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Xu J, Bock CH, Janisse J, Woo J, Cher ML, Ginsburg K, Yacoub R, Goodman M. Determinants of active surveillance uptake in a diverse population-based cohort of men with low-risk prostate cancer: The Treatment Options in Prostate Cancer Study (TOPCS). Cancer 2024; 130:1797-1806. [PMID: 38247317 DOI: 10.1002/cncr.35190] [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] [Received: 09/17/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Active surveillance (AS) is the preferred strategy for low-risk prostate cancer (LRPC); however, limited data on determinants of AS adoption exist, particularly among Black men. METHODS Black and White newly diagnosed (from January 2014 through June 2017) patients with LRPC ≤75 years of age were identified through metro-Detroit and Georgia population-based cancer registries and completed a survey evaluating factors influencing AS uptake. RESULTS Among 1688 study participants, 57% chose AS (51% of Black participants, 61% of White) over definitive treatment. In the unadjusted analysis, patient factors associated with initial AS uptake included older age, White race, and higher education. However, after adjusting for covariates, none of these factors was significant predictors of AS uptake. The strongest determinant of AS uptake was the AS recommendation by a urologist (adjusted prevalence ratio, 6.59, 95% CI, 4.84-8.97). Other factors associated with the decision to undergo AS included a shared patient-physician treatment decision, greater prostate cancer knowledge, and residence in metro-Detroit compared with Georgia. Conversely, men whose decision was strongly influenced by the desire to achieve "cure" or "live longer" with treatment and those who perceived their LRPC diagnosis as more serious were less likely to choose AS. CONCLUSIONS In this contemporary sample, the majority of patients with newly diagnosed LRPC chose AS. Although the input from their urologists was highly influential, several patient decisional and psychological factors were independently associated with AS uptake. These data shed new light on potentially modifiable factors that can help further increase AS uptake among patients with LRPC.
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Affiliation(s)
- Jinping Xu
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Cathryn H Bock
- Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - James Janisse
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Justin Woo
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Michael L Cher
- Department of Urology, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Kevin Ginsburg
- Department of Urology, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Rami Yacoub
- Department of Epidemiology, School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, School of Public Health, Emory University, Atlanta, Georgia, USA
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Gartrell BA, Phalguni A, Bajko P, Mundle SD, McCarthy SA, Brookman-May SD, De Solda F, Jain R, Yu Ko W, Ploussard G, Hadaschik B. Influential Factors Impacting Treatment Decision-making and Decision Regret in Patients with Localized or Locally Advanced Prostate Cancer: A Systematic Literature Review. Eur Urol Oncol 2024:S2588-9311(24)00106-8. [PMID: 38744587 DOI: 10.1016/j.euo.2024.04.016] [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: 01/22/2024] [Revised: 04/06/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
CONTEXT Treatment decision-making (TDM) for patients with localized (LPC) or locally advanced (LAPC) prostate cancer is complex, and post-treatment decision regret (DR) is common. The factors driving TDM or predicting DR remain understudied. OBJECTIVE Two systematic literature reviews were conducted to explore the factors associated with TDM and DR. EVIDENCE ACQUISITION Three online databases, select congress proceedings, and gray literature were searched (September 2022). Publications on TDM and DR in LPC/LAPC were prioritized based on the following: 2012 onward, ≥100 patients, journal article, and quantitative data. The Preferred Reporting Items Reviews and Meta-analyses guidelines were followed. Influential factors were those with p < 0.05; for TDM, factors described as "a decision driver", "associated", "influential", or "significant" were also included. The key factors were determined by number of studies, consistency of evidence, and study quality. EVIDENCE SYNTHESIS Seventy-five publications (68 studies) reported TDM. Patient participation in TDM was reported in 34 publications; overall, patients preferred an active/shared role. Of 39 influential TDM factors, age, ethnicity, external factors (physician recommendation most common), and treatment characteristics/toxicity were key. Forty-nine publications reported DR. The proportion of patients experiencing DR varied by treatment type: 7-43% (active surveillance), 12-57% (radical prostatectomy), 1-49% (radiotherapy), 28-49% (androgen-deprivation therapy), and 21-47% (combination therapy). Of 42 significant DR factors, treatment toxicity (sexual/urinary/bowel dysfunction), patient role in TDM, and treatment type were key. CONCLUSIONS The key factors impacting TDM were physician recommendation, age, ethnicity, and treatment characteristics. Treatment toxicity and TDM approach were the key factors influencing DR. To help patients navigate factors influencing TDM and to limit DR, a shared, consensual TDM approach between patients, caregivers, and physicians is needed. PATIENT SUMMARY We looked at factors influencing treatment decision-making (TDM) and decision regret (DR) in patients with localized or locally advanced prostate cancer. The key factors influencing TDM were doctor's recommendation, patient age/ethnicity, and treatment side effects. A shared, consensual TDM approach between patients and doctors was found to limit DR.
