Nutrition services for men with prostate cancer: A health professional survey.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 25-25
Author(s):  
Kaity McLaughlin ◽  
Lindsay Hedden ◽  
Phil Pollock ◽  
Celestia S. Higano ◽  
Rachel A Murphy
Keyword(s):  
Prostate Cancer ◽  
Health Care Professionals ◽  
Online Survey ◽  
Unmet Need ◽  
Nutrition Support ◽  
Registered Dietitians ◽  
Nutrition Services ◽  
Radiation Oncologists ◽  
Medical Oncologists ◽  
Nutrition Service

25 Background: Nutrition is a key part of prostate cancer (PC) survivorship for management of PC, treatment side effects, and overall health. The Prostate Cancer Supportive Care (PCSC) Program is one of only a few PC survivorship programs in Canada that provide nutrition support as part of standard care. A survey was conducted as part of a broader needs assessment to understand health care professionals’ (HCPs) perspectives on nutrition services for men with PC and inform nutrition programs. Methods: An online survey was administered to British Columbia (BC) HCPs caring for men with PC including urologists, radiation oncologists, medical oncologists, registered dietitians and researchers. We used purposive sampling to identify relevant HCPs. HCPs were asked about the importance of oncological nutrition services and how they should be delivered to men with PC. We summarized the percent agreement for each question and across professions then thematically analyzed qualitative data. Results: Of the 56 HCPs invited to participate in the survey, 38 (68%) responded. The majority (61%) agreed that men with PC require more nutritional support. HCPs indicated nutrition services should be offered multiple times throughout survivorship and facilitated through online resources, individual consultations with registered dietitians and consecutive group education sessions. Most (75%) urologists, radiation oncologists and medical oncologists responded that weight management should be the focus for nutrition services, whereas 90% of dietitians responded that nutrition for reducing the risk of PC progression should be the focus. The main themes that arose from the survey suggested that nutrition services should be available in different forms to facilitate individual needs and adapted based on cultural and community settings. Conclusions: HCPs confirm that there is an unmet need for nutrition services for men with PC in BC as existing services prioritize and offer services for cancer-related weight loss. Special consideration should be given to the focus of nutrition service provided, and when and how it is offered. These results will inform the development of additional resources for men with PC to support their nutritional needs.

scholarly journals Patterns of care for prostate cancer radiotherapy—results from a survey among German-speaking radiation oncologists

2021 ◽  
Author(s):  
Marco M. E. Vogel ◽  
Sabrina Dewes ◽  
Eva K. Sage ◽  
Michal Devecka ◽  
Jürgen E. Gschwend ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Online Survey ◽  
Treatment Options ◽  
Equivalent Dose ◽  
Patterns Of Care ◽  
Treatment Recommendation ◽  
Published Data ◽  
Prostate Bed ◽  
Radiation Oncologists ◽  
German Speaking

Abstract Background Emerging moderately hypofractionated and ultra-hypofractionated schemes for radiotherapy (RT) of prostate cancer (PC) have resulted in various treatment options. The aim of this survey was to evaluate recent patterns of care of German-speaking radiation oncologists for RT of PC. Methods We developed an online survey which we distributed via e‑mail to all registered members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 109 participants between March 3 and April 3, 2020. For evaluation of radiation dose, we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy, equivalent dose (EQD2 [1.5 Gy]). Results Median EQD2(1.5 Gy) for definitive RT of the prostate is 77.60 Gy (range: 64.49–84.00) with median single doses (SD) of 2.00 Gy (range: 1.80–3.00), while for postoperative RT of the prostate bed, median EQD2(1.5 Gy) is 66.00 Gy (range: 60.00–74.00) with median SD of 2.00 Gy (range: 1.80–2.00). For definitive RT, the pelvic lymph nodes (LNs) are treated in case of suspect findings in imaging (82.6%) and/or according to risk formulas/tables (78.0%). In the postoperative setting, 78.9% use imaging and 78.0% use the postoperative tumor stage for LN irradiation. In the definitive and postoperative situation, LNs are irradiated with a median EQD2(1.5 Gy) of 47.52 Gy with a range of 42.43–66.00 and 41.76–62.79, respectively. Conclusion German-speaking radiation oncologists’ patterns of care for patients with PC are mainly in line with the published data and treatment recommendation guidelines. However, dose prescription is highly heterogenous for RT of the prostate/prostate bed, while the dose to the pelvic LNs is mainly consistent.

