. RESEARCH DESIGN We compiled a unique database from cancer registry records from 4 large states, Medicare enrollment and claims for the years 2005-2014 and SK & A physician surveys corroborated by extensive internet searches. We estimated a multinomial logit model to examine the influence of urologist practice structure on type of initial treatment received. RESULTS The probability of being monitored with active surveillance was 7.4% and 4.2% points higher for men treated by health system and nonhealth system employed urologists ( P <0.01), respectively, in comparison to men treated by single specialty urology practices. Among multispecialty practices, the rate of active surveillance use was 3% points higher compared with single specialty urology practices( P <0.01). Use of intensity modulated radiation therapy among urologists with ownership in intensity modulated radiation therapy was 17.4% points higher compared with urologists working in small single specialty practices. CONCLUSIONS Physician practice structure attributes are significantly associated with type of treatment received but few studies control for such factors. Our findings-coupled with the observation that urologist practice structure shifted substantially over this time period due to mergers of small urology groups-provide one explanation for the limited uptake of active surveillance among men with low-risk disease in the US.
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Affiliation(s)
- Jean M. Mitchell
- McCourt School of Public Policy, Georgetown University, Old North 314, 37 & “O” Streets, NW, Washington DC 20007
| | - Carole Roan Gresenz
- Department of Health Systems Administration, Georgetown University, 3800 Reservoir Road, NW, Washington DC 20007
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9
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Abstract
Genetic testing for prostate cancer is rapidly growing and is increasingly being driven by precision medicine. Rates of germline pathogenic variants have been reported in up to 15% of men with prostate cancer, particularly in metastatic disease, and results of genetic testing could uncover options for precision therapy along with a spectrum of hereditary cancer-predisposition syndromes with unique clinical features that have complex management options. Thus, the pre-test discussion, whether delivered by genetic counsellors or by health-care professionals in hybrid models, involves information on hereditary cancer risk, extent of gene testing, purpose of testing, medical history and family history, potential types of results, additional cancer risks that might be uncovered, genetically based management and effect on families. Understanding precision medicine, personalized cancer risk management and syndrome-related cancer risk management is important in order to develop collaborative strategies with genetic counselling for optimal care of patients and their families. In this Review, Russo and Giri describe and discuss germline testing criteria, genetic testing strategies, genetically informed screening, precision management, delivery of genetic counselling or alternative genetic services and special considerations for men with prostate cancer. Germline (hereditary) genetic testing is rising in importance for treatment, screening and risk assessment of prostate cancer. Multiple hereditary cancer syndromes might be associated with prostate cancer, might confer risk of other cancerous and non-cancerous conditions, and can have hereditary cancer implications for family members. The rates of these syndromes can vary based upon the attributed genetic mutations. Multiple aspects of germline testing should be discussed in the pre-test setting for men to make an informed decision, including the purpose of genetic testing, the benefits and risks of testing, hereditary cancer risk, identification of additional cancer risks, familial implications and the state of genetic discrimination protections. Genetic evaluation can be conducted by genetic counsellors or a hybrid model can be employed, in which health-care providers deliver pre-test informed consent for testing, order testing and then determine referral to genetic counselling for appropriate patients. Precision medicine is increasingly driving decisions for germline testing. Poly(ADP-ribose) polymerase (PARP) inhibitors, immune checkpoint inhibitors and various other agents now in clinical trials have clinical activity in patients with certain hereditary cancer gene mutations, such as in DNA repair genes. Patients’ experiences with germline testing can be variable; taking the patient’s current experience into account, considering referral to genetic counselling when needed and offering germline testing for eligible men at repeated intervals if initially declined are important.
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Affiliation(s)
- Jessica Russo
- Cancer Risk Assessment and Clinical Cancer Genetics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Veda N Giri
- Cancer Risk Assessment and Clinical Cancer Genetics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. .,Departments of Medical Oncology, Cancer Biology, and Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
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10
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Jalil NB, Lee PY, Nor Afiah MZ, Abdullah KL, Azizi FNSM, Rassip NNSA, Ong TA, Ng CJ, Lee YK, Cheong AT, Razack AH, Saad M, Alip A, Malek R, Sundram M, Omar S, Sathiyananthan JR, Kumar P. Effectiveness of Decision Aid in Men with Localized Prostate Cancer: a Multicenter Randomized Controlled Trial at Tertiary Referral Hospitals in an Asia Pacific Country. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:169-178. [PMID: 32564251 DOI: 10.1007/s13187-020-01801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients' knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients' knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.
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Affiliation(s)
- N B Jalil
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - P Y Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
| | - M Z Nor Afiah
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - K L Abdullah
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - F N S Mohd Azizi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - N N S Abdul Rassip
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - T A Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - C J Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Y K Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A T Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - A H Razack
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M Saad
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Malek
- Unit of Urology, Selayang Hospital, Selangor, Malaysia
| | - M Sundram
- Unit of Urology, General Hospital of Kuala Lumpur, Kuala Lumpur, Malaysia
| | - S Omar
- Unit of Urology, Johor Bahru Hospital, Johor Bahru, Johor, Malaysia
| | | | - P Kumar
- Department of Surgery, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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11
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Irusen H, Burger H, Fernandez PW, Van der Merwe A, Esterhuizen T, du Plessis DE, Seedat S. Decisional Conflict is Associated with Treatment Modality and not Disease Knowledge in South African Men with Prostate Cancer: Baseline Results from a Longitudinal Prospective Observational Study. Cancer Control 2022; 29:10732748221082791. [PMID: 35442835 PMCID: PMC9024077 DOI: 10.1177/10732748221082791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Decisional conflict (DC) is a psychological construct that an individual experiences in making a decision that involves risk, loss, regret, or challenges to one's values. This study assessed DC in a cohort of South African men undergoing curative treatment for localised prostate cancer (LPC). The objectives were to (1) to examine the association between DC and prostate cancer knowledge (PCK), demographics, state anxiety, prostate cancer anxiety and time to treatment and (2) to compare levels of DC between treatment groups [prostatectomy (RP) and external beam radiation (RT)]. METHOD Data, comprising the Decisional Conflict Scale (DCS), Prostate Cancer Knowledge (PCK), State-Trait Anxiety Inventory (STAI-S), the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) and demographic data from 83 participants of a larger prospective longitudinal observational study examining depression, anxiety and health related quality of life (DAHCaP) were analysed. RESULTS The mean age of participants was 63 years (RP 61yrs and RT 65yrs; p< 0.001). Most were of mixed ancestry (72.3%). The total DCS scores between the treatment groups (RP 25.00 and RT 18.75; p = 0.037) and two DCS sub-scores-uncertainty (p = 0.033), and support (p = 0.048), were significantly higher in the RP group. A statistically significant negative correlation was observed between state anxiety and time between diagnosis and treatment in the RP group (Spearman's rho = -0.368; p = 0.030). There was no correlation between the DCS score and PCK within each treatment group (Spearman's rho RP = -0.249 and RT = -0.001). CONCLUSION Decisional conflict was higher in men undergoing RP. Men were more anxious in the RP group regarding the time treatment was received from diagnosis. No correlation was observed between DC and PCK. Pre-surgical management of DC should include shared decision making (SDM) which is cognisant of patients' values facilitated by a customised decision aid.
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Affiliation(s)
- Hayley Irusen
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Henriette Burger
- Division of Radiation Oncology, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital and Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Pedro W Fernandez
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Andre Van der Merwe
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Tonya Esterhuizen
- Biostatistics Unit, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Danelo E du Plessis
- Department of Urology, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, 26697Stellenbosch University, Cape Town, South Africa
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12
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Abashidze N, Stecher C, Rosenkrantz AB, Duszak R, Hughes DR. Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test. JAMA Netw Open 2021; 4:e2132388. [PMID: 34748010 PMCID: PMC8576586 DOI: 10.1001/jamanetworkopen.2021.32388] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities. Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. OBJECTIVE To assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. MAIN OUTCOMES AND MEASURES Multivariable logistic regression was used to examine associations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL. Analyses were stratified by race, ethnicity, and age. RESULTS Of 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI. CONCLUSIONS AND RELEVANCE Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decision-making biases and other potential sources of disparities in prostate cancer diagnosis and management.