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Affiliation(s)
- Benjamin A Gartrell
- Departments of Oncology and Urology, Montefiore Einstein Comprehensive Cancer Center, Bronx, NY, USA.
| | - Angaja Phalguni
- Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK
| | - Paulina Bajko
- Evidence Synthesis, Genesis Research Group, Newcastle upon Tyne, UK
| | - Suneel D Mundle
- Global Medical Affairs, Janssen Research & Development, Raritan, NJ, USA
| | - Sharon A McCarthy
- Clinical Research Oncology, Janssen Research & Development, Raritan, NJ, USA
| | - Sabine D Brookman-May
- Clinical Research Oncology, Janssen Research & Development, Spring House, PA, USA; Ludwig-Maximilians-University, München, Germany
| | - Francesco De Solda
- Global Commercial Strategy Organization, Janssen Global Services, Raritan, NJ, USA
| | - Ruhee Jain
- Global Commercial Strategy Organization, Janssen Global Services, Raritan, NJ, USA
| | - Wellam Yu Ko
- University of British Columbia Men's Health Research Program, Vancouver, BC, Canada
| | | | - Boris Hadaschik
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
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Chen N, McGrath CB, Ericsson CI, Vaselkiv JB, Rencsok EM, Stopsack KH, Guard HE, Autio KA, Rathkopf DE, Enting D, Bitting RL, Mateo J, Githiaka CW, Chi KN, Cheng HH, Davis ID, Anderson SG, Badal SAM, Bjartell A, Russnes KM, Heath EI, Pomerantz MM, Henegan JC, Hyslop T, Esteban E, Omlin A, McDermott R, Fay AP, Popoola AA, Ragin C, Nowak J, Gerke T, Kantoff PW, George DJ, Penney KL, Mucci LA. Marital Status, Living Arrangement, and Survival among Individuals with Advanced Prostate Cancer in the International Registry for Men with Advanced Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:419-425. [PMID: 38189661 PMCID: PMC10922505 DOI: 10.1158/1055-9965.epi-23-1207] [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: 10/06/2023] [Revised: 11/15/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Studies have shown improved survival among individuals with cancer with higher levels of social support. Few studies have investigated social support and overall survival (OS) in individuals with advanced prostate cancer in an international cohort. We investigated the associations of marital status and living arrangements with OS among individuals with advanced prostate cancer in the International Registry for Men with Advanced Prostate Cancer (IRONMAN). METHODS IRONMAN is enrolling participants diagnosed with advanced prostate cancer (metastatic hormone-sensitive prostate cancer, mHSPC; castration-resistant prostate cancer, CRPC) from 16 countries. Participants in this analysis were recruited between July 2017 and January 2023. Adjusting for demographics and tumor characteristics, the associations were estimated using Cox regression and stratified by disease state (mHSPC, CRPC), age (<70, ≥70 years), and continent of enrollment (North America, Europe, Other). RESULTS We included 2,119 participants with advanced prostate cancer, of whom 427 died during up to 5 years of follow-up (median 6 months). Two-thirds had mHSPC. Most were married/in a civil partnership (79%) and 6% were widowed. Very few married participants were living alone (1%), while most unmarried participants were living alone (70%). Married participants had better OS than unmarried participants [adjusted HR: 1.44; 95% confidence interval (CI): 1.02-2.02]. Widowed participants had the worst survival compared with married individuals (adjusted HR: 1.89; 95% CI: 1.22-2.94). CONCLUSIONS Among those with advanced prostate cancer, unmarried and widowed participants had worse OS compared with married participants. IMPACT This research highlighted the importance of social support in OS within this vulnerable population.
