A population-based study examining the impact of a multidisciplinary rapid access clinic on utilization of initial treatment options for patients with localized prostate cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 15-15
Author(s):  
Clement K. Ho ◽  
Joseph D. Ruether ◽  
Bryan J Donnelly ◽  
Marc Kerba
Keyword(s):  
Prostate Cancer ◽  
Initial Treatment ◽  
Treatment Options ◽  
Population Level ◽  
Treatment Decisions ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Rapid Access ◽  
Rapid Access Clinic ◽  
The Impact

15 Background: Treatment decisions in localized prostate cancer (LPCa) are complicated by the variety of available options. A rapid access cancer clinic (RAC) has been unique to Calgary, Alberta (AB) since 2007. RAC offers multidisciplinary prostate cancer care by a urologist, medical oncologist, and radiation oncologist. It is hypothesized that treatment utilization data from decisions taken at RAC may serve to benchmark the appropriateness of treatment decisions on a population level. Objectives: To compare utilization rates for initial treatment of LPCa between AB and RAC. Methods: Records of patients with clinically LPCa in AB between 2007-9 were reviewed with ethics approval. Records were linked to the AB cancer registry database. Clinical, treatment and health services characteristics pertaining to patients attending RAC were compared to those managed elsewhere in AB. The primary endpoints were utilization rates by initial treatment; prostatectomy (P), radiotherapy (RT), hormone therapy (H), active surveillance (A). A logistics regression model was constructed to examine the influence of RAC on initial treatment decisions, while controlling for interactions and factors of interest. Results: 2,660 patients were diagnosed with LPCa. 375 presented to RAC. Utilization rates among RAC patients: P-60.3% (95%CI: 55.3-65.2), A-16%(12.3-19.7), RT-11.7%(8.5-15.0) and H-8.0%(CI:5.2-10.8). This compares to AB rates of P-47.2%(45.9-48.3), A-6.1%(15.2-17.0), RT-18.8%(17.9-19.7), and H-14.5%(13.6-15.4). On multivariate analysis, RAC was associated with a trend towards receiving RT (OR 1.6, p=0.097). Conclusions: A specialized clinic for LPCa may be associated with a higher likelihood of receiving radiotherapy as initial treatment compared to the prostate cancer population in Alberta.

scholarly journals A population-based study examining the influence of a specialized rapid-access cancer clinic on initial treatment choice in localized prostate cancer

2018 ◽  
Vol 12 (7) ◽  
pp. E314-7
Author(s):  
Larissa J. Vos ◽  
Clement K. Ho ◽  
Bryan J. Donnelly ◽  
J. Dean Reuther ◽  
Marc Kerba
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Initial Treatment ◽  
Cancer Education ◽  
Treatment Decisions ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Rapid Access ◽  
Utilization Data ◽  
Cancer Clinic

Introduction: Treatment decisions in localized prostate cancer are complicated by the available choices. A rapid-access cancer clinic (RAC) has been unique to Calgary, AB, since 2007. This RAC offers multidisciplinary prostate cancer education by a urologist, medical oncologist, and radiation oncologist. It is hypothesized that treatment utilization data from decisions taken at RAC may serve to benchmark the appropriateness of treatment decisions on a population level.Methods: Records of patients with clinically localized prostate cancer in Alberta between October 1, 2007 and September 30, 2009 were reviewed with ethics approval. Records were linked to the Alberta Cancer Registry database. Clinical, treatment, and health services characteristics pertaining to patients attending RAC were compared to the general population. The primary endpoint was utilization rates of each initial treatment.Results: During this two-year period, 2838 patients were diagnosed with localized prostate cancer; 375 attended RAC. The utilization rates among RAC patients vs. the whole Alberta population were: prostatectomy 60.3% (95% confidence interval [CI] 55.3–65.2) vs. 48.0% (95% CI 47.1‒50.7; χ2 p<0.001); active surveillance 16.0% (95% CI 12.3‒19.7%) vs. 13.5% (95% CI 12.2‒15.8; χ2 p=0.214); radiotherapy 11.7% (95% CI 8.5‒15.0) vs. 18.0% (95% CI 16.9‒20.5; χ2 p=0.002); and hormone therapy 8.0% (95% CI 5.2‒10.8) vs. 17.4% (95% CI 16.1‒18.9; χ2 p<0.001).Conclusions: A specialized clinic for localized prostate cancer may be associated with a higher likelihood of receiving surgery or active surveillance as initial treatment compared to the prostate cancer population in Alberta.