Understanding Active Surveillance for Prostate Cancer

2021 ◽  
pp. OP.20.00929
Author(s):  
Lillian Y. Lai ◽  
Vahakn B. Shahinian ◽  
Mary K. Oerline ◽  
Samuel R. Kaufman ◽  
Ted A. Skolarus ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Guideline Development ◽  
Multinomial Logistic Regression ◽  
Specific Antigen ◽  
National Sample ◽  
Logistic Regression Models ◽  
Radiation Oncologists ◽  
Medical Oncologists ◽  
Testing Patterns

PURPOSE: To assess how active surveillance for prostate cancer is apportioned across specialties and how testing patterns and transition to treatment vary by specialty. METHODS: We used a 20% national sample of Medicare claims to identify men diagnosed with prostate cancer from 2010 through 2016 initiating surveillance (N = 13,048). Patients were assigned to the physician responsible for the bulk of surveillance care based on billing patterns. Freedom from treatment was assessed by specialty of the responsible physician (urology, radiation oncology, medical oncology, and primary care). Multinomial logistic regression models were used to examine associations between specialty and treatment patterns. RESULTS: Urologists were responsible for surveillance in 93.7% of patients in 2010 and 96.2% of patients in 2016 ( P for trend = .01). Testing patterns varied by specialty. For example, patients of medical oncologists had more frequent prostate-specific antigen testing compared with patients of urologists (1.85 v 2.39 tests per year, respectively; P < .01). Three years after diagnosis, a significantly smaller proportion of patients managed by radiation oncologists (64.3%) remained on surveillance compared with patients managed by other physicians (75.8%-79.5%; P < .01). Although radiation was the most common treatment among all men who transitioned to treatment, a disproportionate percentage of patients followed by radiation oncologists (28.9%) ultimately underwent radiation compared with patients followed by other physicians (15.1%-15.4%; P < .01). CONCLUSION: Nontrivial percentages of patients on active surveillance are managed by physicians outside of urology. Given the interspecialty variations observed, efforts to strengthen the evidence underlying surveillance pathways and to engage other specialties in guideline development are needed.

Patterns of prostate cancer management across Canadian prostate cancer treatment specialists.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 321-321
Author(s):  
Bobby Shayegan ◽  
Alan I. So ◽  
Shawn Malone ◽  
Sebastien J. Hotte ◽  
Antonio Finelli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Advanced Prostate Cancer ◽  
Patterns Of Care ◽  
Online Questionnaire ◽  
Prostate Cancer Treatment ◽  
Chi Square ◽  
Cancer Management ◽  
Radiation Oncologists ◽  
Medical Oncologists

321 Background: The Canadian GU Research Consortium (GURC) was recently established to bring comprehensive prostate cancer centres together to collaborate on research, education, and adoption of best practices. As an initial step to inform the work of the GURC, an electronic questionnaire was designed to assess management of advanced prostate cancer care in Canada and better understand patterns of care. Methods: A 59-item online questionnaire was developed by a multidisciplinary scientific committee to measure physician practices, patterns of care, treatment sequencing, and management of mCRPC. After pre-testing, the online questionnaire was sent to 93 urologists, uro-oncologists, medical oncologists, radiation oncologists, and general practitioner oncologists who are actively involved in the treatment of prostate cancer. Results: A total of 49 (53%) respondents completed the questionnaire between April 17, 2017 to May 17, 2017. Although all respondents indicated a role in initiating life-prolonging oral therapy for mCRPC and monitoring treatment and side effects, chemotherapy initiation was mainly a medical oncologist role compared to other specialties (p < 0.05, chi-square). Symptom management such as palliative care and end-of-life care were provided mainly by radiation oncologists (100%) and medical oncologists (81%) compared to urologists (33%) and uro-oncologists (50%), p < 0.05, chi-square). Patient mix varied across the disciplines. Urologist practices were composed primarily of non-metastatic prostate cancer patients (73%), as were radiation oncologist practices (77%), while uro-oncologist practices included both non-metastatic (58%) and metastatic (40%) patients. Medical oncologists practices were mainly (91%) metastatic patients. Referral patterns also varied by discipline. Conclusions: In Canada, prostate cancer treatment involves multiple disciplines providing a range of care at different points across the treatment continuum. We plan to do further research to better understand variation in practice and improve multidisciplinary coordination for patients with advanced prostate cancer.

