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Wang Z, Kwan ML, Haque R, Singh PK, Goniewicz M, Pratt R, Lee VS, Roh JM, Ergas IJ, Cannavale KL, Loo RK, Aaronson DS, Quesenberry CP, Zhang Y, Ambrosone CB, Kushi LH, Tang L. Modifying Effects of Genetic Variations on the Association Between Dietary Isothiocyanate Exposure and Non-muscle Invasive Bladder Cancer Prognosis in the Be-Well Study. Mol Nutr Food Res 2024; 68:e2400087. [PMID: 38581346 DOI: 10.1002/mnfr.202400087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/10/2024] [Indexed: 04/08/2024]
Abstract
SCOPE Dietary isothiocyanate (ITC) exposure from cruciferous vegetable (CV) intake may improve non-muscle invasive bladder cancer (NMIBC) prognosis. This study aims to investigate whether genetic variations in key ITC-metabolizing/functioning genes modify the associations between dietary ITC exposure and NMIBC prognosis outcomes. METHODS AND RESULTS In the Bladder Cancer Epidemiology, Wellness, and Lifestyle Study (Be-Well Study), a prospective cohort of 1472 incident NMIBC patients, dietary ITC exposure is assessed by self-reported CV intake and measured in plasma ITC-albumin adducts. Using Cox proportional hazards regression models, stratified by single nucleotide polymorphisms (SNPs) in nine key ITC-metabolizing/functioning genes, it is calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence and progression. The rs15561 in N-acetyltransferase 1 (NAT1) is alter the association between CV intake and progression risk. Multiple SNPs in nuclear factor E2-related factor 2 (NRF2) and nuclear factor kappa B (NFκB) are modify the associations between plasma ITC-albumin adduct level and progression risk (pint < 0.05). No significant association is observed with recurrence risk. Overall, >80% study participants are present with at least one protective genotype per gene, showing an average 65% reduction in progression risk with high dietary ITC exposure. CONCLUSION Despite that genetic variations in ITC-metabolizing/functioning genes may modify the effect of dietary ITCs on NMIBC prognosis, dietary recommendation of CV consumption may help improve NMIBC survivorship.
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Affiliation(s)
- Zinian Wang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Reina Haque
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Prashant K Singh
- Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maciej Goniewicz
- Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Rachel Pratt
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - David S Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | | | - Yuesheng Zhang
- Department of Pharmacology and Toxicology, and Massey Comprehensive Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Wang Z, Kwan ML, Haque R, Pratt R, Lee VS, Roh JM, Ergas IJ, Cannavale KL, Loo RK, Aaronson DS, Quesenberry CP, Ambrosone CB, Kushi LH, Tang L. Environmental and Occupational Exposures and Prognosis in Patients with Non-Muscle Invasive Bladder Cancer in the Be-Well Study. Am J Epidemiol 2023:kwad236. [PMID: 38055616 DOI: 10.1093/aje/kwad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Bladder cancer is primarily diagnosed as non-muscle invasive bladder cancer (NMIBC) with high recurrence and progression rates. Environmental and occupational exposures to carcinogens are well-known risk factors for developing bladder cancer, yet their effects on prognosis remain unknown. In the Be-Well Study, a population-based prospective cohort study of 1,472 patient with newly diagnosed NMIBC from 2015 to 2019, we examined history of environmental and occupational exposures in relation to tumor stage and grade at initial diagnosis by multivariable logistic regression, and subsequent recurrence and progression by Cox proportional hazards regression. Exposure to environmental and occupational carcinogens was significantly associated with increased risk of progression (HR = 1.79; 95% CI: 1.04, 3.09), specifically increased progression into muscle-invasive disease (HR = 2.28; 95% CI: 1.16, 4.50). Exposure to asbestos and arsenic were associated with increased odds of advanced stage at diagnosis (asbestos: OR = 1.43; 95% CI: 1.11, 1.84; arsenic, OR = 1.27; 95% CI: 1.01, 1.63), and formaldehyde exposure was associated with increased risk of recurrence (HR = 1.38; 95% CI: 1.12, 1.69). Our findings suggest that history of these exposures may benefit current risk stratification systems to tailor clinical care and improve prognosis in patients with NMIBC.
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Affiliation(s)
- Zinian Wang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Reina Haque
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Rachel Pratt
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente Downey Medical Center, Downey, CA
| | - David S Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | | | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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3
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Wang Z, Kwan ML, Haque R, Goniewicz M, Pratt R, Lee VS, Roh JM, Ergas IJ, Cannavale KL, Loo RK, Aaronson DS, Quesenberry CP, Zhang Y, Ambrosone CB, Kushi LH, Tang L. Associations of dietary isothiocyanate exposure from cruciferous vegetable consumption with recurrence and progression of non-muscle-invasive bladder cancer: findings from the Be-Well Study. Am J Clin Nutr 2023; 117:1110-1120. [PMID: 37044209 PMCID: PMC10447500 DOI: 10.1016/j.ajcnut.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND High recurrence and progression rates are major clinical challenges for non-muscle-invasive bladder cancer (NMIBC). Dietary isothiocyanates (ITCs), phytochemicals primarily from cruciferous vegetables (CV), show strong anticancer activities in preclinical BC models, yet their effect on NMIBC prognosis remains unknown. OBJECTIVES This study aimed to investigate the associations of dietary ITC exposure at diagnosis with NMIBC recurrence and progression. METHODS The study analyzed 1143 participants from the Be-Well study, a prospective cohort of newly diagnosed NMIBC cases in 2015-2019 with no prior history of BC. Dietary ITC exposure was indicated by self-reported CV intake, estimated ITC intake, urinary metabolites, and plasma ITC-albumin adducts. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence and progression, and unconditional logistic regression models were used to calculate odds ratios (ORs) and 95% CIs for delayed and multiple recurrence. RESULTS Over a mean follow-up of 25 mo, 347 (30%) developed recurrence and 77 (6.7%) had disease progression. Despite no significant associations with the overall risk of recurrence, urinary ITC metabolites (OR: 1.96; 95% CI: 1.01, 4.43) and dietary ITC intake (OR: 2.13; 95% CI: 1.03, 4.50) were associated with late recurrence after 12-mo postdiagnosis compared with before 12-mo postdiagnosis. Raw CV intake was associated with reduced odds of having ≥2 recurrences compared with having one (OR: 0.34; 95% CI: 0.16, 0.68). Higher plasma concentrations of ITC-albumin adducts were associated with a reduced risk of progression, including progression to muscle-invasive disease (for benzyl ITC, HR: 0.40; 95% CI: 0.17, 0.93; for phenethyl ITC, HR: 0.40; 95% CI: 0.19, 0.86). CONCLUSIONS Our findings indicate the possible beneficial role of dietary ITCs in NMIBC prognosis. Given the compelling preclinical evidence, increasing dietary ITC exposure with CV intake could be a promising strategy to attenuate recurrence and progression risks in patients with NMIBC.