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Affiliation(s)
- Nino Abashidze
- Haub School of Environment and Natural Resources, University of Wyoming, Laramie
| | - Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Danny R. Hughes
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
- School of Economics, Georgia Institute of Technology, Atlanta
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13
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Chhatre S, Wittink MN, Gallo JJ, Jayadevappa R. Sources of Information for Learning and Decision-Making in Men With Localized Prostate Cancer. Am J Mens Health 2021; 14:1557988320945461. [PMID: 33000703 PMCID: PMC7533942 DOI: 10.1177/1557988320945461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Information seeking is essential for effective patient-centered decision-making. However, prostate cancer patients report a gap between information needed and information received. The importance of different information sources for treatment decision remains unclear. Thus, using the Comprehensive Model of Health Information (CMIS) framework, we assessed the antecedent factors, information carrier factors, and information-seeking activities in localized prostate cancer patients. Data were collected via semistructured one-on-one, interviews and structured survey. Men with localized prostate cancer were recruited from two urban health-care centers. Following the interview, participants completed a survey about sources that were helpful in learning about prostate cancer treatment and decision-making. The interviews were audio-recorded, transcribed, and subjected to a thematic analysis using NVivo 10. Fifty localized prostate cancer survivors completed the interviews and surveys. Important antecedent factors that were observed were age, marital status, uncertainty, anxiety, caregiver burden, and out-of-pocket expenses. We identified complexity, magnitude, and reliability as information carrier characteristics. Preferred sources for information were health providers, medical websites, and pamphlets from the doctor’s office. These sources were also perceived as most helpful for decision-making. Urologists, urological oncologists, and radiation/radiation oncologists were important sources of information and helpful in decision-making. Prostate cancer patients obtained information from multiple sources. Most prostate cancer patients make patient-centered choices by incorporating personal factors and medical information. By considering factors that influence patients’ treatment decisions, health-care providers can enhance the patient-centeredness of care. Multiple strategies and interventions are necessary for disseminating valid, reliable, and unbiased information to prostate cancer patients to facilitate informed decisions.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ravishankar Jayadevappa
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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14
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Hur S, Tzeng M, Cricco-Lizza E, Basourakos S, Yu M, Ancker J, Abramson E, Saigal C, Ross A, Hu J. Perceptions of partial gland ablation for prostate cancer among men on active surveillance: A qualitative study. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2021; 3:e000068. [PMID: 34458727 PMCID: PMC8388575 DOI: 10.1136/bmjsit-2020-000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES – Partial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS). DESIGN – 92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semi-structured telephone interviews on PGA. SETTING – Single tertiary care center located in New York City. PARTICIPANTS – 20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews. MAIN OUTCOME MEASURES – Emerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology. RESULTS – Four themes were derived from twenty interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while 9 men (45%) expressed interest at the current moment. CONCLUSIONS – Though an emerging treatment modality, patients were broadly accepting of PGA for PCa with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men's preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.
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Affiliation(s)
- Sonia Hur
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Michael Tzeng
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Eliza Cricco-Lizza
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Spyridon Basourakos
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Miko Yu
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Jessica Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
| | - Erika Abramson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Christopher Saigal
- Department of Urology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Ashley Ross
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jim Hu
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
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15
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Ellis SD, Hwang S, Morrow E, Kimminau KS, Goonan K, Petty L, Ellerbeck E, Thrasher JB. Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists. BMC Cancer 2021; 21:649. [PMID: 34058998 PMCID: PMC8165996 DOI: 10.1186/s12885-021-08386-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists' recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. METHODS We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention. RESULTS Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient's ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. CONCLUSIONS Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.
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Affiliation(s)
- Shellie D. Ellis
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS USA
| | - Soohyun Hwang
- Department of Health Policy and Management, School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7411 USA
| | - Emily Morrow
- Department of Sociology, University of Kansas, Kansas City, KS USA
| | - Kim S. Kimminau
- Department of Family Medicine, School of Medicine, University of Kansas, Kansas City, KS USA
| | - Kelly Goonan
- Independent Researcher/Consultant/Scientific Writer, Greensboro, NC USA
| | - Laurie Petty
- Department of Sociology, University of Kansas, Kansas City, KS USA
| | - Edward Ellerbeck
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS USA
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16
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McCormick BZ, Chery L, Chapin BF. Contemporary outcomes following robotic prostatectomy for locally advanced and metastatic prostate cancer. Transl Androl Urol 2021; 10:2178-2187. [PMID: 34159100 PMCID: PMC8185652 DOI: 10.21037/tau-20-1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
While radical prostatectomy (RP) plays a prominent role in the management of localized prostate cancer, its role in high risk or metastatic disease is less clear. Due to changes in prostate cancer screening patterns, particularly those made by the United States Preventive Services Task Force, data is suggesting increasing incidences of high risk and metastatic disease, underlying the importance of continued research in this area. While past approaches to management may have discouraged surgical intervention, more contemporary approaches have attempted to evaluate its effectiveness and utility. The purpose of this review is an updated discussion of the current literature regarding surgical approaches to high risk prostate cancer. The PubMed and Medline databases were queried for English language articles related to the surgical management of high-risk prostate adenocarcinoma. In this review, we examine the utility of surgery as a single or multimodal approach to management with patients with high risk, locally advanced, and metastatic prostate cancer. Outcomes measures are reviewed including data on survival and recurrence rates. Functional outcomes are an important consideration in prostate cancer management and while data is more limited, this review examines some of the key findings. Finally, a discussion regarding surgical complication rates and ongoing clinical trials is addressed. While surgery appears to be promising in this patient cohort, there remains significant heterogeneity in the data that ongoing trials may be able to address. At its current level of understanding, surgery should be considered as a potential tool in patient management, but may play a more prominent role in a multi-modality setting for optimal outcomes.
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Affiliation(s)
- Barrett Z McCormick
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisly Chery
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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17
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Paudel R, Ferrante S, Qi J, Dunn RL, Berry DL, Semerjian A, Brede CM, George AK, Lane BR, Ginsburg KB, Montie JE, Lane GI. Patient Preferences and Treatment Decisions for Prostate Cancer: Results From A Statewide Urological Quality Improvement Collaborative. Urology 2021; 155:55-61. [PMID: 33933504 DOI: 10.1016/j.urology.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine the relationship between influential factors and treatment decisions among men with newly diagnosed prostate cancer (PCa). METHODS We identified men in the Michigan Urological Surgery Improvement Collaborative registry diagnosed with localized PCa between 2018-2020 who completed Personal Patient Profile-Prostate. We analyzed the proportion of active surveillance (AS) between men who stated future bladder, bowel, and sexual problems (termed influential factors) had "a lot of influence" on their treatment decisions versus other responses. We also assessed the relationship between influential factors, confirmatory testing results and choice of AS. RESULTS A total of 509 men completed Personal Patient Profile-Prostate. Treatment decisions aligned with influential factors for 88% of men with favorable risk and 49% with unfavorable risk PCa. A higher proportion of men who identified bladder, bowel and sexual concerns as having "a lot of influence" on their treatment decision chose AS, compared with men with other influential factors, although not statistically significant (44% vs 35%, P = .11). Similar results were also found when men were stratified based on PCa risk groups (favorable risk: 78% vs 67%; unfavorable risk: 17% vs 9%, respectively). Despite a small sample size, a higher proportion of men with non-reassuring confirmatory testing selected AS if influential factors had "a lot of influence" compared to "no influence" on their treatment decisions. CONCLUSION Men's concerns for future bladder, bowel, and sexual function problems, as elicited by a decision aid, may help explain treatment selection that differs from traditional clinical recommendation.
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Affiliation(s)
- Roshan Paudel
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI.
| | | | - Ji Qi
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Rodney L Dunn
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| | - Alice Semerjian
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; IHA Urology, St. Joseph Mercy Health System, Ypsilanti, MI
| | | | - Arvin K George
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Kevin B Ginsburg
- Department of Urology, Wayne State University School of Medicine, Detroit, MI; Department of Surgical Oncology, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - James E Montie
- Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI; Department of Urology, University of Michigan, Ann Arbor, MI
| | - Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor, MI
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18
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Bleak TC, Calaf GM. Breast and prostate glands affected by environmental substances (Review). Oncol Rep 2021; 45:20. [PMID: 33649835 PMCID: PMC7879422 DOI: 10.3892/or.2021.7971] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022] Open
Abstract
Environmental endocrine disruptor chemicals are substances that can alter the homeostasis of the endocrine system in living organisms. They can be released from several products used in daily activities. Once in the organism, they can disrupt the endocrine function by mimicking or blocking naturally occurring hormones due to their similar chemical structure. This endocrine disruption is the most important cause of the well‑known hormone‑associate types of cancer. Additionally, it is decisive to determine the susceptibility of each organ to these compounds. Therefore, the present review aimed to summarize the effect of different environmental substances such as bisphenol A, dichlorodiphenyltrichloroethane and polychlorinated biphenyls in both the mammary and the prostate tissues. These organs were chosen due to their association with the hormonal system and their common features in carcinogenic mechanisms. Outcomes derived from the present review may provide evidence that should be considered in future debates regarding the effects of endocrine disruptors on carcinogenesis.
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Affiliation(s)
- Tammy C. Bleak
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica, Arica 1000000, Chile
| | - Gloria M. Calaf
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica, Arica 1000000, Chile
- Center for Radiological Research, Columbia University Medical Center, New York, NY 10032, USA
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19
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Bruce MA, Bowie JV, Barge H, Beech BM, LaVeist TA, Howard DL, Thorpe RJ. Religious Coping and Quality of Life Among Black and White Men With Prostate Cancer. Cancer Control 2021; 27:1073274820936288. [PMID: 32638611 PMCID: PMC7346696 DOI: 10.1177/1073274820936288] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Prostate cancer is a significant impediment in men’s lives as this condition often exacerbates stress and reduces quality of life. Faith can be a resource through which men cope with health crises; however, few studies examine how religion or spirituality can have implications for racial disparities in health outcomes among men. The purpose of this study is to assess the associations between religious coping and quality of life among black and white men with prostate cancer. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 624 black and white men with complete information on the primary outcome and predictor variables. The primary outcome for this study was overall quality of life as measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The main independent variable was religious coping measured by 2 subscales capturing positive and negative forms of coping. Black men in the study had lower overall quality of life scores (134.6 ± 19.6) than their white peers (139.8 ± 14.1). Black men in the sample also had higher average positive religious coping scores (12.9 ± 3.3) than white men (10.3 ± 4.5). Fully adjusted linear regression models of the total sample produced results indicating that positive religious coping was correlated with an increase in quality of life (β = .38, standard error [SE] = 0.18, P < .05). Negative religious coping was associated with a reduction in quality of life (β = −1.48, SE = 0.40, P < .001). Faith-oriented beliefs or perceptions can have implications for quality of life among men with prostate cancer. Sensitivity to the role of religion, spirituality, and faith should be seen by providers of health care as potential opportunities for improved outcomes in patients with prostate cancer and survivors.