Contemporary trends in abiraterone and enzalutamide prescription by provider specialty.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 366-366
Author(s):  
Daniel Pucheril ◽  
Ye Wang ◽  
Dimitar V. Zlatev ◽  
Paul L. Nguyen ◽  
Adam S. Kibel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Abiraterone Acetate ◽  
Optimal Timing ◽  
Part D ◽  
Southern States ◽  
Radiation Oncologists ◽  
Medical Oncologists ◽  
Specific Outcome ◽  
Castrate Resistant Prostate Cancer ◽  
Castrate Resistant

366 Background: Androgen deprivation therapy (ADT) with LHRH-agonists and anti-androgens, is established in the management of prostate cancer and is administered by urologists, medical oncologists, and radiation oncologists. Newer agents for ADT, abiraterone acetate (ABI) and enzalutamide (ENZA) were approved by the FDA in 2011 and 2012, respectively, for the management of metastatic castrate resistant prostate cancer (mCRPC) after failing chemotherapy. We evaluated the contemporary economic burden of ABI and ENZA and their adoption by specialty. Methods: Because a majority of men with mCRPC are > 65 years of age, we utilized Medicare Part D data from 2013-15. The specific outcome variables of interest included the aggregate reimbursement and total number of prescriptions for ABI and ENZA, by specialty. Descriptive statistics and trend analysis were performed. Results: From 2013-15, the total number of prescription rose from 52457 to 81058 for ABI and from 17141 to 69181 for ENZA. Though medical oncologists prescribed more than 75% of ABI/ENZA prescriptions each year, the proportion of prescriptions written by urologists increased annually. The greatest increase in the percentage of prescriptions originating from urology occurred from 2013-2014 for ABI (3.96% to 8.62%) and from 2014-15 for ENZA (5.42% to 15.64%); meanwhile, prescriptions by radiation oncology were negligible throughout the study. Southern states accounted for greater than one third of ABI and ENZA prescriptions. By 2015, the aggregate reimbursement of Part D claims for ENZA and ABI was $790 million each. Among all medication claims, ENZA and ABI represent the 29th and 30th most expensive by aggregate cost. Conclusions: While medical oncologists account for the vast majority of ENZA and ABI prescriptions, the prescriptions by urologists is increasing while prescriptions by radiation oncologists remain negligible. Though approved for mCRPC patients, ENZA and ABI are already among the costliest medications covered by Medicare. As Level 1 indications for the use of these medications increase and now include castrate-sensitive patients, further study should be directed at determining optimal timing and indication for prescription.

scholarly journals Personal prostate-specific antigen screening and treatment choices for localized prostate cancer among expert physicians

2017 ◽  
Vol 12 (2) ◽  
pp. E59-63
Author(s):  
Christopher Wallis ◽  
Douglas Cheung ◽  
Laurence Klotz ◽  
Venu Chalasani ◽  
Ricardo Leao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Secondary Outcome ◽  
University Of Toronto ◽  
Radiation Oncologists ◽  
Medical Oncologists ◽  
Treat Prostate Cancer ◽  
Healthcare Interventions