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Affiliation(s)
- Zinian Wang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Reina Haque
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Maciej Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Rachel Pratt
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente Downey Medical Center, Downey, CA, United States
| | - David S Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Yuesheng Zhang
- Department of Pharmacology and Toxicology, and Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
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4
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Kwan ML, Haque R, Young-Wolff KC, Lee VS, Roh JM, Ergas IJ, Wang Z, Cannavale KL, Ambrosone CB, Loo RK, Aaronson DS, Quesenberry CP, Kushi LH, Tang L. Smoking Behaviors and Prognosis in Patients With Non-Muscle-Invasive Bladder Cancer in the Be-Well Study. JAMA Netw Open 2022; 5:e2244430. [PMID: 36449286 PMCID: PMC9713602 DOI: 10.1001/jamanetworkopen.2022.44430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
Importance Tobacco smoking is an established risk factor associated with bladder cancer, yet its impact on bladder cancer prognosis is unclear. Objective To examine associations of use of tobacco (cigarettes, pipes, and cigars), e-cigarettes, and marijuana with risk of recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) and to explore use of smoking cessation interventions. Design, Setting, and Participants The Be-Well Study is a prospective cohort study of patients with NMIBC diagnosed from 2015 to 2019 and followed-up for 26.4 months in the Kaiser Permanente Northern and Southern California integrated health care system. Eligibility criteria were age at least 21 years, first NMIBC diagnosis (stages Ta, Tis, or T1), alive, and not in hospice care. Exclusion criteria were previous diagnosis of bladder cancer or other cancer diagnoses within 1 year prior to or concurrent with NMIBC diagnosis. Data were analyzed from April 1 to October 4, 2022. Exposures Use of cigarettes, pipes, cigars, e-cigarettes, and marijuana was reported in the baseline interview. Use of smoking cessation interventions (counseling and medications) was derived from electronic health records. Main Outcomes and Measures Hazard ratios (HRs) and 95% CIs of recurrence and progression of bladder cancer were estimated by multivariable Cox proportional hazards regression. Results A total of 1472 patients (mean [SD] age at diagnosis, 70.2 [10.8%] years; 1129 [76.7%] male patients) with NMIBC were enrolled at a mean (SD) of 2.3 (1.3) months after diagnosis, including 874 patients (59.4%) who were former smokers and 111 patients (7.5%) who were current cigarette smokers; 67 patients (13.7%) smoked pipes and/or cigars only, 65 patients (4.4%) used e-cigarettes, 363 patients (24.7%) used marijuana. Longer cigarette smoking duration and more pack-years were associated with higher risk of recurrence in a dose-dependent manner, with the highest risks for patients who had smoked for 40 or more years (HR, 2.36; 95% CI, 1.43-3.91) or 40 or more pack-years (HR, 1.97; 95% CI, 1.32-2.95). There was no association of having ever smoked, being a former or current cigarette smoker, and years since quit smoking with recurrence risk. No associations with pipes, cigars, e-cigarettes, or marijuana were found. Of 102 patients offered a smoking cessation intervention, 57 (53.8%) received an interventions after diagnosis, with female patients more likely than male patients to engage in such interventions (23 of 30 female patients [76.7%] vs 34 of 76 male patients [44.7%]; P = .003). Conclusions and Relevance These findings suggest that longer duration and more pack-years of cigarette smoking were associated with higher risk of NMIBC recurrence. Cigarette smoking remains a critical exposure before and after diagnosis in survivors of NMIBC.
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Affiliation(s)
- Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Reina Haque
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Valerie S. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Janise M. Roh
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Isaac J. Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Zinian Wang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kimberly L. Cannavale
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Christine B. Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ronald K. Loo
- Department of Urology, Kaiser Permanente Downey Medical Center, Downey, California
| | - David S. Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | | | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Danforth KN, Sidell MA, Luong TQ, Yi DK, Yamamoto A, Kawatkar AA, Kim PH, Loo RK, Williams SG. Care Quality and Variability in the Use of Intravesical Therapy for Initial Treatment of Nonmuscle Invasive Bladder Cancer Within a Large, Diverse Integrated Delivery System. Urology 2019; 131:93-103. [PMID: 31129191 DOI: 10.1016/j.urology.2019.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine treatment variability, disparities, and quality among newly diagnosed nonmuscle invasive bladder cancer (NMIBC) patients, and to identify factors associated with treatment use in a large, diverse integrated delivery system. METHODS Retrospective cohort study of 5386 NMIBC patients diagnosed between January 2001 and June 2015 within Kaiser Permanente Southern California. Electronic health data were used to identify treatment outcomes and patient, provider, and tumor characteristics. Outcomes were use of (1) postoperative intravesical chemotherapy, (2) induction Bacille Calmette-Guérin (BCG) immunotherapy, and (3) any intravesical therapy. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using generalized linear mixed models with a binary outcome and urologist as a random effect. RESULTS From 2001 to 2015, 41% of newly diagnosed NMIBC patients were treated with intravesical therapy. Postoperative chemotherapy use increased significantly over this period (OR per-year = 1.16, 95% CI: 1.07-1.25). BCG use was strongly associated with tumor characteristics: patients with high-grade or carcinoma in situ tumors were more likely to receive BCG (OR = 10.10, 95% CI: 8.39-12.16). Few treatment differences were found by sex or race/ethnicity, but were observed by age. Wide treatment variability across urologists was observed, with some urologists never using intravesical therapy as part of initial treatment while others almost always used it. Differences across urologists accounted for more variability in postoperative chemotherapy (intraclass correlation coefficient = 0.52) than BCG immunotherapy (intraclass correlation coefficient = 0.11) use. CONCLUSION Substantial variability in initial treatment of NMIBC was observed across urologists, accounting for tumor, patient, and provider characteristics. Results suggest a considerable opportunity for quality improvement programs to reduce unwanted treatment variability and improve care for patients.
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Affiliation(s)
- Kim N Danforth
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | - Margo A Sidell
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Tiffany Q Luong
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - David K Yi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ayae Yamamoto
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA; Department of Quality and Risk Management, Kaiser Foundation Hospital and Health Plan, Pasadena, CA
| | - Aniket A Kawatkar
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Philip H Kim
- Department of Urology, Southern California Permanente Medical Group, San Diego, CA
| | - Ronald K Loo
- Department of Urology, Southern California Permanente Medical Group, Downey, CA
| | - Stephen G Williams
- Department of Urology, Southern California Permanente Medical Group, Riverside, CA
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6
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Wallner LP, Slezak JM, Loo RK, Bastani R, Jacobsen SJ. Ten-Year Trends in Preventive Service Use Before and After Prostate Cancer Diagnosis: A Comparison with Noncancer Controls. Perm J 2018; 21:16-184. [PMID: 29035180 DOI: 10.7812/tpp/16-184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Few studies have assessed the longer-term quality of preventive care in prostate cancer (PCa) survivors. OBJECTIVE To compare the rates of preventive services among PCa survivors five years before and after diagnosis, to men without PCa. DESIGN Men enrolled in Kaiser Permanente Southern California with newly diagnosed PCa (2002-2008) were matched 1:1 to men without a PCa diagnosis on age, race, and timing of prostate-specific antigen test (N = 31,180). The use of preventive services, including colorectal cancer screening, diabetes tests, lipid panels, and influenza and pneumococcal vaccinations was assessed 5 years before and after diagnosis (or index date for controls). MAIN OUTCOME MEASURES Relative rates (RRs) of use were calculated for cases and controls separately and compared using Poisson regression, adjusting for comorbidities and outpatient utilization in 2014. RESULTS Overall, the rates of preventive services were lower among men with PCa vs men without PCa. However, in the 5 years after diagnosis, rates of preventive service use for all services were greater among PCa survivors vs men without PCa (colorectal cancer: RR = 1.05, 95% confidence interval [CI] = 1.01-1.10; lipids: RR = 1.10, 95% CI = 1.08-1.11; hemoglobin A1C: RR = 1.17, 95% CI = 1.14-1.19; glucose: RR = 1.24, 95% CI = 1.23-1.26; influenza vaccine: RR = 1.05, 95% CI = 1.03-1.07; pneumococcal vaccine: RR = 1.03, 95% CI = 0.97-1.09). CONCLUSION Delivery of preventive care improved after PCa diagnosis, with survivors receiving comparable preventive care to men without PCa during the five years following diagnosis.