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Affiliation(s)
- Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Janice V Bowie
- Hopkins Center for Health Disparities Solutions, Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Haley Barge
- Franklin and Marshall University, Lancaster, PA, USA.,Program for Research on Men's Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bettina M Beech
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, University of Houston, Houston, TX, USA
| | | | - Daniel L Howard
- Department of Psychological and Brain Sciences, Diversity Science Research Cluster, Texas A&M University, College Station, TX, USA
| | - Roland J Thorpe
- Program for Research on Faith, Justice, and Health, Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.,Hopkins Center for Health Disparities Solutions, Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Program for Research on Men's Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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20
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Pratsinis M, Halabi S, Güsewell S, Gillessen S, Omlin A. In-depth analysis of the 2019 Advanced Prostate Cancer Consensus Conference (APCCC) - The importance of representation of medical specialty and geographic regions. EUR UROL SUPPL 2021; 26:14-17. [PMID: 34308382 PMCID: PMC8297969 DOI: 10.1016/j.euros.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The rapid innovation of the treatment and diagnostic procedures in advanced prostate cancer has led to improved outcomes, though uncertainty remains regarding the best management approach in many clinical situations. The Advanced Prostate Cancer Consensus Conference (APCCC) 2019 addressed these areas of uncertainty with a multidisciplinary, international expert panel. A total of 57 experts voted on 123 carefully prepared questions. The primary analysis of the APCCC 2019 showed consensus (≥ 75% agreement on one answer) for 33 questions. Here we investigate whether agreement with the consensus answers differed according to medical discipline and region of practice. Overall there was no compelling evidence for group differences of agreement with the consensus answers, i.e. expert sub-groups differed no more than could be expected by chance due to differences between individual experts. All questions that achieved consensus, had at least 50% agreement of each expert sub-group. Furthermore, the set of consensus questions changed only moderately if one of the sub-groups was excluded from the panel. The identification of consensus questions and answers at APCCC 2019 appeared to be robust to the composition of the panel and well supported.
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Affiliation(s)
- Manolis Pratsinis
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Sabine Güsewell
- Biostatistics, Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland, Università della Svizzera Italiana, Lugano, Switzerland
| | - Aurelius Omlin
- Medical Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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21
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Schofield P, Gough K, Hyatt A, White A, Frydenberg M, Chambers S, Gordon LG, Gardiner R, Murphy DG, Cavedon L, Richards N, Murphy B, Quinn S, Juraskova I. Navigate: a study protocol for a randomised controlled trial of an online treatment decision aid for men with low-risk prostate cancer and their partners. Trials 2021; 22:49. [PMID: 33430950 PMCID: PMC7802237 DOI: 10.1186/s13063-020-04986-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is the disease management option of choice for low-risk prostate cancer. Despite this, men with low-risk prostate cancer (LRPC) find management decisions distressing and confusing. We developed Navigate, an online decision aid to help men and their partners make management decisions consistent with their values. The aims are to evaluate the impact of Navigate on uptake of AS; decision-making preparedness; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life and anxiety. In addition, the healthcare cost impact, cost-effectiveness and patterns of use of Navigate will be assessed. This paper describes the study protocol. METHODS Three hundred four men and their partners are randomly assigned one-to-one to Navigate or to the control arm. Randomisation is electronically generated and stratified by site. Navigate is an online decision aid that presents up-to-date, unbiased information on LRPC tailored to Australian men and their partners including each management option and potential side-effects, and an interactive values clarification exercise. Participants in the control arm will be directed to the website of Australia's peak national body for prostate cancer. Eligible patients will be men within 3 months of being diagnosed with LRPC, aged 18 years or older, and who are yet to make a treatment decision, who are deemed eligible for AS by their treating clinician and who have Internet access and sufficient English to participate. The primary outcome is self-reported uptake of AS as the first-line management option. Secondary outcomes include self-reported preparedness for decision-making; decisional conflict, regret and satisfaction; quality of illness communication; and prostate cancer-specific quality of life. Uptake of AS 1 month after consent will be determined through patient self-report. Men and their partners will complete study outcome measures before randomisation and 1, 3 and 6 months after study consent. DISCUSSION The Navigate online decision aid has the potential to increase the choice of AS in LRPC, avoiding or delaying unnecessary radical treatments and associated side effects. In addition, Navigate is likely to reduce patients' and partners' confusion and distress in management decision-making and increase their quality of life. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ACTRN12616001665426 . Registered on 2 December 2016. All items from the WHO Trial Registration Data set can be found in this manuscript.
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Affiliation(s)
- Penelope Schofield
- Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia. .,Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia. .,Swinburne University of Technology, John Street, Hawthorn, Australia.
| | - Karla Gough
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Amelia Hyatt
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Malvern, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Louisa G Gordon
- Population Health Department, Health Economics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Robert Gardiner
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Declan G Murphy
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lawrence Cavedon
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Natalie Richards
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Barbara Murphy
- Department of Psychology, The University of Melbourne, Parkville, Victoria, Australia.,Faculty of Health, Deakin University, Bundoora, Victoria, Australia
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ilona Juraskova
- School of Psychology, Faculty of Science, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, New South Wales, Australia
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22
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Oswald LB, Schumacher FA, Gonzalez BD, Moses KA, Penson DF, Morgans AK. What Do Men with Metastatic Prostate Cancer Consider When Making Treatment Decisions? A Mixed-methods Study. Patient Prefer Adherence 2020; 14:1949-1959. [PMID: 33116438 PMCID: PMC7569052 DOI: 10.2147/ppa.s271620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/05/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Metastatic prostate cancer (mPCa) patients often make complicated treatment decisions, yet decision aids to facilitate shared decision-making for mPCa are uncommon. To inform the development of patient-centered mPCa decision aids, we examined what mPCa survivors considered most important when making treatment decisions. METHODS Using an exploratory sequential approach, we conducted three focus groups with 14 advanced prostate cancer survivors (n=5, n=3, n=6 in each group) to identify considerations for making treatment decisions. Focus groups were audio-recorded and transcribed, and we identified qualitative themes. We then developed a quantitative survey to assess the importance of each theme and administered the survey to mPCa survivors (N=100). We used relative frequencies to determine the most strongly endorsed items and chi-squared and Fisher's exact tests to assess associations with participant characteristics. RESULTS Focus groups yielded 11 themes, and the resulting survey included 20 items. The most strongly endorsed mPCa treatment considerations were: relying on physician's treatment recommendations (79% strongly agree); wanting to feel well enough to spend quality time with loved ones (72% strongly agree); the importance of dying in a manner consistent with one's wishes (70% strongly agree); hoping to eliminate cancer completely (68% strongly agree); and optimizing treatment efficacy (65% strongly agree). Age, race, marital status, employment status, and self-reported health were related to how strongly men endorsed various considerations for mPCa treatment decision-making. CONCLUSION We identified multiple considerations that mPCa survivors appraised when making treatment decisions. These data may inform the development of patient-centered decision aids for mPCa.
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Affiliation(s)
- Laura B Oswald
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Frank A Schumacher
- Department of Medicine (Hematology and Oncology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian D Gonzalez
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Urology, VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
| | - Alicia K Morgans
- Department of Medicine (Hematology and Oncology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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23
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El-Haouly A, Dragomir A, El-Rami H, Liandier F, Lacasse A. Treatment decision-making in men with localized prostate cancer living in a remote area: A cross-sectional, observational study. Can Urol Assoc J 2020; 15:E160-E168. [PMID: 32807284 DOI: 10.5489/cuaj.6521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION For the management of localized prostate cancer, patient treatment choice is poorly documented among people living in remote areas, where access to certain treatments offered in large centers involves travelling several hundred kilometres. This study aimed to describe and identify the determinants of treatment decision-making in men with localized prostate cancer living in remote areas. METHODS In this cross-sectional study, patients with prostate cancer were recruited from Rouyn-Noranda's urology clinic (Quebec, Canada) between 2017 and 2019. RESULTS A total of 127 men (mean age 68.34±7.23 years) constituted the study sample. Radiotherapy, a treatment not available locally, was chosen most frequently (67.7%), followed by options available locally, such as surgery (22.8%) and active surveillance (9.4%). Most patients preferred to play an active role in this choice (53.5%) and agreed with the statement, "I chose that treatment because it gives the best chance for a cure" (86.6%). Multiple logistic regression analysis revealed that cancer stage (odds ratio [OR] 10.15; 95% confidence interval [CI] 3.18-32.40) was the only factor associated with radiotherapy choice (patients with lower stage cancer were more likely to choose radiotherapy). The socioeconomic status was not associated with treatment choice. CONCLUSIONS While radiotherapy was not available locally, it was the most frequently chosen treatment, even though the available literature suggests that no one treatment option is superior in terms of cancer control. The choice of radiotherapy is not associated with patient income, but rather the cancer stage. This result could be explained by the patients' desire to avoid surgery and its adverse effects.