scholarly journals Prostate Cancer: Evidence Update for Clinicians

2017 ◽  
Author(s):  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Treatment Options ◽  
Treatment Decisions ◽  
Localized Prostate Cancer ◽  
Related Quality ◽  
Effect Of Treatment ◽  
The Impact

Given the evidence of high 5- and 10-year survivorship rates for localized prostate cancer, the effect of treatment on symptom-related quality of life is an important consideration for men choosing among available treatment options. Two PCORI-funded studies published in the March 21, 2017 issue of JAMA compare the impact of current treatments on symptom-related quality of life for men with localized prostate cancer. Quality of life scores refer to symptoms, how much men were bothered by symptoms, or a combination of the two. The studies looked at observed outcomes from a combined total of 3,600 men for periods of two and three years following treatment. This evidence offers information that can help patients make treatment decisions.

Associations between patient knowledge of others' experiences and treatment choice in men with localized prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6578-6578
Author(s):  
Aaron J. Katz ◽  
Ying Cao ◽  
Xinglei Shen ◽  
Deborah Usinger ◽  
Sarah Walden ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
North Carolina ◽  
Cancer Patients ◽  
Treatment Options ◽  
Population Based ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
The North ◽  
Patient Reported

6578 Background: Men with localized prostate cancer must select from multiple treatment options, without one clear best choice. Consequently, personal factors, such as knowing other prostate cancer patients who have undergone treatment, may influence patient decision-making. However, associations between knowledge about others’ experiences and treatment decision-making among localized prostate cancer patients has not been well characterized. We used data from a population-based cohort of localized prostate cancer patients to examine whether patient-reported knowledge of others’ experiences is associated with treatment choice. Methods: The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a population-based cohort of localized prostate cancer patients enrolled from 2011-2013 throughout the state of North Carolina in collaboration with the North Carolina Central Cancer Registry. All patients were enrolled prior to treatment and followed prospectively. Patient decision-making factors including knowledge of others’ experiences with prostate cancer treatment options were collected through patient report. Patient treatment choice was determined through medical record abstraction and cancer registry data. Results: Among 1,202 patients, 17% reported knowing someone who pursued active surveillance (AS) while 28%, 46%, and 59% reported knowing someone who received brachytherapy, external beam radiation (EBRT), or radical prostatectomy (RP), respectively; 26% underwent AS, 9% brachytherapy, 21% EBRT, and 39% RP as their initial treatment. In unadjusted analyses, patients with knowledge of others’ experiences with brachytherapy, EBRT or RP had more than twice the odds of receiving that treatment compared to patients who did not. Knowledge of others’ experience with AS was not associated with choice to undergo AS. Multivariable analysis adjusting for age, race, risk group, and patient-reported goals of care showed knowledge of others’ experiences with brachytherapy (OR 4.60, 95% confidence interval [CI] 2.76 to 7.68), EBRT (OR 2.38, 95% CI 1.69 to 3.34), or RP (OR 4.02, 95% CI 2.84 to 5.70) was significantly associated with odds of receiving that treatment. The odds of receiving a particular treatment option were further increased among patients who reported knowing someone who had a “good” experience with the treatment in question. Conclusions: This is the first population-based study to directly demonstrate the impact of a patient’s knowledge of others’ experiences on treatment choice in prostate cancer. These data provide a new consideration to clinicians in their counseling of patients with newly diagnosed prostate cancer, and also impacts research into the informed decision-making process for this disease.