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Affiliation(s)
- Lauren P Wallner
- Assistant Professor of Internal Medicine and Epidemiology at the University of Michigan in Ann Arbor, and an Adjunct Investigator at the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Jeffrey M Slezak
- Research Manager of Biostatistics for the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Ronald K Loo
- Regional Assistant Medical Director for the Southern California Permanente Medical Group and Chair of the Kaiser Permanente Interregional Urology Chiefs.
| | - Roshan Bastani
- Professor of Health Management and Policy at the University of California, Los Angeles.
| | - Steven J Jacobsen
- Senior Director of Research in the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena.
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Wallner LP, DiBello JR, Li BH, Van Den Eeden SK, Weinmann S, Ritzwoller DP, Abell JE, D'Agostino R, Loo RK, Aaronson DS, Horwitz RI, Jacobsen SJ. The Use of 5-Alpha Reductase Inhibitors to Manage Benign Prostatic Hyperplasia and the Risk of All-cause Mortality. Urology 2018; 119:70-78. [PMID: 29906480 DOI: 10.1016/j.urology.2018.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/07/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To compare the risk of mortality among men treated for benign prostatic hyperplasia (BPH) with 5 alpha-reductase inhibitors (5ARI) to those treated with alpha-blockers (AB) in community practice settings. METHODS We employed a retrospective matched cohort study in 4 regions of an integrated healthcare system. Men aged 50 years and older who initiated pharmaceutical treatment for BPH and/or lower urinary tract symptoms between 1992 and 2008 and had at least 3 consecutive prescriptions that were eligible and followed through 2010 (N = 174,895). Adjusted hazard ratios were used to estimate the risk of mortality due to all-causes associated with 5ARI use (with or without concomitant ABs) as compared to AB use. RESULTS In this large and diverse sample with 543,523 person-years of follow-up, 35,266 men died during the study period, 18.9% of the 5ARI users and 20.4% of the AB users. After adjustment for age, medication initiation year, race, region, prior AB history, Charlson score, and comorbidities, 5ARI use was not associated with an increased risk of mortality when compared to AB use (Adjusted hazard ratios: 0.64, 95% confidence interval: 0.62, 0.66). CONCLUSION Among men receiving medications for BPH in community practice settings, 5ARI use was not associated with an increased risk of mortality when compared to AB use. These data provide reassurance about the safety of using 5ARIs in general practice to manage BPH and/or lower urinary tract symptoms.
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Affiliation(s)
- Lauren P Wallner
- Department of Medicine and Epidemiology, University of Michigan, Ann Arbor, USA, MI; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA, CA.
| | - Julia R DiBello
- Real World Evidence & Epidemiology, GlaxoSmithKline, Harrisburg, USA, PA
| | - Bonnie H Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA, CA
| | | | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, USA, OR
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA, CO
| | | | - Ralph D'Agostino
- Department of Biostatistical Science, Wake Forest University, Winston-Salem, USA NC
| | - Ronald K Loo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA, CA
| | - David S Aaronson
- Division of Research, Kaiser Permanente Northern California, Oakland, USA, CA
| | - Ralph I Horwitz
- Institute for Transformative Medicine, Temple University and Visiting Scholar, Institute of Medicine, Philadelphia, USA, PA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA, CA
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8
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Chien GW, Slezak JM, Harrison TN, Jung H, Gelfond JS, Zheng C, Wu E, Contreras R, Loo RK, Jacobsen SJ. Health-related quality of life outcomes from a contemporary prostate cancer registry in a large diverse population. BJU Int 2017; 120:520-529. [DOI: 10.1111/bju.13843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gary W. Chien
- Department of Urology; Kaiser Permanente Los Angeles Medical Center; Los Angeles CA USA
| | - Jeff M. Slezak
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | - Teresa N. Harrison
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | - Howard Jung
- Department of Urology; Kaiser Permanente; Honolulu HI USA
| | - Joy S. Gelfond
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | - Chengyi Zheng
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | - Edward Wu
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | - Richard Contreras
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | - Ronald K. Loo
- Department of Urology; Kaiser Permanente Downey Medical Center; Downey CA USA
| | - Steven J. Jacobsen
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
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Goharderakhshan RZ, NG CK, Guerrero C, Loo RK. MP95-15 POPULATION MANAGEMENT KIDNEY STONE CARE APPROACH IMPROVES COMPLIANCE WITH THE AMERICAN UROLOGICAL ASSOCIATION (AUA) RECOMMENDATIONS ON MEDICAL MANAGEMENT OF KIDNEY STONES. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Lippmann QK, Slezak JM, Menefee SA, Ng CK, Whitcomb EL, Loo RK. Evaluation of microscopic hematuria and risk of urologic cancer in female patients. Am J Obstet Gynecol 2017; 216:146.e1-146.e7. [PMID: 27751797 DOI: 10.1016/j.ajog.2016.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/21/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Urologic cancer has a lower prevalence in women compared with men; however, there are no differences in the recommended evaluation for women and men with microscopic hematuria. OBJECTIVES The purpose of this study was to identify risk factors that are associated with urologic cancer in women with microscopic hematuria and to determine the applicability of a hematuria risk score for women. STUDY DESIGN We conducted a retrospective cohort study within an integrated healthcare system in Southern California. All urinalyses with microscopic hematuria (>3 red blood cells per high-power field) that were performed from 2009-2015 were identified. Women who were referred for urologic evaluation were entered into a prospective database. Clinical and demographic variables that included the presence of gross hematuria in the preceding 6 months were recorded. The cause of the hematuria, benign or malignant, was entered into the database. Cancer rates were compared with the use of chi-square and logistic regression models. Adjusted risk ratios of urologic cancer were estimated with the use of multivariate regression analysis. We also explored the applicability of a previously developed, gender nonspecific, hematuria risk score in this female cohort. RESULTS A total of 2,705,696 urinalyses were performed in women during the study period, of which 552,119 revealed microscopic hematuria. Of these, 14,539 women were referred for urologic evaluation; clinical data for 3573 women were entered into the database. The overall rate of urologic cancer was 1.3% (47/3573). In women <60 years old, the rate of urologic cancer was 0.6% (13/2053) compared with 2.2% (34/1520) in women ≥60 years old (P<.01). In women who reported a history of gross hematuria, the rate of urologic cancer was 5.8% (20/346) compared with a 0.8% (27/3227) in women with no history of gross hematuria (P<.01). In multivariate analysis, > 60 years old (odds ratio, 3.1; 95% confidence interval, 1.6-5.9), a history of smoking (odds ratio, 3.2; 95% confidence interval, 1.8-5.9), and a history of gross hematuria in the previous 6 months (odds ratio, 6.2; 95% confidence interval, 3.4-11.5) were associated with urologic cancers. A higher microscopic hematuria risk score was associated with an increased risk of cancer in this test cohort (P<.01). Women in the highest risk group had a urologic cancer rate of 10.8% compared with a rate of 0.5% in the lowest risk group. CONCLUSIONS In this female population, >60 years old and a history of smoking and/or gross hematuria were the strongest predictors of urologic cancer. Absent these risk factors, the rate of urologic cancer did not exceed 0.6%. A higher hematuria risk score correlated significantly with the risk of urologic cancer in this female test cohort.