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Affiliation(s)
- Naiyu Chen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Colleen B. McGrath
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Caroline I. Ericsson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jane B. Vaselkiv
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emily M. Rencsok
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA
| | - Konrad H. Stopsack
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hannah E. Guard
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Karen A. Autio
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana E. Rathkopf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Joaquin Mateo
- Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital Campus, Barcelona, Spain
| | | | - Kim N. Chi
- BC Cancer, Vancouver, British Columbia, Canada
| | - Heather H. Cheng
- University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Ian D. Davis
- Monash University Faculty of Medicine, Melbourne, Australia
- Eastern Health, Melbourne, Australia
| | - Simon G. Anderson
- The Glasgow-Caribbean Centre for Development Research and the Caribbean Institute of Health Research, The University of the West Indies, Bridgetown, Barbados
- African–Caribbean Cancer Consortium, Philadelphia, PA, USA
| | - Simone Ann Marie Badal
- African–Caribbean Cancer Consortium, Philadelphia, PA, USA
- The University of the West Indies Mona, Kingston, Jamaica
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - Elisabeth I. Heath
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Mark M. Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John C. Henegan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Terry Hyslop
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Emilio Esteban
- Department of Medical Oncology, Hospital Universitario Central of Asturias, ISPA, Oviedo, Spain
| | | | - Ray McDermott
- St Vincent’s University Hospital & Cancer Trials Ireland, Dublin, Ireland
| | - Andre P. Fay
- PUCRS School of Medicine, Hospital Nora Teixeira, Porto Alegre, Brazil
| | | | - Camille Ragin
- African–Caribbean Cancer Consortium, Philadelphia, PA, USA
- Fox Chase Cancer Center, Philadelphia, PA
| | | | - Travis Gerke
- Prostate Cancer Clinical Trials Consortium, New York, NY, USA
| | - Philip W. Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Kathryn L. Penney
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Santi SA, Caswell JM, Beruar AS, Conlon M, Carlson RG, Pearce AG. A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada. Adv Radiat Oncol 2022; 8:101131. [PMID: 36845619 PMCID: PMC9943768 DOI: 10.1016/j.adro.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Recommendations from Cancer Care Ontario stress the importance of multidisciplinary care from radiologists and urologists for prostate cancer treatment. The present study sought to examine what percentage of patients had a consultation with a radiation oncologist before undergoing a radical prostatectomy in Ontario, Canada, between 2010 and 2019. Methods and Materials Administrative health care databases were used to analyze the number of consultations billed to the Ontario Health Insurance Plan from radiologists and urologists who treated men with a first prostate cancer diagnosis (n = 22,169). Results In Ontario, 94.70% of Ontario Health Insurance Plan billings for patients with prostate cancer who had a prostatectomy within 1 year of a prostate cancer diagnosis were from urology, and 37.66% and 1.77% of billings were received from radiation oncology and medical oncology specialties, respectively. When sociodemographic variables were examined, having a lower neighborhood income (adjusted odds ratio [aOR], 0.69; confidence interval [CI], 0.62-0.76) and a rural residence (aOR, 0.72; CI, 0.65-0.79) were associated with lower odds of receiving a consultation from a radiation oncologist. When billings for consultations were examined geographically by region, Northeast Ontario (Local Health Integrated Network 13) had the lowest odds of receiving a radiation consultation compared with the rest of Ontario (aOR, 0.50; CI, 0.42-0.59). Conclusions The results of this study show that differences in equitable access to multidisciplinary health care exist for men with a first prostate cancer diagnosis who reside in more northern and rural regions within Ontario, relative to the rest of the province. The reasons for these findings are likely multifactorial and may include factors such as patient treatment preference and distance/travel to receive treatment. However, as diagnosis year increased, so did the chances of receiving a radiation oncologist consultation, and this upward trend may reflect the implementation of Cancer Care Ontario guidelines.
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Affiliation(s)
- Stacey A. Santi
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Joseph M. Caswell
- ICES North Satellite Site, Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Ananya S. Beruar
- Radiation Oncology, Cross Cancer Institute University of Alberta, Edmonton, Alberta, Canada
| | - M.S.C. Conlon
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- ICES North Satellite Site, Health Sciences North Research Institute, Sudbury, Ontario, Canada
- School of Rural and Northern Health, Laurentian University, Sudbury, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Ryan G. Carlson
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Radiation Oncology, Northeast Cancer Centre, Health Sciences North, Sudbury, Ontario, Canada
| | - Andrew G. Pearce
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Radiation Oncology, Northeast Cancer Centre, Health Sciences North, Sudbury, Ontario, Canada
- Corresponding author: Andrew G. Pearce, MD
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McIntosh M, Opozda MJ, Short CE, Galvão DA, Tutino R, Diefenbach M, Ehdaie B, Nelson C. Social ecological influences on treatment decision-making in men diagnosed with low risk, localised prostate cancer. Eur J Cancer Care (Engl) 2022; 31:e13697. [PMID: 36138320 PMCID: PMC9786728 DOI: 10.1111/ecc.13697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Individuals diagnosed with low risk, localised prostate cancer (PCa) face a difficult decision between active surveillance (AS) and definitive treatment. We aimed to explore perceived influences on treatment decision-making from the patient and partner's perspectives. METHODS Patients (and partners) who met AS criteria and had chosen their treatment were recruited. Semi-structured individual interviews were conducted via telephone to explore experiences of diagnosis, impact on patient lifestyle, experiences with physicians, treatment preferences/choice, treatment information understanding and needs, and overall decision-making process. Interviews were audio recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis. RESULTS Twenty-four male patients (18 chose AS) and 12 female partners participated. Five themes relating to social-ecological influences on treatment choice were identified: (1) partner support and direct influence on patient treatment choice, (2) patient and partner vicarious experiences may influence treatment decisions, (3) the influence of the patient's life circumstances, (4) disclosing to wider social networks: friends, family, and co-workers, and (5) the importance of a good relationship and experience with physicians. Additionally, two themes were identified relating to information patients and partners received about the treatment options during their decision-making process. CONCLUSIONS A range of individual and social influences on treatment decision-making were reported. Physicians providing treatment recommendations should consider and discuss the patient and partner's existing beliefs and treatment preferences and encourage shared decision-making. Further research on treatment decision-making of partnered and non-partnered PCa patients is required. We recommend research considers social ecological factors across the personal, interpersonal, community, and policy levels.