Introduction: We aimed to determine the personal practices of urologists, radiation oncologists, and medical oncologists regarding prostate cancer screening and treatment using the physician surrogate method, which seeks to identify acceptable healthcare interventions by ascertaining interventions physicians select for themselves.Methods: A hierarchical, contingent survey was developed through a consensus involving urologists, medical oncologists, and radiation oncologists. It was piloted at the University of Toronto and then circulated to urologists, radiation oncologists, and medical oncologists through professional medical societies in the U.S., Canada, Central and South America, Australia, and New Zealand. The primary outcome was physicians’ personal choices regarding prostatespecific antigen (PSA) screening and the secondary outcome was treatment selection among those diagnosed with prostate cancer.Results: A total of 869 respondents provided consent and completed the survey. Of these, there were 719 urologists, 89 radiation oncologists, nine medical oncologists, and 53 undisclosed specialists. Most (784 of 869 respondents; 90%) endorsed past or future screening for themselves (among male physicians) or for relatives (among female physicians). Among urologists and radiation oncologists making prostate cancer treatment decisions, there was a significant correlation between physician specialty and the treatment selected (Phi coefficient=0.61; p=0.001).Conclusions: Physicians who routinely treat prostate cancer are likely to undertake prostate cancer screening themselves or recommend it for immediate family members. Treatment choice is influenced by the well-recognized specialty bias.

scholarly journals Oncologists and medical assistance in dying: where do we stand? Results of a national survey of Canadian oncologists

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
G. Chandhoke ◽  
Gregory Pond ◽  
O. Levine ◽  
S. Oczkowski
Keyword(s):  
End Of Life ◽  
National Survey ◽  
Online Survey ◽  
Therapeutic Option ◽  
Willingness To Participate ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists

Background In June 2016, when the Parliament of Canada passed Bill C-14, the country joined the small number of jurisdictions that have legalized medical assistance in dying (maid). Since legalization, nearly 7000 Canadians have received maid, most of whom (65%) had an underlying diagnosis of cancer. Although Bill C-14 specifies the need for government oversight and monitoring of maid, the government-collected data to date have tracked patient charac­teristics, rather than clinician encounters and beliefs. We aimed to understand the views of Canadian oncologists 2 years after the legalization of maid. Methods We developed and administered an online survey to medical and radiation oncologists to understand their exposure to maid, self-perceived knowledge, willingness to participate, and perception of the role of oncologists in introducing maid as an end-of-life care option. We used complete sampling through the Canadian Association of Medical Oncologists and the Canadian Association of Radiation Oncology membership e-mail lists. The survey was sent to 691 physicians: 366 radiation oncologists and 325 medical oncologists. Data were collected during March–June 2018. Results are presented using descriptive statistics and univariate or multivariate analysis. Results The survey attracted 224 responses (response rate: 32.4%). Of the responding oncologists, 70% have been approached by patients requesting maid. Oncologists were of mixed confidence in their knowledge of the eligibility criteria. Oncologists were most willing to engage in maid with an assessment for eligibility, and yet most refer to specialized teams for assessments. In terms of introducing maid as an end-of-life option, slight more than half the responding physicians (52.8%) would initiate a conversation about maid with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions In this first national survey of Canadian oncologists about maid, we found that most respondents encounter patient requests for maid, are confident in their knowledge about eligibility, and are willing to act as assessors of eligibility. Many oncologists believe that, under some circumstances, it is appropriate to present maid as a therapeutic option at end of life. That finding warrants further deliberation by national or regional bodies for the development of consensus guidelines to ensure equitable access to maid for patients who wish to pursue it.  

Questionnaire to evaluate prostate cancer multidisciplinary committees in Spain.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e568-e568
Author(s):  
Javier Cassinello ◽  
Iván Henríquez López ◽  
Aranzazu Gonzalez del Alba ◽  
Carmen González San Segundo ◽  
José López Torrecilla ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Therapeutic Strategies ◽  
Urological Cancer ◽  
Radiation Oncologists ◽  
Medical Oncologists ◽  
Wide Range ◽  
Final Score ◽  
Medical Specialities ◽  
Cluster 2