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11
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Wallner LP, DiBello JR, Li BH, Van Den Eeden SK, Weinmann S, Ritzwoller DP, Abell JE, D'Agostino R, Loo RK, Aaronson DS, Richert-Boe K, Horwitz RI, Jacobsen SJ. 5-Alpha Reductase Inhibitors and the Risk of Prostate Cancer Mortality in Men Treated for Benign Prostatic Hyperplasia. Mayo Clin Proc 2016; 91:1717-1726. [PMID: 28126151 PMCID: PMC8080281 DOI: 10.1016/j.mayocp.2016.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the risk of prostate cancer mortality among men treated with 5- alpha reductase inhibitors (5-ARIs) with those treated with alpha-adrenergic blockers (ABs) in community practice settings. PATIENTS AND METHODS A retrospective matched cohort (N=174,895) and nested case-control study (N=18,311) were conducted in 4 regions of an integrated health care system. Men 50 years and older who initiated pharmaceutical treatment for benign prostatic hyperplasia between January 1, 1992, and December 31, 2007, and had at least 3 consecutive prescriptions were followed through December 31, 2010. Adjusted subdistribution hazard ratios, accounting for competing risks of death, and matched odds ratios were used to estimate prostate cancer mortality associated with 5-ARI use (with or without concomitant ABs) as compared with AB use. RESULTS In the cohort study, 1,053 men died of prostate cancer (mean follow-up, 3 years), 15% among 5-ARI users (N= 25,388) and 85% among AB users (N=149,507) (unadjusted mortality rate ratio, 0.80). After accounting for competing risks, it was found that 5-ARI use was not associated with prostate cancer mortality when compared with AB use (adjusted subdistribution hazard ratio, 0.85; 95% CI, 0.72-1.01). Similar results were observed in the case-control study (adjusted matched odds ratio, 0.95; 95% CI, 0.78-1.17). CONCLUSION Among men being pharmaceutically treated for benign prostatic hyperplasia, 5-ARI use was not associated with an increased risk of prostate cancer-specific mortality when compared with AB use. The increased prevalence of high-grade lesions at the time of diagnosis noted in our study and the chemoprevention trials may not result in increased prostate cancer mortality.
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Affiliation(s)
- Lauren P Wallner
- Department of Medicine, University of Michigan, Ann Arbor, MI; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | | | - Bonnie H Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, ORG
| | | | | | - Ralph D'Agostino
- Department of Biostatistical Science, Wake Forest University, Winston-Salem, NC
| | - Ronald K Loo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - David S Aaronson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Ralph I Horwitz
- Temple University, Philadelphia, PA; Institute of Medicine, Washington, DC
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Kwan ML, Kushi LH, Quinn VP, Ghai NR, Roh JM, Becerra T, Martinez A, Cannavale KL, Carruth AS, Lee VS, Ergas IJ, Loo RK, Aaronson DS, Zhang Y, Ambrosone CB, Tang L. Abstract 3415: Identifying lifestyle and genetic factors to prevent recurrence of non-muscle invasive bladder cancer in a prospective cohort study at Kaiser Permanente (The Be-Well Study). Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Bladder cancer is one of the top 10 incident cancers. Most cases (75%) are diagnosed as non-muscle invasive disease (NMID), yet NMID typically recurs (70%) and a subset (25%) progresses to muscle-invasive disease. The Be-Well Study is an NCI-funded collaborative, multi-center prospective cohort study, with NMID bladder cancer patients enrolled at Kaiser Permanente Northern (KPNC) and Southern California (KPSC) and bioassays performed at Roswell Park Cancer Institute (RPCI). The goal is to examine diet and lifestyle factors and prognosis, with an emphasis on cruciferous vegetable (CV) intake and their unique isothiocyanate (ITC) content, the modifying effect of polymorphisms of ITC-metabolizing genes, and interactions with treatment. Our prior work suggests that dietary ITCs may prevent disease recurrence and progression in NMID patients.
Methods: Newly-diagnosed patients with NMID (Ta, Tis, T1), who are English-speaking, KP members, and ≥21 years of age, are ascertained rapidly from electronic pathology reports and enrolled on average 2.6 months post-diagnosis. Baseline participation consists of a telephone interview including a food frequency questionnaire focused on CV intake, and providing blood and urine samples. Patients will be contacted for follow-up interviews and urine samples at 12 and 24 months. Smoking, medication use, occupational exposures, physical activity, quality of life, and urinary function are also queried. Biospecimens are processed and assayed at RPCI. Strong support for Be-Well by KP urologists will promote dissemination of study results in patient care and recommendations.
Results: Recruitment began in February 2015. To date, 222 patients have completed the baseline interview, representing 78% male and 22% female, and 81% White, 7% Black, 5% Hispanic, 3% Asian, and 4% Other. Urine specimens have been collected from 82% of consented patients. Blood specimens have been collected from 85% of KPNC patients, and collection at KPSC began in November 2015. The 12-month follow-up interview and outcome ascertainment for disease recurrence and progression are scheduled to begin in February 2016.
Conclusions: The Be-Well Study is poised to be the largest and most comprehensive study to answer critical questions related to prognosis, quality of life, and care in patients diagnosed with early-stage bladder cancer.
Citation Format: Marilyn L. Kwan, Lawrence H. Kushi, Virginia P. Quinn, Nirupa R. Ghai, Janise M. Roh, Tracy Becerra, Adriana Martinez, Kimberly L. Cannavale, Alexander S. Carruth, Valerie S. Lee, Isaac J. Ergas, Ronald K. Loo, David S. Aaronson, Yuesheng Zhang, Christine B. Ambrosone, Li Tang. Identifying lifestyle and genetic factors to prevent recurrence of non-muscle invasive bladder cancer in a prospective cohort study at Kaiser Permanente (The Be-Well Study). [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3415.