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Affiliation(s)
- Megan McIntosh
- School of Medicine, Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSAAustralia,Freemasons Centre for Male Health and WellbeingSouth Australian Health and Medical Research Institute and The University of AdelaideAdelaideSAAustralia
| | - Melissa J. Opozda
- Freemasons Centre for Male Health and WellbeingSouth Australian Health and Medical Research Institute and The University of AdelaideAdelaideSAAustralia
| | - Camille E. Short
- Melbourne School of Psychological Sciences and Melbourne School of Health Sciences (jointly appointed)The University of MelbourneMelbourneVICAustralia
| | - Daniel A. Galvão
- Exercise Medicine Research InstituteEdith Cowan UniversityJoondalupWAAustralia
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Xu J, Goodman M, Janisse J, Cher ML, Bock CH. Five-year follow-up study of a population-based prospective cohort of men with low-risk prostate cancer: the treatment options in prostate cancer study (TOPCS): study protocol. BMJ Open 2022; 12:e056675. [PMID: 35190441 PMCID: PMC8860062 DOI: 10.1136/bmjopen-2021-056675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) is recommended for men with low-risk prostate cancer (LRPC) to reduce overtreatment and to maintain patients' quality of life (QOL). However, whether African American (AA) men can safely undergo AS is controversial due to concerns of more aggressive disease and lack of empirical data on the safety and effectiveness of AS in this population. Withholding of AS may lead to a lost opportunity for improving survivorship in AA men. In this study, peer-reviewed and funded by the US Department of Defense, we will assess whether AS is an equally effective and safe management option for AA as it is for White men with LRPC. METHODS AND ANALYSIS The project extends follow-up of a large contemporary population-based cohort of LRPC patients (n=1688) with a high proportion of AA men (~20%) and well-characterised baseline and 2-year follow-up data. The objectives are to (1) determine any racial differences in AS adherence, switch rate from AS to curative treatment and time to treatment over 5 years after diagnosis, (2) compare QOL among AS group and curative treatment group over time, overall and by race and (3) evaluate whether reasons for switching from AS to curative treatment differ by race. Validation of survey responses related to AS follow-up procedures is being conducted through medical record review. We expect to obtain 5-year survey from ~900 (~20% AA) men by the end of this study to have sufficient power. Descriptive and inferential statistical techniques will be used to examine racial differences in AS adherence, effectiveness and QOL. ETHICS AND DISSEMINATION The parent and current studies were approved by the Institutional Review Boards at Wayne State University and Emory University. Since it is an observational study, ethical or safety risks are low. We will disseminate our findings to relevant conferences and peer-reviewed journals.
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Affiliation(s)
- Jinping Xu
- Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael Goodman
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James Janisse
- Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael L Cher
- Urology, Wayne State University School of Medicine, Detroit, Michigan, USA
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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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8
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Gillis C, Ilie G, Mason R, Bailly G, Lawen J, Bowes D, Patil N, Wilke D, Rutledge RDH, Bell D, Rendon R. Personality Traits and Urinary Symptoms Are Associated with Mental Health Distress in Patients with a Diagnosis of Prostate Cancer. Curr Oncol 2021; 28:2993-3002. [PMID: 34436028 PMCID: PMC8395397 DOI: 10.3390/curroncol28040262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE With a prolonged natural history compared with many other cancers, prostate cancer patients have high rates of mental illness over the duration of their treatment. Here, we examine the relationship between personality and mental health distress in a sample of prostate cancer patients. METHODS This study was conducted in the Canadian Maritime provinces, where a cohort of 189 men with prostate cancer were invited to complete a quality-of-life online survey between May 2017 and December 2019. The presence or absence of screening positive for mental health illness was the primary outcome and was assessed using Kessler's 10-item scale (K10). Urinary symptoms were assessed using the International Prostate Symptom Score (IPSS). The ten-item personality inventory (TIPI) assessed extraversion, agreeableness, conscientiousness, emotional stability (or neuroticism), and openness to experiences. A multivariate logistic regression model was created to examine the association between personality, urinary symptoms, and mental health distress, while controlling for time from diagnosis, treatment type, age, and multimorbidity. RESULTS Screening positive for mental illness (18.0%) was associated with personality traits of low levels of emotional stability (OR = 0.07, 95% CI: 0.03-0.20) and moderate to severe urinary problems (OR = 5.21, 95% CI: 1.94-14.05)). There was no identified association between treatment received for prostate cancer and personality type. CONCLUSION Screening for mental health illness in this population may help reduce morbidity associated with cancer treatment, as well as identify patients who may be at risk of mental health distress and could benefit from individualized mental health support services. These findings suggest that multidisciplinary care is essential for the management of these patients.