scholarly journals Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions

2016 ◽  
Vol 37 (1) ◽  
pp. 56-69 ◽  
Author(s):  
Karen A. Scherr ◽  
Angela Fagerlin ◽  
Timothy Hofer ◽  
Laura D. Scherer ◽  
Margaret Holmes-Rovner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Active Treatment ◽  
Patient Preferences ◽  
Initial Treatment ◽  
Specific Antigen ◽  
Treatment Decisions ◽  
Localized Prostate Cancer ◽  
Treatment Preference ◽  
Medical Factors

Objective. To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. Methods. We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients’ baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients’ interest in sex. Results. Patients’ initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists’ recommendations, Δχ2(2) = 32.81, P < 0.001. Urologists’ recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ2(6) = 0, P = 1. Urologists rarely discussed patients’ interest in sex (<15% of appointments). Conclusions. Patients’ treatment decisions were based largely on urologists’ recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients’ personal views of the relative pros and cons of treatment alternatives.

Survival gains needed to justify the side effects of treatment for localized prostate cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5119-5119
Author(s):  
M. T. King ◽  
R. Viney ◽  
I. Hossain ◽  
D. Smith ◽  
E. Savage ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Treatment Options ◽  
Relative Survival ◽  
Random Parameter ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Common Side Effect ◽  
Base Case ◽  
Compensating Variation

5119 Background: Men diagnosed with localized prostate cancer face difficult treatment decisions. Evidence about the relative survival benefit of treatment options is lacking or piecemeal. Side-effects can vary widely with treatment, affecting some fundamental aspects of quality of life (QOL). Little is known about patients’ views of the relative tolerability of these side-effects or the survival gains needed to justify them. Methods: QOL data were collected prospectively 3 years post-diagnosis in a population-based cohort of men treated for localized prostate cancer (n=1642); these data were used to identify common side-effect profiles. A patient preference survey was conducted in a subset (n=357, stratified by treatment); hypothetical treatment alternatives were described in terms of side-effects and survival. Random parameter logit models were estimated. We adapted the concept of compensating variation from welfare economics to derive a parameter function for the value of changes in QOL in terms of survival time; i.e., the survival gains needed to justify persistent side-effects. Bootstrap confidence intervals (CI) were constructed. Results: The table shows the survival gains needed for a range of common treatment profiles, relative to the base case of active surveillance (in which men typically experienced mild loss of libido and mild fatigue). For example, radical prostatectomy often resulted in severe impotence and mild urinary leakage; men required an extra 8.0 months (95% CI 7.4–8.7) of life to make this worthwhile. Generally, urinary dysfunction and bowel symptoms were considered the least tolerable, hormonal symptoms and fatigue came next, and sexual dysfunction was considered relatively benign. This pattern was relatively consistent across treatment groups. Conclusions: These results highlight the need for better evidence about the actual survival benefits of alternative treatments. They also help to target supportive care to optimize patient QOL after treatment for localized prostate cancer. [Table: see text] No significant financial relationships to disclose.

Treatment outcomes of radiotherapy versus prostatectomy for localized prostate cancer with Gleason 8 or more on biopsy.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 120-120
Author(s):  
Christopher Baker ◽  
Andrew M. McDonald ◽  
Grant Clark ◽  
Caleb Dulaney ◽  
Eddy Shih-Hsin Yang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Gleason Score ◽  
Initial Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Biochemical Failure ◽  
Localized Prostate Cancer ◽  
Kaplan Meier ◽  
Initial Biopsy