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Affiliation(s)
| | | | | | | | | | - Tracy Becerra
- 2Kaiser Permanente Southern California, Pasadena, CA
| | | | | | | | | | | | - Ronald K. Loo
- 2Kaiser Permanente Southern California, Pasadena, CA
| | | | | | | | - Li Tang
- 3Roswell Park Cancer Institute, Buffalo, NY
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13
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Reading SR, Porter KR, Hsu JWY, Wallner LP, Loo RK, Jacobsen SJ. Racial and Ethnic Variation in Time to Prostate Biopsy After an Elevated Screening Level of Serum Prostate-specific Antigen. Urology 2016; 96:121-127. [PMID: 27316374 DOI: 10.1016/j.urology.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the racial and ethnic variation in time to prostate biopsy after an elevated screening level of serum prostate-specific antigen (PSA). METHODS Male members of the Kaiser Permanente of Southern California health plan, 45 years of age or older, with no history of prostate cancer or a prostate biopsy, and at least 1 elevated screening level of serum PSA between January 1, 1998 and December 31, 2007 were retrospectively identified (n = 59,506). All participants were passively followed via electronic health records until their time of prostate biopsy, death, membership disenrollment, or study conclusion (December 31, 2014), whichever was the initial event. Proportional hazard regression analyses were used to estimate the association between time from an elevated screening level of serum PSA to prostate biopsy, adjusting for age, benign prostatic hyperplasia, prostatitis, type 2 diabetes mellitus, hypertension, and Charlson Comorbidity Index score. RESULTS Median time until biopsy was 0.6 years (214 days), with approximately 41% of participants receiving a prostate biopsy within the study period. Results from the fully adjusted analysis indicated that the non-Hispanic Asian or Pacific Islanders (hazard ratio: 1.10, 95% confidence interval: [1.04, 1.15]) and the non-Hispanic blacks (hazard ratio: 1.04, 95% confidence interval: [1.00, 1.08]) had a slightly shorter time to prostate biopsy after an elevated screening level of serum PSA compared to the non-Hispanic whites. CONCLUSION These data suggest that, within an integrated healthcare organization, minimal differences exist between racial and ethnic subgroups in their time to prostate biopsy after an elevated screening level of serum PSA.
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Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Kimberly R Porter
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Lauren P Wallner
- Department of Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente of Southern California, Los Angeles, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA.
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14
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Kwan ML, Kushi LH, Quinn VP, Ghai NR, Roh JM, Becerra TA, Martinez AA, Cannavale KL, Carruth AS, Lee VS, Ergas IJ, Loo RK, Aaronson DS, Zhang Y, Ambrosone CB, Tang L. Identifying lifestyle and genetic factors to prevent recurrence of non-muscle invasive bladder cancer in a prospective cohort study at Kaiser Permanente (the Be-Well study). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.e296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e296 Background: Bladder cancer is one of the top 10 incident cancers. Most cases (75%) are diagnosed as non-muscle invasive disease (NMID), yet NMID typically recurs (70%) and a subset (25%) progresses to muscle-invasive disease. Be-Well is a 5-year, NCI-funded prospective cohort study of NMID bladder cancer patients at Kaiser Permanente Northern (KPNC) and Southern California (KPSC). The goal is to examine diet and lifestyle factors and prognosis, with an emphasis on cruciferous vegetable (CV) intake and their unique isothiocyanate (ITC) content, the modifying effect of polymorphisms of ITC-metabolizing genes, and interactions with treatment. Our prior work suggests that dietary ITCs may prevent disease recurrence and progression in NMID patients. Methods: Newly-diagnosed patients with NMID (Ta, Tis, T1), who are English-speaking, KP members, and ≥ 21 years of age, are rapidly ascertained from electronic pathology reports and enrolled on average 2.6 months post-diagnosis. Baseline participation consists of a telephone interview including a food frequency questionnaire focused on CV intake, and providing blood and urine samples. Patients will be contacted for follow-up interviews and urine samples at 12 and 24 months. Smoking, medication use, occupational exposures, physical activity, quality of life, and urinary function are also queried. Biospecimens are processed and assayed at Roswell Park Cancer Institute. Strong support for Be-Well by KP urologists will promote dissemination of study results in patient care and recommendations. Results: Recruitment began in February 2015. To date, 159 patients have completed the baseline interview, representing 76% male and 24% female, and 80% White, 8% Black, 6% Hispanic, 3% Asian, and 3% Other. Urine specimens have been collected from 87% of consented patients. Blood specimens have been collected from 87% of KPNC patients, with collection at KPSC to begin in Fall 2015. Conclusions: The Be-Well Study is poised to be the largest and most comprehensive study to answer critical questions related to prognosis, quality of life, and care in patients diagnosed with early-stage bladder cancer.
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Affiliation(s)
- Marilyn L. Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Virginia P. Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Nirupa R. Ghai
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Janise M. Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Tracy A. Becerra
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Kimberly L. Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alexander S. Carruth
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Valerie S. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Isaac J. Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Ronald K. Loo
- Downey Medical Center, Kaiser Permanente Southern California, Downey, CA
| | - David S. Aaronson
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA
| | | | | | - Li Tang
- Roswell Park Cancer Institute, Buffalo, NY
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15
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Wallner LP, Hsu JWY, Loo RK, Palmer-Toy DE, Schottinger JE, Jacobsen SJ. Trends in Prostate-specific Antigen Screening, Prostate Biopsies, Urology Visits, and Prostate Cancer Treatments From 2000 to 2012. Urology 2015; 86:498-505. [DOI: 10.1016/j.urology.2015.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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16
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Wallner LP, Loo RK, Jacobsen SJ. Reply: To PMID 26123517. Urology 2015; 86:505. [PMID: 26282017 DOI: 10.1016/j.urology.2015.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren P Wallner
- Department of Medicine and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Ronald K Loo
- Department of Urology, Southern California Permanente Medical Group, Pasadena, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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17
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Affiliation(s)
| | - Janet S. Lee
- Kaiser Permanente Southern California, Pasadena, CA
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18
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Wallner LP, Slezak JM, Quinn VP, Loo RK, Schottinger JE, Bastani R, Jacobsen SJ. Quality of preventive care before and after prostate cancer diagnosis. J Mens Health 2015; 11:14-21. [PMID: 26430473 PMCID: PMC4587561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To examine if the use of general preventive services were diminished in a cohort of men following their diagnosis of prostate cancer. PATIENTS AND METHODS 16,604 men enrolled in Kaiser Permanente Southern California who were newly diagnosed with prostate cancer from January 1, 2002 through December 31, 2009 were passively followed through electronic medical records to determine the use of preventive services, including screening for colorectal cancer (colonoscopy and/or fecal occult blood tests (FOBT)), tests for diabetes (glucose and hemoglobin A1c) and heart disease (serum cholesterol, high density lipoprotein (HDL) and triglycerides) and vaccinations (influenza and pneumococcal). Preventive service use was compared in the two years prior to and following prostate cancer diagnosis using matched odds ratios (MOR) and 95% confidence intervals (CI) in 2013. RESULTS Men were more likely to receive a flu vaccine (MOR: 2.70, 95% CI: 2.52-2.90), lipid tests (MOR: 1.51, 95% CI: 1.42-1.61), diabetes tests (MOR: 2.13, 95% CI: 2.00-2.26) and screening for colorectal cancer (MOR: 1.80, 95% CI: 1.71-1.89) in the two years after prostate cancer diagnosis compared to before. Men with advanced disease at diagnosis were more likely to receive all types of preventive services after diagnosis when compared to men with localized disease. CONCLUSIONS Once diagnosed with prostate cancer in this setting, no less attention was paid to general preventive care, although there remains room for improvement in pneumococcal vaccination and colon cancer screening rates. The delivery of high-quality continuing care after diagnosis is critical for aging cancer patients.