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Affiliation(s)
- Charles Gillis
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
| | - Gabriela Ilie
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (D.B.); (N.P.); (D.W.); (R.D.H.R.)
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
| | - Gregory Bailly
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
| | - Joseph Lawen
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
| | - David Bowes
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (D.B.); (N.P.); (D.W.); (R.D.H.R.)
| | - Nikhilesh Patil
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (D.B.); (N.P.); (D.W.); (R.D.H.R.)
| | - Derek Wilke
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (D.B.); (N.P.); (D.W.); (R.D.H.R.)
| | - Robert David Harold Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (D.B.); (N.P.); (D.W.); (R.D.H.R.)
| | - David Bell
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.G.); (R.M.); (G.B.); (J.L.); (D.B.); (R.R.)
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9
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Smith A'B, Rincones O, Mancuso P, Sidhom M, Wong K, Berry M, Forstner D, Ngo D, Bokey L, Girgis A. Low conflict and high satisfaction: Decisional outcomes after attending a combined clinic to choose between robotic prostatectomy and radiotherapy for prostate cancer. Urol Oncol 2021; 40:8.e1-8.e9. [PMID: 34116935 DOI: 10.1016/j.urolonc.2021.05.007] [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: 02/11/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Decisional conflict and post-treatment decisional regret have been documented in men with localised prostate cancer (LPC). However, there is limited evidence regarding decisional outcomes associated with the choice between robotic-assisted radical prostatectomy (RARP) and radiotherapy, when both treatment options are available in the public health system. There is increasing support for multidisciplinary approaches to guide men with LPC in their decision-making process. This study assessed decisional outcomes in men deciding between RARP or radiotherapy treatment before and after attending a LPC combined clinic (CC). METHODS Quantitative longitudinal data were collected from 52 men who attended a LPC CC, where they saw both a urologist and radiation oncologist. Patients completed questionnaires assessing involvement in decision-making, decisional conflict, satisfaction and regret before and after the CC, three months, six months and 12 months post-treatment. Urologists and radiation oncologists also reported their perceptions regarding patients' suitability for, openness to, perceived preferences and appropriateness for each treatment. Data was analysed using paired/independent samples t-tests and McNemar's tests. RESULTS Most participants (n = 37, 71%) opted for RARP over radiotherapy (n = 14, 27%); one participant deferred treatment (2%). Urologists and radiation oncologists reported low agreement (κ = 0.26) regarding the most appropriate treatment for each patient. Participants reported a desire for high levels of control over their decision-making process (77.5% patient-led, 22.5% shared) and high levels of decisional satisfaction (M = 4.4, SD = 0.47) after the CC. Decisional conflict levels were significantly reduced (baseline: M = 29.3, SD = 16.9, post-CC: M = 16.3, SD = 11.5; t = 5.37, P < 0.001) after the CC. Mean decisional regret scores were 'mild' at three-months (M = 16.0, SD = 17.5), six-months (M = 18.8, SD = 18.7) and 12-months (M = 18.2, SD = 15.1) post-treatment completion. CONCLUSION This is the first Australian study to assess decisional outcomes when patients are offered the choice between RARP and radiotherapy in the public health system. A CC seems to support decision-making in men with LPC and positively impact some decisional outcomes. However, larger-scale controlled studies are needed to confirm these findings.
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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, NSW; South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW.
| | - Orlando Rincones
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW
| | - Pascal Mancuso
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Department of Urological Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Mark Sidhom
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Karen Wong
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Megan Berry
- South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW; Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Dion Forstner
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW; School of Medicine, Western Sydney University, Penrith , NSW
| | - Diana Ngo
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Lesley Bokey
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW; Division of Surgery, Liverpool Hospital, South Western Sydney Local Health District, Liverpool , NSW
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Liverpool, NSW; South Western Sydney Clinical School, University of New South Wales, Liverpool , NSW
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10
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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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11
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Eleswarapu SV, Jiang T, Mills JN, Osadchiy V. Digital ethnographic analysis of prostate cancer discussions on social media. BJUI COMPASS 2020; 2:82-85. [PMID: 35474884 PMCID: PMC8988692 DOI: 10.1002/bco2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sriram V. Eleswarapu
- Division of Andrology Department of Urology David Geffen School of Medicine University of California Los Angeles CA USA
- Consortium for Health Activity on Social Media David Geffen School of Medicine University of California Los Angeles CA USA
| | - Tommy Jiang
