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DuMontier C, Loh KP, Soto-Perez-de-Celis E, Dale W. Decision Making in Older Adults With Cancer. J Clin Oncol 2021; 39:2164-2174. [PMID: 34043434 PMCID: PMC8260915 DOI: 10.1200/jco.21.00165] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/12/2021] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clark DuMontier
- Brigham and Women's Hospital, Boston, MA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - William Dale
- City of Hope Comprehensive Cancer Center, Duarte, CA
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Kim G, Kim M. Impacts of Psychological Distress, Gender Role Attitude, and Housekeeping Sharing on Quality of Life of Gynecologic Cancer Survivors. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2018; 24:287-296. [PMID: 37684935 DOI: 10.4069/kjwhn.2018.24.3.287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To determine impacts of psychological distress, gender role attitude, and housekeeping sharing on quality of life of gynecologic cancer survivors. METHODS Subjects completed questionnaires consisting of four measurements: FACT-G (ver. 4) for quality of life, anxiety and depression from SCL-90-R for psychological distress, gender role attitude, and housekeeping sharing. A total of 158 completed data sets were analyzed by descriptive statistics, independent t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis using SPSS 21.0 program. RESULTS Quality of life was significantly and negatively correlated with psychological distress (r=-0.64, p < .001), but not with gender role attitude (r=-0.14, p=.820) or housekeeping sharing (r=0.08, p=.350). Psychological distress was significantly and positively correlated with gender role attitude (r=0.25, p < .010). Factors that significantly impacted quality of life were type of cancer (t=2.27, p=.025), number of treatment methods (t=2.58, p=.011), education level (t=3.33, p < .001), and psychological distress (t=-9.96, p < .001). CONCLUSION Nursing interventions that can relieve psychological distress need to be developed for gynecologic cancer survivors. Nurses need to put priority on ovarian cancer survivors who have low education level with multiple treatment methods when performing nursing interventions to improve the quality of life of gynecologic cancer survivors.
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Affiliation(s)
- Gunhee Kim
- Nurse, Dongnam Institute of Radiological · Medical Sciences, Busan, Korea
| | - Moonjeong Kim
- Nurse, Dongnam Institute of Radiological · Medical Sciences, Busan, Korea
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Clinicopathological, functional, and immediate oncologic outcome assessment in men aged≤50 years with prostate cancer after robotic prostatectomy. Urol Oncol 2016; 35:30.e17-30.e24. [PMID: 27567690 DOI: 10.1016/j.urolonc.2016.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND To define the pathologic and functional outcomes of men 50 years of age and younger with prostate cancer in a contemporary robotic cohort, this study was designed. METHODS Patients undergoing robotic-assisted laparoscopic prostatectomy from April 2002 to April 2012 (n = 2,495) formed the base population for the current analyses. The patients were dichotomized according to their age≤50 (n = 271) and>50-year-old (n = 2,224). Clinicopathological and health-related quality-of-life outcomes were recorded and analyzed for differences. Propensity score matching was used when assessing urinary and sexual function outcome. RESULTS Baseline prostate-specific antigen and clinical stage were similar between men older than 50 years and those younger. Younger patients had less severe disease (D׳Amico risk and Gleason scores) and smaller prostates. Young men had higher rates of erectile function at all time points, including baseline (94% vs. 83% at 12mo, P <0.01). Continence was similar at all time points except for 6 months, where younger patients experienced a faster return than older patients and then remained constant, while older patients continued to improve (96% vs. 89%, P<0.01). After matching process, the difference in erectile function at 6-month follow-up was lost. CONCLUSION Most men aged 50 years and younger who received robotic-assisted laparoscopic prostatectomy had clinically significant prostate cancer. Although histopathologic and short-term oncologic outcomes were nearly identical when compared to older patients, younger men had a more rapid and superior return of erectile function.
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Abstract
In patients diagnosed with prostate cancer, the selection of treatment, including the type of therapy and its aggressiveness, is often based on a patient's age and life expectancy. Life expectancy estimates are too often calculated solely on the patient's chronological age, overlooking comorbid conditions and their severity, which can greatly affect life expectancy. If, in addition to chronological age, comorbid conditions are used to assess a patient's life expectancy, the most appropriate treatment options are more likely to be selected. Older, healthy patients might be able to tolerate more aggressive treatment than would be administered on the basis of their age alone, and younger patients with numerous comorbid conditions could avoid harsh therapy that might not be appropriate given their current state of health. The key idea to consider in treatment selection is what a patient's quality of life would be like with or without a particular treatment option. In an era of precision medicine, decisions regarding the provision of health care should be made rationally and on the basis of objective estimates of the threat of disease and the benefits and costs of intervention and within the context of the patient's characteristics and desires.