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Affiliation(s)
- Abir El-Haouly
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Hares El-Rami
- Centre hospitalier de Rouyn-Noranda, Centre intégré de santé et de services sociaux (CISSS) de l'Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Frédéric Liandier
- Centre hospitalier de Rouyn-Noranda, Centre intégré de santé et de services sociaux (CISSS) de l'Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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24
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Kilpeläinen TP, Talala K, Taari K, Raitanen J, Kujala P, Pylväläinen J, Tammela TL, Auvinen A. Patients' education level and treatment modality for prostate cancer in the Finnish Randomized Study of Screening for Prostate Cancer. Eur J Cancer 2020; 130:204-210. [PMID: 32229417 DOI: 10.1016/j.ejca.2020.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/22/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In prostate cancer (PCa), lower education level is associated with less screening, more advanced stage at diagnosis and worse survival. The aim of this study was to estimate the association between education level and treatment modality and subsequently survival. METHODS The 9255 men diagnosed with PCa in the Finnish Randomized Study of Screening for Prostate Cancer were included. Cancer stage, comorbidity, education level and primary treatment modality were extracted from the patient records, the Finnish Cancer Registry, Statistics Finland and the National Institute of Health and Welfare, and these covariates were used in logistic regression (treatment selection) and Cox regression (survival analysis). RESULTS In high-risk cancers, men with tertiary education were more likely to be treated with radical prostatectomy (odds ratio [OR] = 1.76; 95% confidence interval [CI] = 1.27-2.44) than men with primary education. Men with secondary (OR = 0.57; 95% CI = 0.38-0.84) or tertiary (OR = 0.42; 95% CI = 0.29-0.60) education were managed less frequently with mere hormonal therapy. In locally advanced cases, tertiary education was associated with more curatively aimed therapies and less hormonal therapy (OR for radical prostatectomy = 2.34; 95% CI = 1.49-3.66; OR for radiotherapy = 1.42; 95% CI = 1.09-1.85; OR for hormonal therapy = 0.45; 95% CI = 0.33-0.60). The hazard ratio for PCa death was lower in men with secondary (0.81; 95% CI = 0.69-0.95) and tertiary (0.75; 95% CI = 0.65-0.87) education than in the patients with primary education. CONCLUSIONS When controlled for the cancer risk group, comorbidity and patient's age, low education level is independently associated with less curatively aimed treatment in men with high-risk or locally advanced PCa and subsequently worse prognosis.
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Affiliation(s)
- Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | | | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jani Raitanen
- UKK Institute for Health Promotion Research, Tampere, Finland; Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - Paula Kujala
- Department of Pathology, Fimlab Laboratories, Tampere, Finland
| | - Juho Pylväläinen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Teuvo Lj Tammela
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
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25
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Dosanjh A, Harvey P, Baldwin S, Mintz H, Evison F, Gallier S, Trudgill N, James ND, Sooriakumaran P, Patel P. High-intensity Focused Ultrasound for the Treatment of Prostate Cancer: A National Cohort Study Focusing on the Development of Stricture and Fistulae. Eur Urol Focus 2020; 7:340-346. [PMID: 31924529 DOI: 10.1016/j.euf.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/25/2019] [Accepted: 11/14/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) is a novel therapy for prostate cancer. Owing to a lack of long-term data, HIFU is recommended for use only in the context of research. OBJECTIVE To examine the trend for HIFU use nationally and rates of strictures and fistulae. DESIGN, SETTING, AND PARTICIPANTS Patients undergoing HIFU for prostate cancer between April 2007 and March 2018 were studied in an English national database (Hospital Episode Statistics). Data on complications were included for patients with a minimum of 1-yr follow-up. Analysis of complications was controlled for other interventions. OUTCOME MEASURES AND STATISTICAL ANALYSIS Descriptive analyses of HIFU rates and the incidence of strictures and fistulae were carried out. Cox and logistic regression models were built for urethral stricture incidence. RESULTS AND LIMITATIONS A total of 2320 HIFU treatments among 1990 patients were identified. The median age was 67yr (interquartile range 61-72). Some 1742 patients met the criteria for follow-up analysis. The highest-volume centre performed 1513 HIFU procedures, followed by 194 at the second highest. The number of HIFU procedures increased annually, rising from 196 to 283 per year. There were 208 patients (11.9%) who went on to have radiotherapy and 102 (5.9%) radical prostatectomy after HIFU. Following HIFU, stricture developed in 133/1290 patients (10.3%) and urinary fistula in 16/1240 (1.3%) before any further intervention. More recent years for HIFU were associated with a lower likelihood of stricture formation (2016/2017 vs 2007/2008: hazard ratio 0.30, 95% confidence interval 0.11-0.79; p=0.015). Limitations include the lack of staging information and unknown rates of HIFU outside of publicly funded health care. CONCLUSIONS HIFU is performed at a large number of low-volume centres and complication rates do not differ from those for established therapies. PATIENT SUMMARY This report highlights the trend for provision of high-intensity focused ultrasound treatment for prostate cancer in England. The results suggest that the rate of urethral structural complications may not be lower than that for established prostate cancer treatments.
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Affiliation(s)
- Amandeep Dosanjh
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Philip Harvey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Baldwin
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Harriet Mintz
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Felicity Evison
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nigel Trudgill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospital, London, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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26
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Tan WS, Trinh QD, Hayn MH, Marchese M, Lipsitz SR, Nabi J, Kilbridge KL, Vale JA, Khoubehi B, Kibel AS, Sun M, Chang SL, Sammon JD. Delayed nephrectomy has comparable long-term overall survival to immediate nephrectomy for cT1a renal cell carcinoma: A population-based analysis. Urol Oncol 2019; 38:74.e13-74.e20. [PMID: 31864937 DOI: 10.1016/j.urolonc.2019.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Early surgical resection remains the recommended treatment option for most small renal mass (≤4 cm). We examined the long-term overall survival (OS) of patients managed with delayed and immediate nephrectomy of cT1a renal cancer. PATIENT AND METHODS We utilized the National Cancer Database (2005-2010) to identify 14,677 patients (immediate nephrectomy: 14,050 patients vs. late nephrectomy: 627 patients) aged <70 years with Charlson Comorbidity Index 0 and cT1aN0M0 renal cell carcinoma. Immediate nephrectomy and late nephrectomy were defined as nephrectomy performed <30 days and >180 days from diagnosis, respectively. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves and Cox proportional hazards regression analyses were used to compare OS of patients in the 2 treatment arms. Influence of patient age and Charlson Comorbidity Index on treatment effect was tested by interactions. Sensitivity analysis was performed to explore the outcome of delaying nephrectomy for >12 months. RESULTS Median patient age was 55 years with a median follow-up of 82.5 months. Inverse probability of treatment weighting-adjusted Kaplan-Meier curves suggest no significant difference between treatment arms (immediate nephrectomy [<30 days] vs. delayed nephrectomy [>180 days]) (Hazard ratio 0.96; 95% confidence interval 0.73-1.26; P = 0.77). This outcome was consistent between all patients regardless of age (P = 0.48). Sensitivity analysis reports no difference in OS even if nephrectomy was delayed by >12 months (P = 0.60). CONCLUSIONS We report that delayed and immediate nephrectomy for cT1a renal cell carcinoma confers comparable long-term OS. These findings suggest that a period of observation of between 6 and 12 months is safe to allow identification of renal masses, which will benefit from surgical resection.
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Affiliation(s)
- Wei Shen Tan
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Surgery & Interventional Science, Department of Urology, University College London, London, United Kingdom; Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA.
| | - Matthew H Hayn
- Division of Urology, Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
| | - Maya Marchese
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Junaid Nabi
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kerry L Kilbridge
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Justin A Vale
- Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bijan Khoubehi
- Department of Urology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Adam S Kibel
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Maxine Sun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Steven L Chang
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Jesse D Sammon
- Division of Urology, Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME
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27
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Smith A'B, Rincones O, Sidhom M, Mancuso P, Wong K, Berry M, Forstner D, Bokey L, Girgis A. Robot or radiation? A qualitative study of the decision support needs of men with localised prostate cancer choosing between robotic prostatectomy and radiotherapy treatment. PATIENT EDUCATION AND COUNSELING 2019; 102:1364-1372. [PMID: 30803903 DOI: 10.1016/j.pec.2019.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/15/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To understand how best to support men diagnosed with localised prostate cancer to decide which treatment option best suits their needs, when robotic prostatectomy and radiotherapy are equally appropriate to offer them. METHODS Twenty-five men recently diagnosed with localised prostate cancer completed semi-structured interviews asking about information/decision-making needs before and/or after attending a combined clinic in which they consulted a urologist and a radiation oncologist regarding treatment options. Data was transcribed verbatim and thematically analysed. RESULTS Most men preferred robotic prostatectomy pre-combined clinic and chose it afterwards. The thematic analysis revealed four themes: 1) trust in clinicians and the information they provide is critical for treatment choice, 2) perceived fit between treatment characteristics and personal circumstances, 3) additional considerations: specific side effects, socio-emotional and financial factors, and 4) need for tailored information delivery. Robotic prostatectomy was mistakenly believed to provide a more definitive cure than radiotherapy, which was seen as having a lesser lifestyle impact. CONCLUSIONS Treatment choice is largely dependent on clinicians' (mainly urologists') recommendations. PRACTICE IMPLICATIONS Patients need more balanced information about alternatives to robotic prostatectomy earlier in the treatment decision-making process. Referral to a radiation oncologist or combined clinic shortly after diagnosis is recommended.