- Division of Andrology Department of Urology David Geffen School of Medicine University of California Los Angeles CA USA
- Consortium for Health Activity on Social Media David Geffen School of Medicine University of California Los Angeles CA USA
| | - Jesse N. Mills
- Division of Andrology Department of Urology David Geffen School of Medicine University of California Los Angeles CA USA
| | - Vadim Osadchiy
- Division of Andrology Department of Urology David Geffen School of Medicine University of California Los Angeles CA USA
- Consortium for Health Activity on Social Media David Geffen School of Medicine University of California Los Angeles CA USA
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12
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Birkeland S, Linkhorst T, Haakonsson A, Barry MJ, Möller S. Representativeness of personality and involvement preferences in a web-based survey on healthcare decision-making. BMC Health Serv Res 2020; 20:851. [PMID: 32912191 PMCID: PMC7488239 DOI: 10.1186/s12913-020-05717-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background Obtaining a sample that is representative of the group of interest is of utmost importance in questionnaire studies. In a survey using a state authorized web-portal for citizen communication with authorities, we wanted to investigate the view of adult men on patient involvement in health care decision-making regarding Prostate-Specific Antigen test for prostatic cancer. In this paper, we report on sample characteristics and representativeness of our sample in terms of personality and baseline involvement preferences. Methods We compared personality profiles (BFI-10) and baseline healthcare decision-making preferences (CPS) in our sample (n = 6756) to internationally available datasets. Pooled data from a) US, UK, Canada, Australia, and New Zealand (n = 1512), b) Germany, Netherlands, Switzerland, and Belgium (n = 1136), and c) Norway, Sweden, Finland, and Denmark (n = 1313) were used for BFI-10 comparisons. Regarding CPS, we compared our sample with three previous datasets relating to decision-making in cancer (n = 425, 387, and 199). Results Although statistically significant differences particularly appeared in large dataset comparisons, sample BFI-10 and CPS profiles mostly were within the range of those previously reported. Similarity was greatest in BFI-10 comparisons with group a) where no statistically significant difference could be established in factors ‘agreeableness’ and ‘neuroticism’ (p = .095 and .578, respectively). Conclusion Despite some variation, our sample displays personality and baseline preference profiles that are generally similar to those described in previous international studies. For example, this was the case with the BFI-10 ‘agreeableness’ measure (incl. trust and fault-finding items), an important factor in healthcare decision-making.
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Affiliation(s)
- Søren Birkeland
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark.
| | - Thea Linkhorst
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark
| | - Anders Haakonsson
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark
| | - Michael John Barry
- MGH Division of General Internal Medicine & Harvard Medical School, Boston, USA
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark and Open Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 9 a, 3. floor, DK-5000, Odense C, Denmark
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13
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Birkeland SF, Haakonsson AK, Pedersen SS, Rottmann N, Barry MJ, Möller S. Sociodemographic Representativeness in a Nationwide Web-Based Survey of the View of Men on Involvement in Health Care Decision-Making: Cross-Sectional Questionnaire Study. J Med Internet Res 2020; 22:e19517. [PMID: 32663149 PMCID: PMC7495257 DOI: 10.2196/19517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Being able to generalize research findings to a broader population outside of the study sample is an important goal in surveys on the internet. We conducted a nationwide, cross-sectional, web-based survey with vignettes illustrating different levels of patient involvement to investigate men’s preferences regarding participation in health care decision-making. Following randomization into vignette variants, we distributed the survey among men aged 45 to 70 years through the state-authorized digital mailbox provided by the Danish authorities for secure communication with citizens. Objective This study aimed to investigate the sociodemographic representativeness of our sample of men obtained in a nationwide web-based survey using the digital mailbox. Methods Response rate estimates were established, and comparisons were made between responders and nonresponders in terms of age profiles (eg, average age) and municipality-level information on sociodemographic characteristics. Results Among 22,288 men invited during two waves, a total of 6756 (30.31%) participants responded to the survey. In adjusted analyses, responders’ characteristics mostly resembled those of nonresponders. Response rates, however, were significantly higher in older men (odds ratio [OR] 2.83 for responses among those aged 65-70 years compared with those aged 45-49 years, 95% CI 2.58-3.11; P<.001) and in rural areas (OR 1.10 compared with urban areas, 95% CI 1.03-1.18; P=.005). Furthermore, response rates appeared lower in areas with a higher tax base (OR 0.89 in the highest tertile, 95% CI 0.81-0.98; P=.02). Conclusions Overall, the general population of men aged 45 to 70 years was represented very well by the responders to our web-based survey. However, the imbalances identified highlight the importance of supplementing survey findings with studies of the representativeness of other characteristics of the sample like trait and preference features, so that proper statistical corrections can be made in upcoming analyses of survey responses whenever needed.