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Affiliation(s)
- Lauren P Wallner
- Department of Medicine and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | - Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
| | - Ronald K Loo
- Department of Urology, Southern California Permanente Medical Group, Downey, CA, US
| | - Joanne E Schottinger
- Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, Pasadena, CA, US
| | - Roshan Bastani
- Department of Health Services and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA, US
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
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Loo RK, Shapiro C, Tamaddon K, Chien G, Rhee E, Jacobsen SJ. The Continuum of Prostate Cancer Care: An Integrated Population Based Model of Health Care Delivery. Urology Practice 2015. [PMID: 37537816 DOI: 10.1016/j.urpr.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We present a comprehensive model for population based prostate cancer management that is scalable, and has improved quality and outcomes. METHODS Kaiser Permanente Southern California is an integrated health care system that provides comprehensive care for 3.7 million members. Beginning in 2003 we put programs into place to improve the spectrum of care related to prostate cancer. These programs addressed screening, shared decision making for treatment after diagnosis, and care improvement for men with localized and advanced disease. These were implemented with traditional quality improvement techniques and outcomes were evaluated in collaboration with research groups embedded in the organization. RESULTS Prostate cancer screening in men 75 years old or older decreased 50% from 30% to 15%. The Safety Net program identified nearly 1,200 men with prostate cancer who had not been seen for followup from 2006 to 2010. There was a reduction in blood loss in surgical procedures that obviated the need for transfusion while maintaining a low positive margin rate. Hormonal therapy was changed to a dosing approach that was based on circulating testosterone levels, preventing some of the side effects of this therapy. Coupled with a systems approach to osteoporosis prevention, this approach resulted in a dramatic reduction in fracture rates in this high risk population. CONCLUSIONS These data demonstrate that a systems approach to a population based prostate cancer program can lead to efficient and reliable care that can be successfully disseminated through an integrated health plan.
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Affiliation(s)
- Ronald K. Loo
- Department of Urology, Southern California Permanente Medical Group, Downey, California
| | - Charles Shapiro
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Kirk Tamaddon
- Department of Urologic Surgery, Southern California Permanente Medical Group, Los Angeles, California
| | - Gary Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Eugene Rhee
- Department of Urology, Southern California Permanente Medical Group, San Diego, California
| | - Steven J. Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Wallner LP, Slezak JM, Loo RK, Quinn VP, Van Den Eeden SK, Jacobsen SJ. Progression and treatment of incident lower urinary tract symptoms (LUTS) among men in the California Men's Health Study. BJU Int 2014; 115:127-33. [PMID: 24840926 DOI: 10.1111/bju.12810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterise the progression and treatment of lower urinary tract symptoms (LUTS) among men aged 45-69 years in the California Men's Health Study. PATIENTS AND METHODS A total of 39,222 men, aged 45-69 years, enrolled in the Southern California Kaiser Permanente Health Plan were surveyed in 2002-2003 and again in 2006-2007. Those men who completed both surveys who did not have a diagnosis of benign prostatic hyperplasia (BPH) and were not on medication for LUTS at baseline were included in the study (N = 19,505). Among the men with no or mild symptoms at baseline, the incidence of moderate/severe LUTS (American Urological Association Symptom Index [AUASI] score ≥8) and odds of progression to severe LUTS (AUASI score ≥20) was estimated during 4 years of follow-up. RESULTS Of the 9640 men who reported no/mild LUTS at baseline, 3993 (41%) reported moderate/severe symptoms at follow-up and experienced a 4-point change in AUASI score on average. Of these men, 351 (8.8%) had received a pharmacological treatment, eight (0.2%) had undergone a minimally invasive or surgical procedure and 3634 (91.0%) had no treatment recorded. Men who progressed to severe symptoms (AUASI score ≥20; n = 165) were more likely to be on medication for BPH (odds ratio [OR] 8.09, 95% confidence interval [CI] 5.77-11.35), have a BPH diagnosis (OR 4.74, 95% CI 3.40-6.61) or have seen a urologist (OR 2.49, 95% CI 1.81-3.43) when compared with men who did not progress to severe symptoms (AUASI score <20). CONCLUSION These data show that the majority of men who experienced progression did not have pharmacological or surgical therapy for their symptoms and, therefore, may prove to be good candidates for a self-management plan.
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Affiliation(s)
- Lauren P Wallner
- Department of Medicine and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
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21
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Danforth KN, Smith AE, Loo RK, Jacobsen SJ, Mittman BS, Kanter MH. Electronic Clinical Surveillance to Improve Outpatient Care: Diverse Applications within an Integrated Delivery System. EGEMS (Wash DC) 2014; 2:1056. [PMID: 25848588 PMCID: PMC4371433 DOI: 10.13063/2327-9214.1056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Efforts to improve patient safety have largely focused on inpatient or emergency settings, but the importance of patient safety in ambulatory care is increasingly being recognized as a key component of overall health care quality. Care gaps in outpatient settings may include missed diagnoses, medication errors, or insufficient monitoring of patients with chronic conditions or on certain medications. Further, care gaps may occur across a wide range of clinical conditions. We report here an innovative approach to improve patient safety in ambulatory settings – the Kaiser Permanente Southern California (KPSC) Outpatient Safety Net Program – which leverages electronic health information to efficiently identify and address a variety of potential care gaps across different clinical conditions. Between 2006 and 2012, the KPSC Outpatient Safety Net Program implemented 24 distinct electronic clinical surveillance programs, which routinely scan the electronic health record to identify patients with a particular condition or event. For example, electronic clinical surveillance may be used to scan for harmful medication interactions or potentially missed diagnoses (e.g., abnormal test results without evidence of subsequent care). Keys to the success of the program include strong leadership support, a proactive clinical culture, the blame-free nature of the program, and the availability of electronic health information. The Outpatient Safety Net Program framework may be adopted by other organizations, including those who have electronic health information but not an electronic health record. In the future, the creation of a forum to share electronic clinical surveillance programs across organizations may facilitate more rapid improvements in outpatient safety.
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Wallner LP, Slezak JM, Loo RK, Bastani R, Jacobsen SJ. Trends in the quality of preventive care before and after prostate cancer diagnosis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Zhumkhawala AA, Gleason JM, Cheetham TC, Niu F, Loo RK, Dell RM, Jacobsen SJ, Chien GW. Osteoporosis management program decreases incidence of hip fracture in patients with prostate cancer receiving androgen deprivation therapy. Urology 2013; 81:1010-5. [PMID: 23490521 DOI: 10.1016/j.urology.2012.11.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/09/2012] [Accepted: 11/23/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the incidence of hip fracture in men with prostate cancer receiving androgen deprivation therapy (ADT). MATERIALS AND METHODS One of the detrimental side effects of ADT for prostate cancer is osteoporosis. Through an osteoporosis prevention program implemented in our healthcare system, the patients at risk undergo dual x-ray absorptiometry scans and receive treatment if the T-score indicates bone loss. We evaluated the incidence of hip fracture in men with prostate cancer who were receiving ADT through a retrospective, cohort study conducted within a managed care organization. The participants were all men newly diagnosed with prostate cancer from January 2003 to December 2007 receiving leuprolide injections. Patients who had had a dual x-ray absorptiometry scan beginning 3 months before the index date through the end of study were included in the intervention group; all others were included in the comparison group. The main outcome of interest was a hip fracture occurring after the index date, excluding cancer pathologic fractures, traumatic fractures, and fractures associated with epilepsy. RESULTS A total of 1071 patients were in the intervention group, and 411 were in the comparison group. In the intervention group, 18 hip fractures occurred compared with 17 in the comparison group. The incidence rate of hip fractures per 1000 person-years was 5.1 (95% confidence interval 3.0-8.0) in the intervention group and 18.1 (95% confidence interval 10.5-29.0) in the comparison group. CONCLUSION The incidence rate of hip fracture in this population was reduced >70% with enrollment in an osteoporosis management system, avoiding this morbid complication of ADT.