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Affiliation(s)
- Allan 'Ben' Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia.
| | - Orlando Rincones
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia.
| | - Mark Sidhom
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia.
| | - Pascal Mancuso
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Department of Urological Surgery, South Western Sydney Local Health District, Liverpool, Australia.
| | - Karen Wong
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia.
| | - Megan Berry
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia; Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia.
| | - Dion Forstner
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia; School of Medicine, Western Sydney University, Penrith, Australia.
| | - Leslie Bokey
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia; Division of Surgery, South Western Sydney Local Health District, Liverpool, Australia.
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia.
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28
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Giri VN, Hyatt C, Gomella LG. Germline Testing for Men With Prostate Cancer: Navigating an Expanding New World of Genetic Evaluation for Precision Therapy and Precision Management. J Clin Oncol 2019; 37:1455-1459. [DOI: 10.1200/jco.18.02181] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Hogden A, Churruca K, Rapport F, Gillatt D. Appraising risk in active surveillance of localized prostate cancer. Health Expect 2019; 22:1028-1039. [PMID: 31095822 PMCID: PMC6803412 DOI: 10.1111/hex.12912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 04/07/2019] [Accepted: 04/25/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives Men diagnosed with low‐risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making judgements about the risks of prostate cancer against those of active intervention. Our study examined how risk for prostate cancer is perceived and experienced by patients undergoing active surveillance with their clinicians, how risk is communicated in clinical consultations, and the implications for treatment and care. Method Participants were nine patients and three clinicians from a university hospital urology clinic. A staged, qualitative, multi‐method data collection approach was undertaken, comprising: observations of consultations; patient and clinician interviews; and patient surveys. The three data sets were analysed separately using thematic analysis and then integrated to give a comprehensive view of patient and clinician views. Results Thirty data points (eight patient surveys; 10 observations of consultations between patients and clinicians; 10 patient interviews; and two clinician interviews) combined to create a detailed picture of how patients perceived and appraised risk, in three themes of “Making sense of risk”, “Talking about risk” and “Responding to risk”. Conclusion Effective risk communication needs to be finely tuned and timed to individual patient's priorities and information requirements. A structured information exchange process that identifies patients' priorities, and details key moments in risk assessment, so that complexities of risk are discussed in ways that are meaningful to patients, may benefit patient care. These findings could inform the development of patient‐centric risk assessment procedures and service delivery models in prostate cancer care more broadly.
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Affiliation(s)
- Anne Hogden
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Tasmanian School of Business and Economics, Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Kate Churruca
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Faculty of Medicine and Health Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Gillatt
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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30
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Pillay B, Moon D, Meyer D, Crowe H, Mann S, Howard N, Wootten A, Frydenberg M. Exploring the impact of providing men with information about potential prostate cancer treatment options prior to receiving biopsy results. Support Care Cancer 2019; 28:507-514. [PMID: 31065839 DOI: 10.1007/s00520-019-04847-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/30/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE There is little research assessing the impact of providing men with information about prostate cancer (PCa) treatment options at the time of referral for a prostate biopsy. Study objectives were to determine whether receiving an information booklet about PCa treatment options prior to receiving biopsy results was acceptable to patients, and if receiving this information influenced levels of anxiety, depression, distress, and treatment decisional conflict. METHODS Between June 2016 and September 2017, a randomised block design was used to allocate patients from an Australian urology practice into the intervention or control group. Patients in the intervention group were provided with written information about treatment options for localised PCa prior to their biopsy. Outcome measures including the Distress Thermometer, Generalised Anxiety Disorder-7, Patient Health Questionnaire-9, and Decisional Conflict Scale were completed pre-biopsy and 2-3 weeks post-biopsy. Ninety-eight patients referred for an initial prostate biopsy for an elevated PSA test or suspicious digital rectal exam participated in the study (response rate = 78%). RESULTS Multimodal repeated-measures analyses showed no significant differences between control and intervention groups in changes in distress, anxiety, or depression from pre- to post-biopsy, and in decisional conflict post-diagnosis (all p > .05). Thirty-five (87%) patients believed that the resource made it easier to understand subsequent explanation of treatment options, and 51 patients (98%) who received the intervention preferred to be given information at that time. CONCLUSIONS Providing patients with information about treatment options prior to biopsy did not impact on changes in psychological distress and decisional conflict post-biopsy. However, the majority of patients preferred to be given such information at this time point.
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Affiliation(s)
- Brindha Pillay
- Epworth Prostate Centre, Epworth Healthcare, Melbourne, Victoria, Australia.
- Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
| | - Daniel Moon
- Epworth Centre for Robotic Surgery, Epsworth Healthcare, Melbourne, Victoria, Australia
- Australian Urology Associates, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Denny Meyer
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Helen Crowe
- Epworth Prostate Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Australian Prostate Centre, North Melbourne, Victoria, Australia
| | - Sarah Mann
- Australian Urology Associates, Melbourne, Victoria, Australia
| | - Nicholas Howard
- Epworth Prostate Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Addie Wootten
- Epworth Prostate Centre, Epworth Healthcare, Melbourne, Victoria, Australia
- Australian Prostate Centre, North Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Australian Urology Associates, Melbourne, Victoria, Australia
- Urology, Monash Health, Melbourne, Victoria, Australia
- Clinical Institute of Specialty Surgery, Epworth Healthcare, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Banerjee I, Li K, Seneviratne M, Ferrari M, Seto T, Brooks JD, Rubin DL, Hernandez-Boussard T. Weakly supervised natural language processing for assessing patient-centered outcome following prostate cancer treatment. JAMIA Open 2019; 2:150-159. [PMID: 31032481 PMCID: PMC6482003 DOI: 10.1093/jamiaopen/ooy057] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background The population-based assessment of patient-centered outcomes (PCOs) has been limited by the efficient and accurate collection of these data. Natural language processing (NLP) pipelines can determine whether a clinical note within an electronic medical record contains evidence on these data. We present and demonstrate the accuracy of an NLP pipeline that targets to assess the presence, absence, or risk discussion of two important PCOs following prostate cancer treatment: urinary incontinence (UI) and bowel dysfunction (BD). Methods We propose a weakly supervised NLP approach which annotates electronic medical record clinical notes without requiring manual chart review. A weighted function of neural word embedding was used to create a sentence-level vector representation of relevant expressions extracted from the clinical notes. Sentence vectors were used as input for a multinomial logistic model, with output being either presence, absence or risk discussion of UI/BD. The classifier was trained based on automated sentence annotation depending only on domain-specific dictionaries (weak supervision). Results The model achieved an average F1 score of 0.86 for the sentence-level, three-tier classification task (presence/absence/risk) in both UI and BD. The model also outperformed a pre-existing rule-based model for note-level annotation of UI with significant margin. Conclusions We demonstrate a machine learning method to categorize clinical notes based on important PCOs that trains a classifier on sentence vector representations labeled with a domain-specific dictionary, which eliminates the need for manual engineering of linguistic rules or manual chart review for extracting the PCOs. The weakly supervised NLP pipeline showed promising sensitivity and specificity for identifying important PCOs in unstructured clinical text notes compared to rule-based algorithms.
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Affiliation(s)
- Imon Banerjee
- Department of Biomedical Data Science, Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
| | - Kevin Li
- Stanford University School of Medicine, 291 Campus Drive, Stanford, California 94305-5479, USA
| | - Martin Seneviratne
- Department of Biomedical Data Science, Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
- Department of Biomedical Informatics, Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
| | - Michelle Ferrari
- Department of Urology - Divisions, Stanford University School of Medicine, 875 Blake Wilbur, Stanford, California 94305-5479, USA
| | - Tina Seto
- IRT Research Technology, Stanford University School of Medicine, Stanford, California 94305-5479, USA
| | - James D Brooks
- Department of Urology - Divisions, Stanford University School of Medicine, 875 Blake Wilbur, Stanford, California 94305-5479, USA
| | - Daniel L Rubin
- Department of Biomedical Data Science, Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, California 94305-5479, USA
- Department of Medicine (Biomedical Informatics), Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
| | - Tina Hernandez-Boussard
- Department of Biomedical Data Science, Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
- Department of Medicine (Biomedical Informatics), Stanford University School of Medicine, Medical School Office Building (MSOB), 1265 Welch Road, Stanford, California 94305-5479, USA
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive Stanford, California 94305-2200, USA
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Gershman B, Maroni P, Tilburt JC, Volk RJ, Konety B, Bennett CL, Kutikov A, Smaldone MC, Chen V, Kim SP. A national survey of radiation oncologists and urologists on prediction tools and nomograms for localized prostate cancer. World J Urol 2019; 37:2099-2108. [PMID: 30671637 DOI: 10.1007/s00345-019-02637-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Although prediction tools for prostate cancer (PCa) are essential for high-quality treatment decision-making, little is known about the degree of confidence in existing tools and whether they are used in clinical practice from radiation oncologists (RO) and urologists (URO). Herein, we performed a national survey of specialists about perceived attitudes and use of prediction tools. METHODS In 2017, we invited 940 URO and 911 RO in a national survey to query their confidence in and use of the D'Amico criteria, Kattan Nomogram, and CAPRA score. The statistical analysis involved bivariate association and multivariable logistic regression analyses to identify physician characteristics (age, gender, race, practice affiliation, specialty, access to robotic surgery, ownership of linear accelerator and number of prostate cancer per week) associated with survey responses and use of active surveillance (AS) for low-risk PCa. RESULTS Overall, 691 (37.3%) specialists completed the surveys. Two-thirds (range 65.6-68.4%) of respondents reported being "somewhat confident", but only a fifth selected "very confident" for each prediction tool (18.0-20.1%). 19.1% of specialists in the survey reported not using any prediction tools in clinical practice, which was higher amongst URO than RO (23.9 vs. 13.4%; p < 0.001). Respondents who reported not using prediction tools were also associated with low utilization of AS in their low-risk PCa patients (adjusted OR 2.47; p = 0.01). CONCLUSIONS While a majority of RO and URO view existing prediction tools for localized PCa with some degree of confidence, a fifth of specialists reported not using any such tools in clinical practice. Lack of using such tools was associated with low utilization of AS for low-risk PCa.