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Affiliation(s)
- Søren F Birkeland
- Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Anders K Haakonsson
- Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Nina Rottmann
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Nyborg, Denmark
| | - Michael J Barry
- MGH Division of General Internal Medicine, Harvard Medical School, Boston, MA, United States
| | - Sören Möller
- Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
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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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15
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Okoro FO, Song L, Auten B, Whitaker-Brown C, Cornelius J. African-American survivors of prostate cancer: a meta-synthesis of qualitative studies. J Cancer Surviv 2020; 15:40-53. [PMID: 32666419 DOI: 10.1007/s11764-020-00909-4] [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] [Received: 12/18/2019] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to systematically review the current literature on the post-treatment survivorship experiences of African-American men with prostate cancer by exploring qualitative studies to gain a deep understanding of their survivorship experiences. METHOD We searched five databases for studies published from 2008 to 2018. We identified ten relevant qualitative studies, conducted a meta-synthesis using Noblit and Hare's meta-ethnography approach, and evaluated their quality appraisal using the validated Critical Appraisal Skills Program. RESULTS This review generated a total of four main themes and nine subthemes. The Four main themes included coping strategy, psychophysical impact, health system influence, and socioeconomic impact. Spirituality, healthy behaviors, supportive care of spouse/family/friends and non-communicating/reticent were subthemes identified in the coping strategy theme; physical well-being and sexuality and masculinity were subthemes in the psychophysical impact theme; healthcare provider interaction and treatment decision-making were subthemes identified in the health system influence theme, and health insurance status was the subtheme in the socioeconomic impact theme. CONCLUSION Our findings reveal that the experiences of African-American prostate cancer survivors are complex and multidimensional. IMPLICATIONS FOR CANCER SURVIVORS This review highlights the need for further studies with African-American prostate cancer survivors, precisely identify their needs and plan a culturally appropriate intervention to meet those needs.
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Affiliation(s)
- Florence Osita Okoro
- School of Nursing, The University of North Carolina at Charlotte, Charlotte, NC, 28223, USA.
| | - Lixin Song
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC, 27599, USA
| | - Beth Auten
- J. Murrey Atkins Library, The University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Judy Cornelius
- School of Nursing, The University of North Carolina at Charlotte, Charlotte, NC, 28223, USA
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16
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A qualitative examination of patient priorities and preferences during treatment decision-making for recurrent head and neck cancer. Support Care Cancer 2020; 29:377-385. [PMID: 32377842 DOI: 10.1007/s00520-020-05488-9] [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: 12/02/2019] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Patients with recurrent head and neck cancer (HNC) may feel overwhelmed at the prospect of having to consider treatment options particularly if they recently completed treatment for their primary disease or when they have no options that may lead to long-term survival. The purpose of this study was to examine patient priorities and preferences during treatment decision-making for recurrent HNC. METHODS Individuals with newly diagnosed recurrent HNC were recruited at a National Cancer Institute-Designated Cancer Center. Participants were interviewed using a structured interview guide. Descriptive statistics were used to describe participants, and qualitative template analysis was used to analyze interview data. RESULTS Participants (n = 38) considered information from healthcare providers, likelihood of treatment success, and other patient-specific factors in making their treatment decisions. CONCLUSIONS Although patients with recurrent HNC endorse a myriad of decision-making factors, the recommendation of their healthcare provider and the likelihood of treatment success are of paramount importance. Future research should focus on methods to rapidly identify patient priorities at the time of diagnosed recurrence while respecting patient coping and communication styles.
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Antonelli A, Palumbo C, Noale M, Artibani W, Bassi P, Bertoni F, Bracarda S, Bruni A, Corvò R, Gacci M, Magrini SM, Montironi R, Porreca A, Tubaro A, Zagonel V, Maggi S. Overview of potential determinants of radical prostatectomy versus radiation therapy in management of clinically localized prostate cancer: results from an Italian, prospective, observational study (the Pros-IT CNR study). MINERVA UROL NEFROL 2020; 72:595-604. [PMID: 31920063 DOI: 10.23736/s0393-2249.19.03637-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We assessed patients and tumor characteristics, as well as health-related quality of life (HRQoL) items, associated with curative intent treatment decision-making in clinically localized prostate cancer (PCa) patients. METHODS Clinically localized PCa treated with either radical prostatectomy (RP) or radiation therapy (RT) within 12 months from diagnosis were abstracted from The PROState cancer monitoring in ITaly, from the National Research Council (Pros-IT CNR) database. Multivariable logistic regression (MLR) models predicting RT vs. RP were fitted, after adjustment for HRQoL items, patients and tumor characteristics. RESULTS Of 1041 patients, 631 (60.2%) were treated with RP and 410 (39.8%) with RT. Relative to RT, RP patients were younger age (mean age 64.5±6.6 vs. 71.4±4.9, P<0.001) and had higher rates of D'Amico low-intermediate risk groups (31.8 vs. 21.9% low, 46.3% vs. 43.5% intermediate and 21.9% vs. 34.6% high risk, P<0.001). Overall, 93.2% of RP patients were enrolled by urologists and 82.7% of RT patients by radiation oncologists. RP patients had generally higher means values of HRQoL items. In MLR models, higher RT rates were independently associated with more advanced age (odds ratio [OR] 6.14, P<0.001) and BMI≥30 kg/m<sup>2</sup> (OR 1.78, P<0.001). Conversely, lower rates of RT were independently associated with married (OR 0.55, P=0.01) and worker status (OR 0.52, P=0.004), enrollment in academic centers (OR 0.59, P=0.005) and higher physical composite score (OR 0.88, P=0.03) and baseline sexual function items (OR 0.92, P<0.001). CONCLUSIONS Most patients with clinically localized prostate cancer undergoing definitive treatment at Italian institutions receive RP instead of RT. Moreover, those who are younger, married, working, as well as those with better physical and sexual function are more likely to undergo surgery.