e568 Background: Prostate Cancer (PC) management through Multidisciplinary Committees (MDC) has demonstrated some benefits that could be relevant in patient's outcomes. In Spain MDC are widely implemented although they are not homogeneous among hospitals. The aim of the study was to design a questionnaire to evaluate the functionality/effectiveness of PC MDC in Spain. Methods: The questionnaire was developed from a literature review (22 articles included) and validated by 9 opinion leaders (3 medical oncologists, 3 urologists and 3 radiation oncologists). Experts scored each questionnaire item regarding its ability to assess MDC functionality/effectiveness to obtain a final score of each hospital (from 0-minimum to 100-best functionality/effectiveness) used to classify them according to the cluster analysis (high/intermediate/low level of functionality/effectiveness). The questionnaire was distributed to different specialties by the Spanish Societies of Urological Cancer (URONCOR, GUO and SOGUG). Results: 218 physicians answered the questionnaire, 90 medical oncologists, 86 urologists and 42 radiation oncologists, from 109 hospitals with national representativeness. 91% of hospitals had a Urological MDC, 5% a PC MDC and 4% a General Tumour Committee. Core medical specialities (Urology, Medical Oncology, Radiation Oncology, Pathology, Radiology) were represented in > 80% of MDC. Only 9% MDC discussed the treatment of all patients with PC whereas in 60% of MDC less than 50% of the whole population of PC patients were evaluated. According to 95% of physicians, agreement in therapeutic strategies were reached in > 80% of cases discussed. A score was established that allowed the classification of MDC in each center according to its functionality into 3 clusters: 43% of centers fell in cluster 3 (high), 36% in cluster 2 (intermediate) and 21% in cluster 1 (low). Conclusions: Urological Cancer MDC is a widespread practice in Spain, which comprises a wide range of medical specialists that meet regularly to agree on therapeutic strategies for PC patients. Less than 50% of total PC patients are evaluated in Urological MDC. It is still necessary to improve some aspects allowing more hospitals to reach a higher level of functionality.

Oncologists and medical assistance in dying: Where do we stand?

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 64-64
Author(s):  
Gur Chandhoke ◽  
Gregory Russell Pond ◽  
Oren Hannun Levine ◽  
Simon Oczkowski
Keyword(s):  
End Of Life ◽  
Online Survey ◽  
Therapeutic Option ◽  
P Value ◽  
Willingness To Participate ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Radiation Oncologists ◽  
Canadian Association ◽  
Medical Oncologists

64 Background: With the passage of Bill C-14 in June 2016, medical assistance in dying (MAiD) was formally enacted into Canadian law. Since then, approximately 2,000 patients have died with medical assistance across the country, with cancer being the most common qualifying condition. We aimed to understand the views of oncology providers (OPs) regarding MAiD. Methods: We designed and administered an online survey to Canadian OPs’ to assess experience with MAiD, self-perceived knowledge, willingness to participate, and perception of the role of OPs in introducing MAiD as an end-of-life care option. We used complete sampling via the Canadian Association of Medical Oncologists (CAMO) and the Canadian Association of Radiation Oncologists (CARO) membership email lists. The survey was sent to 366 Radiation Oncologists, and 325 Medical Oncologists. Data was collected from April-June 2018. Results were analyzed using descriptive statistics as well as univariate and multivariate analysis. Results: We received 224 responses (response rate 32.4%). 70% of OPs have been approached by patients requesting MAiD. OPs were confident in their knowledge of the eligibility criteria, and previous exposure to MAiD was associated with confidence in this domain (odds ratio [OR]=3.77, 95% CI=2.05-6.94, p value<0.001). OPs were most willing to engage in MAiD with an assessment for eligibility, yet most refer to specialized teams for assessments. A majority of physicians (52.8%) would initiate a conversation of MAiD with a patient under certain circumstances, most commonly the absence of viable therapeutic options, coupled with unmanageable patient distress. Conclusions: In this first national survey of Canadian OP’s regarding MAiD, we found that most OP’s encounter patient requests for MAiD, are confident in knowledge of eligibility, and are willing to act as assessors of eligibility. Many OP’s believe that it is appropriate to present MAiD as a therapeutic option at the end of life under some circumstances. This finding warrants further deliberation amongst national/regional bodies for the development of consensus guidelines in order to ensure equitable access to MAiD for patients who wish to pursue it.

Prostate Cancer Imaging: What Surgeons, Radiation Oncologists, and Medical Oncologists Want to Know

2011 ◽  
Vol 196 (6) ◽  
pp. 1263-1266 ◽  
Author(s):  
Shahin Tabatabaei ◽  
Philip J. Saylor ◽  
John Coen ◽  
Douglas M. Dahl
Keyword(s):  
Prostate Cancer ◽  
Cancer Imaging ◽  
Radiation Oncologists ◽  
Medical Oncologists
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