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Affiliation(s)
- Boris Gershman
- Department of Urology, Brown University, Providence, RI, USA
| | - Paul Maroni
- Division of Urology, University of Colorado, Denver, CO, USA
| | - Jon C Tilburt
- Biomedical Ethics Research Program, Division of General Internal Medicine, Department of Medicine and the Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Robert J Volk
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Charles L Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Alexander Kutikov
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Marc C Smaldone
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Victor Chen
- Department of Urology , Loyola University Medical Center , Maywood, IL, USA
| | - Simon P Kim
- Division of Urology, University of Colorado, Denver, CO, USA.
- Division of Urology, University of Colorado Anschutz Medical Center, University of Colorado School of Medicine, 12631 E. 17th Avenue, M/S 319, Aurora, CO, 80045, USA.
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Parry MG, Sujenthiran A, Cowling TE, Nossiter J, Cathcart P, Clarke NW, Payne H, Aggarwal A, van der Meulen J. Impact of cancer service centralisation on the radical treatment of men with high-risk and locally advanced prostate cancer: A national cross-sectional analysis in England. Int J Cancer 2019; 145:40-48. [PMID: 30549266 PMCID: PMC6590431 DOI: 10.1002/ijc.32068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/30/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
In many countries, specialist cancer services are centralised to improve outcomes. We explored how centralisation affects the radical treatment of high‐risk and locally advanced prostate cancer in the English NHS. 79,085 patients diagnosed with high‐risk and locally advanced prostate cancer in England (April 2014 to March 2016) were identified in the National Prostate Cancer Audit database. Poisson models were used to estimate risk ratios (RR) for undergoing radical treatment by whether men were diagnosed at a regional co‐ordinating centre (‘hub’), for having surgery by the presence of surgical services on‐site, and for receiving high dose‐rate brachytherapy (HDR‐BT) in addition to external beam radiotherapy by its regional availability. Men were equally likely to receive radical treatment, irrespective of whether they were diagnosed in a hub (RR 0.99, 95% CI 0.91–1.08). Men were more likely to have surgery if they were diagnosed at a hospital with surgical services on site (RR 1.24, 1.10–1.40), and more likely to receive additional HDR‐BT if they were diagnosed at a hospital with direct regional access to this service (RR 6.16, 2.94–12.92). Centralisation of specialist cancer services does not affect whether men receive radical treatment, but it does affect treatment modality. Centralisation may have a negative impact on access to specific treatment modalities. What's new? More than one‐quarter of men with high‐risk or locally advanced prostate cancer in England do not receive radical treatment with radiotherapy or surgery, potentially owing to differences in treatment access. Here, prostate cancer service centralisation in England was investigated for potential impacts on treatment access. Among English patients in the National Prostate Cancer Audit database, centralisation had no impact on decisions to use radical treatment. It did, however, affect treatment option availability, with potential consequences for patient outcome. Patients were more likely to undergo surgery or high dose‐rate brachytherapy when diagnosed at hospitals with direct links to these services.
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Affiliation(s)
- Matthew G Parry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Julie Nossiter
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, England.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, England
| | - Heather Payne
- Department of Oncology, University College London Hospitals, Department of Cancer, London, England
| | - Ajay Aggarwal
- Epidemiology, Population, and Global Health, King's College London, London, England.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
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Mansfield E, Bryant J, Carey M, Turon H, Henskens F, Grady A. Getting the right fit: Convergence between preferred and perceived involvement in treatment decision making among medical oncology outpatients. Health Sci Rep 2019; 2:e101. [PMID: 30697595 PMCID: PMC6346985 DOI: 10.1002/hsr2.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/04/2018] [Accepted: 10/08/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND AIMS While cancer patients' preferences for their level of involvement in treatment decision making (TDM) vary, previous research indicates a large proportion of patients are not experiencing TDM that meets their preferences. Evidence is needed to identify the characteristics of cancer patients who are less likely to report experiencing their preferred level of involvement in TDM, so that appropriate decision-making support can be provided to them. We examined in a sample of medical oncology outpatients (1) the level of agreement between preferred and perceived involvement in TDM and (2) demographic, psychological, disease, and treatment characteristics associated with having unmet preferences for involvement in TDM. METHODS AND RESULTS Cancer patients from three medical oncology treatment centers in Australia completed surveys assessing demographic, disease and treatment variables, psychological distress, and preferred and perceived involvement in TDM. Data were collected between February 2013 and December 2014. Factors associated with having unmet TDM preferences were examined using logistic regression. There were 355 patients included in the analysis (75% response rate). The mean age (±SD) of the participants was 61 (±12), and 45% were male. Overall, 60% of participants reported that their preferences for involvement in TDM were met. No demographic, psychological, disease, or treatment characteristics were significantly associated with an increased probability of not having TDM preferences met. CONCLUSIONS In line with previous research, a large proportion (40%) of patients reported TDM experiences that were not in alignment with their preferences. Future research should explore additional characteristics that are associated with a lower likelihood of having TDM preferences met.
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Affiliation(s)
- Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Heidi Turon
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Frans Henskens
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and MedicineUniversity of NewcastleCallaghanAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
| | - Alice Grady
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanAustralia
- Public Health, Hunter Medical Research InstituteNew Lambton HeightsAustralia
- Population Health, Hunter New England Local Health DistrictWallsendAustralia
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Lichtensztajn DY, Leppert JT, Brooks JD, Shah SA, Sieh W, Chung BI, Gomez SL, Cheng I. Undertreatment of High-Risk Localized Prostate Cancer in the California Latino Population. J Natl Compr Canc Netw 2018; 16:1353-1360. [PMID: 30442735 PMCID: PMC6314834 DOI: 10.6004/jnccn.2018.7060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/16/2018] [Indexed: 01/07/2023]
Abstract
Background: The NCCN Clinical Practice Guidelines in Oncology recommend definitive therapy for all men with high-risk localized prostate cancer (PCa) who have a life expectancy >5 years or who are symptomatic. However, the application of these guidelines may vary among ethnic groups. We compared receipt of guideline-concordant treatment between Latino and non-Latino white men in California. Methods: California Cancer Registry data were used to identify 2,421 Latino and 8,636 non-Latino white men diagnosed with high-risk localized PCa from 2010 through 2014. The association of clinical and sociodemographic factors with definitive treatment was examined using logistic regression, overall and by ethnicity. Results: Latinos were less likely than non-Latino whites to receive definitive treatment before (odds ratio [OR], 0.79; 95% CI, 0.71-0.88) and after adjusting for age and tumor characteristics (OR, 0.84; 95% CI, 0.75-0.95). Additional adjustment for sociodemographic factors eliminated the disparity. However, the association with treatment differed by ethnicity for several factors. Latino men with no health insurance were considerably less likely to receive definitive treatment relative to insured Latino men (OR, 0.34; 95% CI, 0.23-0.49), an association that was more pronounced than among non-Latino whites (OR, 0.63; 95% CI, 0.47-0.83). Intermediate-versus high-grade disease was associated with lower odds of definitive treatment in Latinos (OR, 0.75; 95% CI, 0.59-0.97) but not non-Latino whites. Younger age and care at NCI-designated Cancer Centers were significantly associated with receipt of definitive treatment in non-Latino whites but not in Latinos. Conclusions: California Latino men diagnosed with localized high-risk PCa are at increased risk for undertreatment. The observed treatment disparity is largely explained by sociodemographic factors, suggesting it may be ameliorated through targeted outreach, such as that aimed at younger and underinsured Latino men.