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Kent M, Penson DF, Albertsen PC, Goodman M, Hamilton AS, Stanford JL, Stroup AM, Ehdaie B, Scardino PT, Vickers AJ. Successful external validation of a model to predict other cause mortality in localized prostate cancer. BMC Med 2016; 14:25. [PMID: 26860993 PMCID: PMC4748497 DOI: 10.1186/s12916-016-0572-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/26/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Although life expectancy estimation is vital to decision making for localized prostate cancer, there are few, if any, valid and usable tools. Our goal was to create and validate a prediction model for other cause mortality in localized prostate cancer patients that could aid clinician's initial treatment decisions at the point of care. METHODS We combined an adjusted Social Security Administration table with a subset of comorbidities from a UK actuarial life expectancy model. Life tables were adjusted on the basis of survival data from a cohort of almost 10,000 radical prostatectomy patients treated at four major US academic institutions. Comorbidity-specific odds ratios were calculated and incorporated with baseline risk of mortality. We externally validated the model on 2898 patients from the Prostate Cancer Outcomes Study, which included men diagnosed with prostate cancer in six SEER cancer registries. These men had sufficient follow-up for our endpoints of 10- and 15-year mortality and also had self-reported comorbidity data. RESULTS Life expectancy for prostate cancer patients were close to that of a typical US man who was 3 years younger. On external validation, 10- and 15-year concordance indexes were 0.724 and 0.726, respectively. Our model exhibited excellent calibration. Taking into account differences between how comorbidities are used in the model versus how they were recorded in the validation cohort, calibration would improve for most patients, but there would be overestimation of the risk of death in the oldest and sickest patients. CONCLUSIONS We successfully created and externally validated a new life expectancy prediction model that, while imperfect, has clear advantages to any alternative. We urge consideration of its use in counseling patients with localized prostate cancer.
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Affiliation(s)
- Matthew Kent
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA
- Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, CT, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Behfar Ehdaie
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
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Abstract
Since the dissemination of prostate-specific antigen screening, most men with prostate cancer are now diagnosed with localized, low-risk prostate cancer that is unlikely to be lethal. Nevertheless, nearly all of these men undergo primary treatment with surgery or radiation, placing them at risk for longstanding side effects, including erectile dysfunction and impaired urinary function. Active surveillance and other observational strategies (ie, expectant management) have produced excellent long-term disease-specific survival and minimal morbidity for men with prostate cancer. Despite this, expectant management remains underused for men with localized prostate cancer. In this review, various approaches to the expectant management of men with prostate cancer are summarized, including watchful waiting and active surveillance strategies. Contemporary cancer-specific and health care quality-of-life outcomes are described for each of these approaches. Finally, contemporary patterns of use, potential disparities in care, and ongoing research and controversies surrounding expectant management of men with localized prostate cancer are discussed.
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Affiliation(s)
- Christopher P Filson
- Health Services Research Fellow, Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Leonard S Marks
- Professor of Urology, Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Mark S Litwin
- Chair and Professor of Urology, Department of Urology, David Geffen School of Medicine at UCLA; Professor of Health Services, Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
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Kent M, Vickers AJ. A systematic literature review of life expectancy prediction tools for patients with localized prostate cancer. J Urol 2014; 193:1938-42. [PMID: 25463998 DOI: 10.1016/j.juro.2014.11.082] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We aimed to develop a clinical decision support tool for clinicians counseling patients with localized prostate cancer. The tool would provide estimates of patient life expectancy based on age, comorbidities and tumor characteristics. We reviewed the literature to find suitable prediction models. MATERIALS AND METHODS We searched the literature for prediction models for life expectancy. Models were evaluated in terms of whether they provided an estimate of risk, incorporated comorbidities, were clinically feasible and gave plausible estimates. Clinical feasibility was defined in terms of whether the model provided coefficients and could be used in the initial consultation for men across a wide age range without an undue burden of data gathering. RESULTS Models in the literature were characterized by the use of life years rather than a risk of death, questionable approaches to comorbidities, implausible estimates, questionable recommendations and poor clinical feasibility. We found tools that involved applying an unvalidated approach to assessing comorbidities to a clearly erroneous life expectancy table, or requiring that a treatment decision be made before life expectancy could be calculated, or giving highly implausible estimates such as a substantial risk of prostate cancer specific mortality even for a highly comorbid 80-year-old with Gleason 6 disease. CONCLUSIONS We found gross deficiencies in current tools that predict risk of death from other causes. No existing model was suitable for implementation in our clinical decision support system.
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Affiliation(s)
- Matthew Kent
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan Kettering Cancer Center, New York, New York.