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Affiliation(s)
- Alessandro Antonelli
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy -
| | - Carlotta Palumbo
- Unit of Urology, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Marianna Noale
- Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy
| | - Walter Artibani
- Unit of Urology, University Hospital of Verona, Verona, Italy
| | - Pierfrancesco Bassi
- Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Filippo Bertoni
- Prostate Group of AIRO (Italian Association for Radiation Oncology), Milan, Italy
| | - Sergio Bracarda
- Department of Medical Oncology, USL Toscana Sud-Est, IRCCS Istituto Nazionale Tumori Foundation, Arezzo, Italy
| | - Alessio Bruni
- Unit of Radiotherapy, University Hospital of Modena, Modena, Italy
| | - Renzo Corvò
- Unit of Radiation Oncology, IRCCS San Martino University Hospital, Genoa, Italy
| | - Mauro Gacci
- Unit of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Stefano M Magrini
- Unit of Radiation Oncology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, School of Medicine, United Hospitals, Marche Polytechnic University, Ancona, Italy
| | - Angelo Porreca
- Unit of Urology, Polyclinic of Abano Terme, Padua, Italy
| | - Andrea Tubaro
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Stefania Maggi
- Aging Branch, Neuroscience Institute, Section of Padua, National Research Council of Italy, Padua, Italy
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Windon MJ, D'Souza G, Fakhry C. Treatment preferences in human papillomavirus-associated oropharyngeal cancer. Future Oncol 2018; 14:2521-2530. [PMID: 30265132 PMCID: PMC6275561 DOI: 10.2217/fon-2018-0063] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/09/2018] [Indexed: 01/18/2023] Open
Abstract
The population of survivors with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) is rising. The improved prognosis of this etiologic subset is reflected in new staging guidelines as well as ongoing deintensification trials aiming to preserve excellent survival while decreasing treatment-related toxicities. However, as staging criteria and treatment standards evolve in the era of transoral surgery and deintensification, little is known regarding the needs and treatment preferences of patients with HPV-OPSCC. Herein, the current knowledge regarding treatment preferences and priorities, quality of life and concerns among patients with HPV-OPSCC is reviewed.
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Affiliation(s)
- Melina J Windon
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Gypsyamber D'Souza
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Bloomberg–Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Tentori K, Pighin S, Divan C, Crupi V. Mind the gap: Physicians' assessment of patients' importance weights in localized prostate cancer. PLoS One 2018; 13:e0200780. [PMID: 30048485 PMCID: PMC6062014 DOI: 10.1371/journal.pone.0200780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The management of localized prostate cancer is challenging because of the many therapeutic options available, none of which is generally acknowledged as superior to the others in every respect. The selection of the most appropriate treatment should therefore reflect patients' preferences. OBJECTIVE The purpose of the following study was to pilot a new approach for investigating whether urologists who had previously provided patients with therapeutic advice actually knew their patients' importance weights concerning the relevant aspects of the treatments at issue. METHOD Participants were patients recently diagnosed with localized prostate cancer (n = 20), urologists (n = 10), and non-medical professionals (architects, n = 10). These last served as a control group for the urologists and were matched to them for age and gender. Patients' importance weights were elicited by two standard methods (Direct Rating and Value Hierarchy). Each urologist was asked to estimate (with Direct Rating) his/her patient's importance weights. The same task was performed by a corresponding architect, who never met the patient and knew only the patient's age. Univariate and bivariate statistical analyses were performed to investigate the association between importance weights as elicited from patients and as estimated by urologists and architects, as well as to assess whether such agreement was attribute-dependent. RESULTS Participants found both elicitation methods easy to use. The correlation between patients' actual importance weights and urologists' estimates was poor and comparable to that obtained between patients and architects. This result did not depend on the attribute considered, with the sole exception of the attribute "Effectiveness in curing the cancer", which was evaluated as the most important attribute by the majority of participants. CONCLUSION These findings demonstrate the feasibility of the employed methodology and highlight the need to support preference-sensitive decisions in clinical practice by facilitating the elicitation of patients' importance weights, as well as their communication to physicians.
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Affiliation(s)
- Katya Tentori
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - Stefania Pighin
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - Claudio Divan
- Urology Division of the Santa Chiara Hospital, Trento, Italy
| | - Vincenzo Crupi
- Department of Philosophy and Educational Sciences, University of Torino, Torino, Italy
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