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Affiliation(s)
| | - John T. Leppert
- Stanford Cancer Institute, Stanford, CA
- Division of Urology, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - James D. Brooks
- Stanford Cancer Institute, Stanford, CA
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Sumit A. Shah
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Weiva Sieh
- Departments of Population Health Science and Policy, and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin I. Chung
- Stanford Cancer Institute, Stanford, CA
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Scarlett L. Gomez
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Iona Cheng
- Greater Bay Area Cancer Registry, Cancer Prevention Institute of California, Fremont, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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Alibhai SMH, Ritvo P, Santa Mina D, Sabiston C, Krahn M, Tomlinson G, Matthew A, Lukka H, Warde P, Durbano S, O’Neill M, Culos-Reed SN. Protocol for a phase III RCT and economic analysis of two exercise delivery methods in men with PC on ADT. BMC Cancer 2018; 18:1031. [PMID: 30352568 PMCID: PMC6199786 DOI: 10.1186/s12885-018-4937-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is commonly used to treat prostate cancer. However, side effects of ADT often lead to reduced quality of life and physical function. Existing evidence demonstrates that exercise can ameliorate multiple treatment-related side effects for men on ADT, yet adherence rates are often low. The method of exercise delivery (e.g., supervised group in-centre vs. individual home-based) may be important from clinical and economic perspectives; however, few studies have compared different delivery models. Additionally, long-term exercise adherence and an understanding of predictors of adherence are critical to achieving sustained benefits, but such data are lacking. The primary aim of this multi-centre phase III non-inferiority randomized controlled trial is to determine whether a home-based delivery model is non-inferior to a group-based delivery model in terms of benefits in fatigue and fitness in this population. Two other key aims include examining cost-effectiveness and long-term adherence. METHODS Men diagnosed with prostate cancer of any stage, starting or continuing on ADT for at least 6 months, fluent in English, and living close to a study centre are eligible. Participants complete five assessments over 12 months (baseline and every 3 months during the 6-month intervention and 6-month follow-up phases), including a fitness assessment and self-report questionnaires. Biological outcomes are collected at baseline, 6, and 12 months. A total of 200 participants will be randomized in a 1:1 fashion to supervised group training or home-based training supported by smartphones, health coaches, and Fitbit technology. Participants are asked to complete 4 to 5 exercise sessions per week, incorporating aerobic, resistance and flexibility training. Outcomes include fatigue, quality of life, fitness measures, body composition, biological outcomes, and program adherence. Cost information will be obtained using patient diary-based self-report and utilities via the EQ-5D. DISCUSSION To disseminate publicly funded exercise programs widely, clinical efficacy and cost-effectiveness have to be demonstrated. The goals of this trial are to provide these data along with an increased understanding of adherence to exercise among men with prostate cancer receiving ADT. TRIAL REGISTRATION The trial has been registered at clinicaltrials.gov (Registration # NCT02834416 ). Registration date was June 2, 2016.
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Affiliation(s)
- Shabbir M. H. Alibhai
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
- Toronto General Hospital, 200 Elizabeth St Room EN14-214, Toronto, ON M5G 2C4 Canada
| | - Paul Ritvo
- Cancer Care Ontario, Toronto, ON M5G 2L3 Canada
| | - Daniel Santa Mina
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | | | - Murray Krahn
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | - George Tomlinson
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
| | | | - Himu Lukka
- The Juravinski Cancer Centre, Hamilton, ON L8V 5C2 Canada
| | - Padraig Warde
- University Health Network, Toronto, ON M5G 2C4 Canada
- University of Toronto, Toronto, ON M5S 2J7 Canada
- Cancer Care Ontario, Toronto, ON M5G 2L3 Canada
| | - Sara Durbano
- University Health Network, Toronto, ON M5G 2C4 Canada
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Ranasinghe W, de Silva D, Bandaragoda T, Adikari A, Alahakoon D, Persad R, Lawrentschuk N, Bolton D. Robotic-assisted vs. open radical prostatectomy: A machine learning framework for intelligent analysis of patient-reported outcomes from online cancer support groups. Urol Oncol 2018; 36:529.e1-529.e9. [PMID: 30236854 DOI: 10.1016/j.urolonc.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/05/2018] [Accepted: 08/18/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The advantages of Robot-assisted laparoscopic prostatectomy (RARP) over open radical prostatectomy (ORP) in Prostate cancer perioperatively are well-established, but quality of life is more contentious. Increasingly, patients are utilising online cancer support groups (OCSG) to express themselves. Currently there is no method of analysis of these sophisticated data sources. We have used the PRIME-2 (Patient Reported Information Multidimensional Exploration version 2) framework for automated identification and intelligent analysis of decision-making, functional and emotional outcomes in men undergoing ORP vs. RARP from OCSG discussions. METHODS The PRIME-2 framework was developed to retrospectively analyse individualised patient-reported information from 5,157 patients undergoing RARP and 579 ORP. The decision factors, side effects, and emotions in 2 groups were analysed and compared using Chi-squared, t tests, and Pearson correlation. RESULTS There were no differences in Gleason score, Prostate Specific Antigen (PSA), and age between the groups. Surgeon experience and preservation of erectile function (P < 0.01) were important factors in the decision making process. There were no significant differences in urinary, sexual, or bowel symptoms between ORP and RARP on a monthly basis during the initial 12 months. Emotions expressed by patients undergoing RARP were more consistent and positive while ORP expressed more negative emotions at the time of surgery and 3 months postsurgery (P < 0.05), due to pain and discomfort, and during ninth month due to fear and anxiety of pending PSA tests. CONCLUSIONS ORP and RARP demonstrated similar side effect profiles for 12 months, but PRIME-2 enables identification of important quality of life features and emotions over time. It is timely for clinicians to accept OCSG as an adjunct to Prostate cancer care.
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Affiliation(s)
- Weranja Ranasinghe
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia.
| | - Daswin de Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Tharindu Bandaragoda
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Victoria, Australia
| | - Raj Persad
- North Bristol, NHS Trust, United Kingdom
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Damien Bolton
- University of Melbourne, Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
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Leinwand GZ, Gabrielson AT, Krane LS, Silberstein JL. Rethinking active surveillance for prostate cancer in African American men. Transl Androl Urol 2018; 7:S397-S410. [PMID: 30363480 PMCID: PMC6178310 DOI: 10.21037/tau.2018.06.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Active surveillance (AS) is a treatment modality for prostate cancer that aims to simultaneously avoid overtreatment and allow for the timely intervention of localized disease. AS has become the de facto standard of care for most men with low-risk prostate cancer. However, few African American (AA) men were included in the prospective observational cohorts that resulted in a paradigm shift in treatment recommendations from active intervention toward AS. It has been established that AA men have an increased prostate cancer incidence, higher baseline prostate-specific antigen (PSA) values, more aggressive prostate cancer features, greater frequency of biochemical recurrence after treatment, and higher overall cancer-specific mortality compared to their Caucasian counterparts. As such, this has given many physicians pause before initiating AS for AA patients. In the following manuscript, we will review the available literature regarding AS, with a particular focus on AA men. The preponderance of evidence demonstrates that AS is as viable a management method for AA with low-risk prostate cancer as it is with other racial groups.
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Affiliation(s)
- Gabriel Z Leinwand
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Louis S Krane
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
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Recurrent Tumors Referred for Mohs Micrographic Surgery: A 12-Year Experience at a Single Academic Center. Dermatol Surg 2018; 43:1418-1422. [PMID: 28595252 DOI: 10.1097/dss.0000000000001220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mohs micrographic surgery (MMS) is used for treatment of primary and recurrent tumors. Compared with primary tumors, recurrent tumors are often more aggressive. OBJECTIVE To understand differing characteristics between primary versus recurrent tumors treated by MMS. MATERIALS AND METHODS The authors conducted a retrospective review of a 12-year period at 1 academic center. Recurrent tumors were defined as recurrent if previously treated with cryotherapy, topical chemotherapeutics, electrodesiccation and curettage, or excision. Statistical analysis was conducted with p ≤ .05 considered significant. RESULTS A total of 17,971 cases were reviewed, of which 10.5% represented recurrent tumors. Recurrent tumors occurred more commonly in men (ratio 2.2:1). They presented in older individuals (p < .01) and occurred more commonly on the scalp (p < .0001), neck (p < .0001), and trunk (p < .0001). Primary tumors were more commonly located on the periocular (p < .0001), nose (p < .0001), and perioral areas (p < .0001). Squamous cell carcinoma more commonly presented as primary tumors (p = .02) while squamous cell carcinoma in situ more commonly presented as recurrent tumors (p < .001). CONCLUSION Distinct characteristics separate primary and recurrent tumors treated by MMS. Primary tumors were more commonly located in Area H, compared with recurrent tumors, which were more commonly located in Area M. This suggests appropriate usage of MMS based on appropriate use criteria.
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A standardized analysis of the current surgical and non-surgical treatment selection process for men with localized prostate cancer. J Robot Surg 2018; 12:215-221. [PMID: 29549504 DOI: 10.1007/s11701-018-0796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
Robot-assisted radical prostatectomy to treat localized prostate cancer has increased in popularity, although other options exist, including radiotherapy and active surveillance. The decision about choosing the right treatment has become pertinent for many patients. This literature review aimed to assess the current state-of-the-art regarding decisional aids and the associated decisional outcomes for the purpose of designing a method for both patients and doctors to use to make the best treatment decision for the patient. A literature search was conducted via MEDLINE, Embase, and Web of Science databases using the keywords "prostate" and "cancer" and "impact" and "decisio*" and "treatment." Articles were included that focused on treatment outcomes, decision-making processes, and the use of decisional aids for localized prostate cancer. Articles that investigated prostate cancer in general or prostate cancer screening were excluded, as were articles that were not written in English. Altogether, 13 articles were finally critically reviewed for this study. Results were conflicting regarding the relations between patient factors, use of decisional aids, and decisional outcomes. There was a large gap in the literature regarding the optimal decision-making process for men with localized prostate cancer. The role of currently available decisional aids is limited to helping patients make the right decisions. There is a need to develop a novel decisional aid in which patient-physician discussion-involving evaluation of a spectrum of patient-, doctor-, and treatment-related factors-is included.