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Lifetime risk for cancer death by sex and smoking status: the lifetime risk pooling project. Cancer Causes Control 2012; 23:1729-37. [PMID: 22825072 DOI: 10.1007/s10552-012-9959-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 04/06/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Understanding how sex and tobacco exposure may modify lifetime risks for cancer mortality is important for effective communication of risk in targeted public health messages. OBJECTIVE To determine lifetime risk estimates for cancer death associated with sex and smoking status in the United States. METHODS A pooled cohort design using ten well-defined epidemiologic cohorts including middle-aged and older individuals was used to estimate the lifetime risk for cancer death at selected index ages, with death from non-cancer causes as the competing risk, by sex and smoking status. RESULTS There were a total of 11,317 cancer-related deaths. At age 45 years, the lifetime risk of cancer death for male smokers is 27.7 % (95 % CI 24.0-31.4 %) compared to 15.8 % (95 % CI 12.7-18.9 %) for male non-smokers. At age 45 years, the lifetime risk of cancer death for female smokers is 21.7 % (95 % CI 18.8-24.6 %) compared to 13.2 % (95 % CI 11.0-15.4 %) for female non-smokers. Remaining lifetime risk for cancer death declined with age, and men have a greater risk for cancer death compared to women. Adjustment for competing risk of death, particularly representing cardiovascular mortality, yielded a greater change in lifetime risk estimates for men and smokers compared to women and non-smokers. CONCLUSIONS At the population level, the lifetime risk for cancer death remains significantly higher for smokers compared to non-smokers, regardless of sex. These estimates may provide clinicians with useful information for counseling individual patients and highlight the need for continued public health efforts related to smoking cessation.
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Lavery HJ, Levinson AW, Brajtbord JS, Samadi DB. Candidacy for active surveillance may be associated with improved functional outcomes after prostatectomy. Urol Oncol 2011; 31:187-92. [PMID: 21795076 DOI: 10.1016/j.urolonc.2010.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/19/2010] [Accepted: 11/22/2010] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In an effort to curb overtreatment, active surveillance (AS) has grown in popularity as an option for men with low-risk prostate cancer. We evaluated the histopathologic and functional outcomes of patients who qualified for AS, but opted for robotic-assisted laparoscopic prostatectomy (RALP), and compared them to non-AS candidates. METHODS An institutional database of 1,477 RALP performed by a single surgeon was queried for AS candidates, defined as PSA <10 ng/mL, biopsy Gleason score ≤6 with a minimum of 10 biopsy cores, <3 positive cores with <50% tumor volume in a single core and clinical stage ≤T2a. RESULTS Of the 352 patients who would have qualified for AS, 159 (45%) were upgraded: 143 (41%) to Gl 3 + 4, 16 (4.5%) to 4 + 3, zero to Gleason 8 or higher. Seventeen (4.8%) patients were upstaged to pT3. AS candidates were younger and had more favorable tumor characteristics, but similar preoperative functional status. Bilateral nerve sparing was performed on 96% of AS candidates vs. 86% of non-AS candidates (P < 0.001). After 12 months of follow-up in patients who received bilateral nerve sparing, continence was higher in the AS cohort (98% vs. 92%, P < 0.001) but potency was equivalent (87% in each, P = 0.89). On multivariable analysis, candidacy for AS was independently associated with improved continence, but not potency. CONCLUSIONS In addition to having the expected favorable histopathologic features, AS candidates who desire definitive therapy have a high likelihood of achieving excellent functional outcomes, perhaps superior to non-AS candidates, following RALP.
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Affiliation(s)
- Hugh J Lavery
- Department of Urology, The Mount Sinai Medical Center, New York, NY 10022, USA.
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Reichlin L, Mani N, McArthur K, Harris AM, Rajan N, Dacso CC. Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer. J Med Internet Res 2011; 13:e4. [PMID: 21239374 PMCID: PMC3221354 DOI: 10.2196/jmir.1519] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 06/28/2010] [Accepted: 07/12/2010] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Men diagnosed with localized prostate cancer face a potentially life-altering treatment decision that can be overwhelming. Enhancing patient knowledge through education can significantly reduce feelings of uncertainty while simultaneously increasing confidence in decision making. Serious games have been shown in other populations to increase health knowledge and assist with the health decision-making process. We developed an interactive serious game, Time After Time, which translates evidence-based treatment outcome data into an accessible and understandable format that men can utilize in their prostate cancer treatment decision-making process. The game specifically aims to raise men's awareness and understanding of the impact of health-related quality of life issues associated with the major treatment options and to enrich their conversations with their health care providers. OBJECTIVE This study determined the acceptability and usability of the alpha version of Time After Time, an interactive decision aid for men diagnosed with localized prostate cancer, in order to inform future iterations of the serious game. METHODS The study employed a mixed methods approach to assess the acceptability and usability of the Time After Time serious game using qualitative focus groups and a quantitative Likert scale survey. RESULTS A total of 13 men who had already completed treatment for localized prostate cancer completed the survey and participated in focus group meetings. The majority of the study participants rated Time After Time as an appropriate decision tool for localized prostate cancer and verified that it meets its goals of increasing focus on side effects and generating questions for the patient's health care team. However, participants also expressed concerns about game usability and the diversity of information covered regarding treatment options and potential treatment outcomes. CONCLUSIONS Serious games are a promising approach to health education and decision support for older men. Participants were receptive to the idea of a serious game as a decision aid in localized prostate cancer. However, usability issues are a major concern for this demographic, as is clarity and transparency of data sources.
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Affiliation(s)
- Lindsey Reichlin
- The Abramson Center for the Future of Health, a joint effort of The Methodist Hospital Research Institute and College of Technology, Houston, TX 77030, USA
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