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Affiliation(s)
- Ali-Asghar Zhumkhawala
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA 90027, USA
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Loo RK, Lieberman SF, Slezak JM, Landa HM, Mariani AJ, Nicolaisen G, Aspera AM, Jacobsen SJ. Stratifying risk of urinary tract malignant tumors in patients with asymptomatic microscopic hematuria. Mayo Clin Proc 2013; 88:129-38. [PMID: 23312369 DOI: 10.1016/j.mayocp.2012.10.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/26/2012] [Accepted: 10/12/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify patients who could safely avoid unnecessary radiation and instrumentation after the detection of microscopic hematuria. PATIENTS AND METHODS We conducted a prospective cohort study of patients who were referred to urologists and underwent a full evaluation for asymptomatic microscopic hematuria during a 2-year period in an integrated care organization in 3 regions along the West Coast of the United States. A test cohort and validation cohort of patients with hematuria evaluations between January 9, 2009, and August 15, 2011, were identified. Patients were followed passively through their electronic health records for a diagnosis of urothelial or renal cancer. The degree of microscopic hematuria, history of gross hematuria, smoking history, age, race, imaging findings, and cystoscopy findings were evaluated as risk factors for malignant tumors. RESULTS The test cohort consisted of 2630 patients, of whom 55 (2.1%) had a neoplasm detected and 50 (1.9%) had a pathologically confirmed urinary tract cancer. Age of 50 years or older and a recent diagnosis of gross hematuria were the strongest predictors of cancer. Male sex was also predictive of cancer, whereas smoking history and 25 or more red blood cells per high-power field on a recent urinalysis were not statistically significant. A Hematuria Risk Index developed from these factors had an area under the receiver operating characteristic curve of 0.809. In the validation cohort of 1784 patients, the Hematuria Risk Index performed comparably (area under the curve = 0.829). Overall, 32% of the population was identified as low risk and 0.2% had a cancer detected; 14% of the population was identified as high risk, of whom 11.1% had a cancer found. CONCLUSION These results suggest that a considerable proportion of patients could avoid extensive evaluations with the use of the Hematuria Risk Index.
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Affiliation(s)
- Ronald K Loo
- Department of Urology, Southern California Permanente Medical Group, Los Angeles, CA, USA
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Wallner LP, Frencher SK, Hsu JWY, Chao CR, Nichol MB, Loo RK, Jacobsen SJ. Changes in serum prostate-specific antigen levels and the identification of prostate cancer in a large managed care population. BJU Int 2013; 111:1245-52. [DOI: 10.1111/j.1464-410x.2012.11651.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren P. Wallner
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
| | | | - Jin-Wen Y. Hsu
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
| | - Chun R. Chao
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
| | - Michael B. Nichol
- School of Pharmacy; University of Southern California; Los Angeles; USA
| | - Ronald K. Loo
- Department of Urology; Southern California Permanente Medical Group; Downey; CA; USA
| | - Steven J. Jacobsen
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
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Danforth KN, Jacobsen SJ, Miyaguchi LN, Zhou H, Slezak JM, Loo RK. Use of an electronic health record to improve follow-up of elevated lab results: The PSA safety net. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.34_suppl.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
292 Background: Follow-up of laboratory results is challenging in outpatient care, and research indicates an electronic health record (EHR) alone is insufficient to ensure appropriate follow-up of abnormal results. Methods: In April 2006, Kaiser Permanente Southern California implemented a Prostate-Specific Antigen (PSA) Safety Net to detect men with elevated serum PSA levels who had not yet received follow-up care at 6 months post-testing. The PSA Safety Net scanned the EHR to identify men age 45-79 with elevated PSA values. Men were then excluded if they had a prior prostate cancer diagnosis or evidence of follow-up care within 6 months of the PSA test, defined as any of the following: a subsequent visit with a urologist or oncologist, normal PSA value, biopsy, or prostate cancer diagnosis. In June 2009, the criterion for follow-up care was reduced from 6 to 3 months. The electronic Safety Net tool was refreshed daily, stored key data (e.g., contact information), and recorded actions of care managers (e.g., expedited appointment scheduled). We evaluated how many men were identified through the PSA Safety Net and whether they were systematically different from men followed through routine care. Results: From 4/2006-12/2010, 45,762 men had an elevated serum PSA level. Twenty percent (n=9,373) were identified through the PSA Safety Net. Of 7,729 prostate cancers diagnosed, 9.6% (n=739) were found through the PSA Safety Net. Age, race/ethnicity, and language preference was similar among men followed through the Safety Net vs. routine care. Men followed through the PSA Safety Net were less likely to be enrolled in kp.org (46% vs. 54% respectively, p<0.001), which provides online access to lab results. Median PSA levels were slightly lower among those followed through the PSA Safety Net. Men in the Safety Net also were less likely to be diagnosed with Stage IV cancers than men followed via routine care (2.8% vs. 5.5%, p=0.002), although stage was similar overall. Conclusions: Within a health system using an advanced EHR, a substantial number of men with elevated PSA levels were identified and managed through a PSA Safety Net. These men were largely similar to those followed through routine care, although tended toward lower risk.
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Affiliation(s)
| | | | | | - Hui Zhou
- Kaiser Permanente Southern California, Pasadena, CA
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Wuerstle MC, Van Den Eeden SK, Poon KT, Quinn VP, Hollingsworth JM, Loo RK, Jacobsen SJ. Contribution of common medications to lower urinary tract symptoms in men. ACTA ACUST UNITED AC 2011; 171:1680-2. [PMID: 21987200 DOI: 10.1001/archinternmed.2011.475] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Londoño DC, Slezak JM, Quinn VP, Van Den Eeden SK, Loo RK, Jacobsen SJ. Population-based study of erectile dysfunction and polypharmacy. BJU Int 2011; 110:254-9. [DOI: 10.1111/j.1464-410x.2011.10761.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jung H, Gleason JM, Loo RK, Patel HS, Slezak JM, Jacobsen SJ. Association of Hematuria on Microscopic Urinalysis and Risk of Urinary Tract Cancer. J Urol 2011; 185:1698-703. [DOI: 10.1016/j.juro.2010.12.093] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Howard Jung
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, California
| | - Joseph M. Gleason
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, California
| | - Ronald K. Loo
- Department of Downey, Kaiser Permanente Southern California, Pasadena, California
| | - Hetal S. Patel
- Department of Downey, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff M. Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven J. Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Gleason JM, Slezak JM, Jung H, Reynolds K, Van den Eeden SK, Haque R, Quinn VP, Loo RK, Jacobsen SJ. Regular nonsteroidal anti-inflammatory drug use and erectile dysfunction. J Urol 2011; 185:1388-93. [PMID: 21334642 DOI: 10.1016/j.juro.2010.11.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE Previous data suggest a potential relationship between inflammation and erectile dysfunction. If it is causal, nonsteroidal anti-inflammatory drug use should be inversely associated with erectile dysfunction. To this end we examined the association between nonsteroidal anti-inflammatory drug use and erectile dysfunction in a large, ethnically diverse cohort of men enrolled in the California Men's Health Study. MATERIALS AND METHODS This prospective cohort study enrolled male members of the Kaiser Permanente managed care plans who were 45 to 69 years old beginning in 2002. Erectile dysfunction was assessed by questionnaire. Nonsteroidal anti-inflammatory drug exposure was determined by automated pharmacy data and self-reported use. RESULTS Of the 80,966 men in this study 47.4% were considered nonsteroidal anti-inflammatory drug users based on the definitions used and 29.3% reported moderate or severe erectile dysfunction. Nonsteroidal anti-inflammatory drug use and erectile dysfunction strongly correlated with age with regular drug use increasing from 34.5% in men at ages 45 to 49 years to 54.7% in men 60 to 69 years old with erectile dysfunction increasing from 13% to 42%. The unadjusted OR for the association of nonsteroidal anti-inflammatory drugs and erectile dysfunction was 2.40 (95% CI 2.27, 2.53). With adjustment for age, race/ethnicity, smoking status, diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, coronary artery disease and body mass index, a positive association persisted (adjusted OR 1.38). The association persisted when using a stricter definition of nonsteroidal anti-inflammatory drug exposure. CONCLUSIONS These data suggest that regular nonsteroidal anti-inflammatory drug use is associated with erectile dysfunction beyond what would be expected due to age and comorbidity.