120 Background: There have been no prospective randomized controlled trials comparing current treatment options for patients with high-risk localized prostate cancer. This study seeks to compare the biochemical and metastatic outcomes of patients that received definitive radiotherapy (dRT) or radical prostatectomy (RP) for localized prostate cancer with Gleason score ≥ 8 on initial biopsy. Methods: A total of 106 patients met the inclusion criteria of Gleason score ≥ 8 on initial biopsy and biochemical follow-up ≥ 1 year. Seventy-one patients were initially treated with dRT (96% also receiving androgen deprivation therapy) and 35 patients were initially treated with RP (with or without postoperative RT). Our primary endpoint was biochemical failure (BF). For dRT patients, BF was recorded according to the Phoenix Consensus or if extranodal metastasis was diagnosed. For surgical patients, BF was recorded according to American Urological Association guidelines or if extranodal metastasis occurred. If adjuvant/salvage RT was given postoperatively, BF was recorded if PSA ≥ 0.5 on two consecutive measures after completion of RT. Pretreatment characteristics were compared using Pearson Chi-square method and independent samples Mann-Whitney U test. Actuarial rates of BF and metastasis were calculated using the Kaplan-Meier method. Results: Median follow-up for all patients was 5.3 years. There was no statistical difference in clinical T-stage, initial PSA, or months of follow up between patients treated initially with radiotherapy vs. prostatectomy. Patients initially treated with dRT were significantly older than those treated with RP. The dRT group had a lower rate of BF compared to the RP group, p < 0.001. The Kaplan-Meier estimate of BF at 5 years was 7.6% in the dRT group compared to 34.5% in the RP group. Additionally, the Kaplan-Meier estimate of distant metastasis at 10 years was 22.7% in the dRT group compared to 55.9% of the RP group, p = 0.01. Conclusions: For our sample of patients with Gleason score ≥ 8 on initial biopsy, initial treatment with dRT was associated with lower rates of biochemical failure and extranodal metastasis when compared to initial treatment with prostatectomy.

Understanding the impact of primary care providers on treatment decisions for men with localized prostate cancer.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 91-91
Author(s):  
Archana Radhakrishnan ◽  
David Grande ◽  
Linda Crossette ◽  
Justin E. Bekelman ◽  
Craig Evan Pollack
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Private Insurance ◽  
Primary Care Providers ◽  
Treatment Decisions ◽  
Localized Prostate Cancer ◽  
Definitive Treatment ◽  
Care Providers ◽  
Risk Prostate Cancer ◽  
The Impact

91 Background: Primary care providers (PCPs) play important roles for cancer patients across the care continuum and may help patients make treatment decisions in line with patients’ preferences. However, the extent of PCP involvement is poorly understood. We evaluated how frequently men with localized prostate cancer discuss treatment with their PCP and whether PCP involvement decreased use of definitive treatment, including among those eligible for surveillance according to clinical guidelines. Methods: We mailed surveys to men diagnosed with localized prostate cancer between 2012 and 2013 in the greater Philadelphia area. Patients reporting having a PCP at the time of diagnosis were asked whether their PCP helped decide how to treat their cancer. Definitive treatment was defined as having radical prostatectomy or radiation therapy. Unadjusted and multivariate logistic regression analyses were used to compare sociodemographic and clinical characteristics of patients who did and did not discuss treatment with their PCP. Similar analyses were used to determine effect of PCP involvement on definitive treatment, both overall and in subgroups of men eligible for surveillance (men > 70 years, with limited life expectancy and with low-risk prostate cancer). Results: 3743 men were mailed a survey, 1757 responded, and 1139 were eligible for analyses. Overall, 438 (38.5%) discussed treatment with their PCP. In adjusted analyses, black men were more likely than white men (Odds Ratio 1.89; 95% Confidence Interval 1.22-2.91) and men with Medicare were more likely than men with private insurance (OR 1.61; 95% CI 1.03-2.51) to discuss treatment with their PCP. However, men who had treatment discussions with their PCP were not less likely to receive definitive treatment (p = 0.11), both overall and among those eligible for surveillance. Conclusions: Though a large proportion of men engaged in treatment discussions with their PCP, these discussions were not associated with differences in the receipt of definitive treatment among men with localized prostate cancer. Understanding the content of these discussions can inform interventions that can help patients make preference concordant treatment decisions.

1769: The Impact of Race on Treatment Decisions for Localized Prostate Cancer

2007 ◽  
Vol 177 (4S) ◽  
pp. 588-588
Author(s):  
Michael N. Ferrandino ◽  
Nicholas T. Karanikolas ◽  
Brent V. Yanke ◽  
Richard J. Macchia ◽  
Ivan Colon
Keyword(s):  
Prostate Cancer ◽  
Treatment Decisions ◽  
Localized Prostate Cancer ◽  
The Impact
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