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Radhakrishnan A, Grande D, Mitra N, Pollack CE. Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer? Urology 2018; 115:133-138. [PMID: 29477313 DOI: 10.1016/j.urology.2018.01.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/06/2018] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine how frequently patients report that their urologist recommended forgoing definitive treatment and assess the impact of these recommendations on treatment choice and perceived quality of cancer care. METHODS We mailed surveys to men newly diagnosed with localized prostate cancer between 2014 and 2015 (adjusted response rate of 51.3%). Men reported whether their urologist recommended forgoing definitive treatment. Using logistic regression models, we assessed patient-level predictors of receiving a recommendation to forgo definitive treatment and estimated associations of receiving this recommendation with receipt of definitive treatment and perceived quality of cancer care among men with low-risk tumors and limited life expectancies. RESULTS Nearly two-thirds (62.2%) of men with low-risk tumors and 46.4% with limited life expectancies received recommendations from their urologists to forgo definitive treatment. Among men with limited life expectancies, those with low-risk tumors were more likely to receive this recommendation compared with men with high-risk tumors (odds ratio [OR] 3.41; 95% confidence interval [CI] 2.17-5.37). Men with low-risk tumors who were recommended to forgo definitive treatment were less likely to receive definitive treatment (OR 0.48; 95% CI 0.32-0.73) but did not report lower perceived quality of care (OR 0.97; 95% CI 0.63-1.48). CONCLUSION In this population-based study, a majority of men with low-risk prostate cancer report receiving recommendations from their urologists to forgo definitive treatment. Our results suggest that urologists have a strong influence on patient treatment choice and could increase active surveillance uptake in men eligible for expectant management without patients perceiving lower quality of cancer care.
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Affiliation(s)
| | - David Grande
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Craig Evan Pollack
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Bandaragoda T, Ranasinghe W, Adikari A, de Silva D, Lawrentschuk N, Alahakoon D, Persad R, Bolton D. The Patient-Reported Information Multidimensional Exploration (PRIME) Framework for Investigating Emotions and Other Factors of Prostate Cancer Patients with Low Intermediate Risk Based on Online Cancer Support Group Discussions. Ann Surg Oncol 2018; 25:1737-1745. [DOI: 10.1245/s10434-018-6372-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 12/19/2022]
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Jin C, Hanna T, Cook E, Miao Q, Brundage M. Variation in Radiotherapy Referral and Treatment for High-risk Pathological Features after Radical Prostatectomy: Results from a Population-based Study. Clin Oncol (R Coll Radiol) 2018; 30:47-56. [DOI: 10.1016/j.clon.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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The role of individual characteristics in predicting decisional conflict for patients with prostate cancer (PCa): preliminary results. CURRENT PSYCHOLOGY 2017. [DOI: 10.1007/s12144-017-9753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Smith AB, Mancuso P, Sidhom M, Wong K, Berry M, Rincones O, Forstner D, Bokey L, Girgis A. Prostatectomy versus radiotherapy for early-stage prostate cancer (PREPaRE) study: protocol for a mixed-methods study of treatment decision-making in men with localised prostate cancer. BMJ Open 2017; 7:e018403. [PMID: 29102996 PMCID: PMC5722081 DOI: 10.1136/bmjopen-2017-018403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Men diagnosed with localised prostate cancer (LPC) wanting curative treatment face a highly preference-sensitive choice between prostatectomy and radiotherapy, which offer similar cure rates but different side effects. This study aims to determine the information, decision-making needs and preferences of men with LPC choosing between robotic prostatectomy and standard external beam or stereotactic radiotherapy. METHODS AND ANALYSIS This study will be conducted at a large public teaching hospital in Australia offering the choice between robotic prostatectomy and radiotherapy from early 2017. Men (20-30) diagnosed with LPC who want curative treatment and meet criteria for either treatment will be invited to participate. In this mixed-methods study, patients will complete semistructured interviews before and after attending a combined clinic in which they consult a urologist and a radiation oncologist regarding treatment and four questionnaires (one before treatment decision-making and three after) assessing demographic and clinical characteristics, involvement in decision-making, decisional conflict, satisfaction and regret. Combined clinic consultations will also be audio-recorded and clinicians will report their perceptions regarding patients' suitability for, openness to and preferences for each treatment. Qualitative data will be transcribed verbatim and thematically analysed and descriptive statistical analyses will explore quantitative decision-making outcomes, with comparison according to treatment choice. DISCUSSION Results from this study will inform how to best support men diagnosed with LPC deciding which curative treatment option best suits their needs and may identify the need for and content required in a decision aid to support these men. ETHICS AND DISSEMINATION All participants will provide written informed consent. Data will be rigorously managed in accordance with national legislation. Results will be disseminated via presentations to both scientific and layperson audiences and publications in peer-reviewed scientific journals.
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Affiliation(s)
- Allan Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Pascal Mancuso
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Department of Urological Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Mark Sidhom
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Karen Wong
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Megan Berry
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Orlando Rincones
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
| | - Dion Forstner
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- School of Medicine, Western Sydney University, Penrith South DC, New South Wales, Australia
| | - Lesley Bokey
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- Division of Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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MacLennan S, Williamson PR, Bekema H, Campbell M, Ramsay C, N'Dow J, MacLennan S, Vale L, Dahm P, Mottet N, Lam T. A core outcome set for localised prostate cancer effectiveness trials. BJU Int 2017; 120:E64-E79. [PMID: 28346770 DOI: 10.1111/bju.13854] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To develop a core outcome set (COS) applicable for effectiveness trials of all interventions for localised prostate cancer. Many treatments exist for localised prostate cancer, although it is unclear which offers the optimal therapeutic ratio; which is confounded by inconsistencies in the selection, definition, measurement and reporting of outcomes in clinical trials. PATIENTS, SUBJECTS AND METHODS A list of 79 outcomes was derived from a systematic review of published localised prostate cancer effectiveness studies and semi-structured interviews with 15 patients with prostate cancer patients. A two-stage consensus process involving 118 patients and 56 international healthcare professionals (HCPs; cancer specialist nurses, urological surgeons and oncologists) was undertaken, consisting of a three-round Delphi survey followed by a face-to-face consensus panel meeting of 13 HCPs and eight patients. RESULTS The final COS included 19 outcomes. In all, 12 apply to all interventions: death from prostate cancer, death from any cause, local disease recurrence, distant disease recurrence/metastases, disease progression, need for salvage therapy, overall quality of life, stress urinary incontinence, urinary function, bowel function, faecal incontinence, and sexual function. Seven were intervention-specific: perioperative deaths (surgery), positive surgical margin (surgery), thromboembolic disease (surgery), bothersome or symptomatic urethral or anastomotic stricture (surgery), need for curative treatment (active surveillance), treatment failure (ablative therapy), and side-effects of hormonal therapy (hormone therapy). The UK-centric participants may limit the generalisability to other countries, but trialists should reason why the COS would not be applicable. The default position should not be that a COS developed in one country will automatically not be applicable elsewhere. CONCLUSION We have established a COS for trials of effectiveness in localised prostate cancer, applicable across all interventions that should be measured in all localised prostate cancer effectiveness trials.
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Affiliation(s)
| | | | - Hanneke Bekema
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Marion Campbell
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Craig Ramsay
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
- Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| | - Thomas Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
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Hospital Quality Factors Influencing the Mobility of Patients for Radical Prostate Cancer Radiation Therapy: A National Population-Based Study. Int J Radiat Oncol Biol Phys 2017; 99:1261-1270. [PMID: 28964586 PMCID: PMC5693556 DOI: 10.1016/j.ijrobp.2017.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/29/2017] [Accepted: 08/12/2017] [Indexed: 11/30/2022]
Abstract
Purpose To investigate whether patients requiring radiation treatment are prepared to travel to alternative more distant centers in response to hospital choice policies, and the factors that influence this mobility. Methods and Materials We present the results of a national cohort study using administrative hospital data for all 44,363 men who were diagnosed with prostate cancer and underwent radical radiation therapy in the English National Health Service between 2010 and 2014. Using geographic information systems, we investigated the extent to which men choose to travel beyond (“bypass”) their nearest radiation therapy center, and we used conditional logistic regression to estimate the effect of hospital and patient characteristics on this mobility. Results In all, 20.7% of men (n=9161) bypassed their nearest radiation therapy center. Travel time had a very strong impact on where patients moved to for their treatment, but its effect was smaller for men who were younger, more affluent, and from rural areas (P for interaction always <.001). Men were prepared to travel further to hospitals that offered hypofractionated prostate radiation therapy as their standard schedule (odds ratio 3.19, P<.001), to large-scale radiation therapy units (odds ratio 1.56, P<.001), and to hospitals that were early adopters of intensity modulated radiation therapy (odds ratio 1.37, P<.001). Conclusions Men with prostate cancer are prepared to bypass their nearest radiation therapy centers. They are more likely to travel to larger established centers and those that offer innovative technology and more convenient radiation therapy schedules. Indicators that accurately reflect the quality of radiation therapy delivered are needed to guide patients' choices for radiation therapy treatment. In their absence, patient mobility may negatively affect the efficiency and capacity of a regional or national radiation therapy service and offer perverse incentives for technology adoption.
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Matthew AG, Raz O, Currie KL, Louis AS, Jiang H, Davidson T, Fleshner NE, Finelli A, Trachtenberg J. Psychological distress and lifestyle disruption in low-risk prostate cancer patients: Comparison between active surveillance and radical prostatectomy. J Psychosoc Oncol 2017; 36:159-174. [DOI: 10.1080/07347332.2017.1342733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andrew G. Matthew
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Orit Raz
- Department of Urology, Macquarie University Hospital, Sydney, Australia
| | - Kristen L. Currie
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Alyssa S. Louis
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Haiyan Jiang
- Department of Biostatistics, University Health Network, Toronto, ON, Canada
| | - Tal Davidson
- Department of Psychology, York University, Toronto, ON, Canada
| | - Neil E. Fleshner
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Antonio Finelli
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - John Trachtenberg
- Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
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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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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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