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Affiliation(s)
- Joseph M Gleason
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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Haque R, Van Den Eeden SK, Jacobsen SJ, Caan B, Avila CC, Slezak J, Sternfeld B, Loo RK, Quinn VP. Correlates of prostate-specific antigen testing in a large multiethnic cohort. Am J Manag Care 2009; 15:793-799. [PMID: 19895183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To examine factors associated with prostate-specific antigen (PSA) testing in the multiethnic California Men's Health Study. STUDY DESIGN Cross-Sectional analysis nested within a cohort of male health plan members (n = 55,278). METHODS We extracted laboratory serum PSA values during the study period from 1998 to 2002. Using selected demographic and healthcare factors, we estimated the proportion of men who underwent PSA testing at least once during the 5-year period. Odds ratios and corresponding 95% confidence intervals were estimated to assess the association between these factors and PSA screening use. RESULTS African American men had substantially higher PSA screening prevalence than white men (82.6% vs 73.7%). Low PSA screening use was associated with Latino race/ethnicity, lower level of education, residency in the United States for 25 years or less, current smoking, and lack of PSA test discussion with healthcare providers. The strongest positive predictors of PSA testing were African American race/ethnicity (odds ratio, 1.66; 95% confidence interval, 1.50-1.83) and high concern about prostate cancer (odds ratio, 1.53; 95% confidence interval, 1.38-1.69). In contrast, when men did not discuss PSA testing with their physicians, they were 80% less likely to undergo screening. CONCLUSIONS In this insured population for whom financial barriers are minimized, PSA screening varied by race/ethnicity and by other patient and clinical factors, possibly reflecting inconsistencies in prostate cancer screening guidelines. Despite these differences, healthcare providers have a key role in patients' likelihood of undergoing PSA screening.
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Affiliation(s)
- Reina Haque
- Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA.
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Abstract
CONTEXT For more than 15 years, 5-alpha reductase inhibitors, which block the conversion of testosterone to dihydrotestosterone, have been used in the treatment of benign prostatic hyperplasia (BPH). Short-term studies show no effects of these agents on bone metabolism,but long-term data are not available. OBJECTIVE To assess the association between use of 5-alpha reductase inhibitors (eg, finasteride) for BPH and occurrence of hip fracture. DESIGN, SETTING, AND PATIENTS Population-based case-control study using data from Kaiser Permanente Southern California, a managed care organization with more than 3 million members. Case patients included 7076 men 45 years and older with incident hip fracture from 1997-2006. Control patients were 7076 men without incident hip fracture, optimally matched at a 1:1 ratio to case patients on age and medical center. Electronic information on pharmaceutical use was used to identify use of finasteride from 1991 forward. RESULTS Overall, 2547 (36%) and 2488 (35%) case and control patients, respectively, had a diagnosis of BPH (P = .30), and 109 (1.5%) and 141 (2.0%) of case and control patients, respectively, had been exposed to finasteride prior to the index date (matched odds ratio, 0.77; 95% confidence interval, 0.59-1.00; P = .04). There was no suggestion of a dose-response relationship between exposure to 5-alpha reductase inhibitors when the exposure was stratified into tertiles of total exposure (P = .12). By contrast, there was a slightly higher prevalence of alpha-blocker use in case vs control patients (32% vs 30%, respectively; P = .04). CONCLUSIONS Exposure to 5-alpha reductase inhibitors was not associated with increased risk of hip fracture. The reduction in risk observed with exposure to 5-alpha reductase inhibitors and the modest increase in risk associated with exposure to alpha-blockers require replication and warrant further investigation.
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Affiliation(s)
- Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Second Floor, Pasadena, CA 91101, USA.
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Enger SM, Van Den Eeden SK, Sternfeld B, Loo RK, Quesenberry CP, Rowell S, Sadler MC, Schaffer DM, Habel LA, Caan BJ. California Men's Health Study (CMHS): a multiethnic cohort in a managed care setting. BMC Public Health 2006; 6:172. [PMID: 16813653 PMCID: PMC1569841 DOI: 10.1186/1471-2458-6-172] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 06/30/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We established a male, multiethnic cohort primarily to study prostate cancer etiology and secondarily to study the etiologies of other cancer and non-cancer conditions. METHODS/DESIGN Eligible participants were 45-to-69 year old males who were members of a large, prepaid health plan in California. Participants completed two surveys on-line or on paper in 2002-2003. Survey content included demographics; family, medical, and cancer screening history; sexuality and sexual development; lifestyle (diet, physical activity, and smoking); prescription and non-prescription drugs; and herbal supplements. We linked study data with clinical data, including laboratory, hospitalization, and cancer data, from electronic health plan files. We recruited 84,170 participants, approximately 40% from minority populations and over 5,000 who identified themselves as other than heterosexual. We observed a wide range of education (53% completed less than college) and income. PSA testing rates (75% overall) were highest among black participants. Body mass index (BMI) (median 27.2) was highest for blacks and Latinos and lowest for Asians, and showed 80.6% agreement with BMI from clinical data sources. The sensitivity and specificity can be assessed by comparing self-reported data, such as PSA testing, diabetes, and history of cancer, to health plan data. We anticipate that nearly 1,500 prostate cancer diagnoses will occur within five years of cohort inception. DISCUSSION A wide variety of epidemiologic, health services, and outcomes research utilizing a rich array of electronic, biological, and clinical resources is possible within this multiethnic cohort. The California Men's Health Study and other cohorts nested within comprehensive health delivery systems can make important contributions in the area of men's health.
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Affiliation(s)
- Shelley M Enger
- Department of Research & Evaluation, Kaiser Permanente Medical Care Program, Pasadena, CA 91188, USA
| | | | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente Medical Care Program, Bellflower Medical Center, Bellflower, CA 90706, USA
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
| | - Sarah Rowell
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
| | - Marianne C Sadler
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
| | - Donna M Schaffer
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
- Current at Kaiser Permanente Care Management Institute, Oakland, CA 94612, USA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
| | - Bette J Caan
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA
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Abstract
The iliac vessels are the standard site for vascular connections for kidney transplantation. Unusual circumstances may render the iliac vessels unusable. We report a case in which a cadaveric renal allograft was successfully transplanted despite an absence of normal venous anatomy, using the inferior mesenteric vein for revascularization.
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