Characteristics and comorbidities of veterans treated with enzalutamide or abiraterone.

e17022 Background: Prostate cancer (PCa) is the most common male malignancy and is the fourth leading cause of cancer-related death in males worldwide. Enzalutamide (ENZ) and Abiraterone (AA) are used in the treatment of castrate resistant PCa after androgen deprivation therapy (ADT), however these agents have not been directly compared. These drugs have various adverse effects with different mechanisms of action and may be selected based on comorbid conditions. In this study, we aim to identify patient characteristics and comorbidities of patients treated with ENZ versus AA. Methods: Patients treated with AA or ENZ between September 10, 2014 and June 3, 2017 were identified in the Veterans Health Administration and followed until April 2020. Only patients with a pathologic diagnosis of PCa and treatment with ADT prior to AA or ENZ were included. Age at initiation of treatment, Elixhauser comorbidity score, PSA at initiation of AA or ENZ, Gleason score at diagnosis, treatment with ADT, docetaxel, and cabazitaxel was collected. Months of filled prescriptions were used to determine length of treatment. Results: Of 2575 patients, 1095 (42.5%) were initially treated with ENZ, 1480 (57.5%) with AA, and 1330 (51.7%) received both agents. Overall, 756 (29.4%) of patients were of black race. Docetaxel was used in 32.3% of patients and cabazitaxel in 11.7% of patients, with no differences between ENZ or AA cohorts. There were no significant differences in time from pathologic diagnosis to initial ADT therapy, or subsequently to treatment with ENZ or AA in either group. Furthermore, there were no differences in PSA (n = 1243, median AA 33.7 vs ENZ 30.7, p = 0.538) or Gleason scores (n = 1816, mean AA 7.85 vs ENZ 7.94, p = 0.142). Patients initially treated with ENZ compared to AA were older (mean 74.2 vs. 73.7 years, p = 0.032), had higher mean comorbidity score (7.1 vs. 6.7, p = 0.002), and had a longer duration of first treatment (median 10.5 months vs. 9.0 months, p < 0.001). As a second agent, ENZ also had a longer duration of treatment (median 5.0 vs. 4.2 months, p < 0.001). Patients treated initially with ENZ were more likely to have heart failure (18.2% vs. 13.7%, p = 0.002), cardiac arrhythmia (42.1% vs 36.6%, p = 0.004), valvular disease (13.7% vs 10.3%, p = 0.009), peripheral vascular disorders (26.8% vs 22.7%, p = 0.016), uncomplicated hypertension (86.8% vs 83.6%, p = 0.024), complicated hypertension (20.2% vs 16.9%, p = 0.033), uncomplicated diabetes (43.9% vs 37.4%, p = 0.001), complicated diabetes (26.0% vs 19.9%, p = 0.000), renal failure (28.3% vs 22.6%, p = 0.001). Conclusions: Overall, we found that patients initially treated with ENZ were older and had higher rates of cardiovascular disease and diabetes compared to those initially treated with AA. Assessment of comorbidities may be helpful in treatment selection to facilitate personalized medicine in prostate cancer, prevent adverse events, and improve outcomes.

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Abstract A055: Racial disparities in metastatic castrate-resistant prostate cancer (mCRPC): Evidence from the Veterans Health Administration (VHA)

10.1158/1538-7445.prca2017-a055 ◽

2018 ◽

Author(s):

Ahmad Halwani ◽

Kelli M. Rasmussen ◽

Vikas Patil ◽

Zachary Burningham ◽

Sujata Narayanan ◽

...

Keyword(s):

Prostate Cancer ◽

Racial Disparities ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Castrate Resistant Prostate Cancer ◽

Castrate Resistant

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Impact of Self-Reported Patient Characteristics Upon Assessment of Glycemic Control in the Veterans Health Administration

Diabetes Care ◽

10.2337/dc06-0771 ◽

2007 ◽

Vol 30 (2) ◽

pp. 245-251 ◽

Cited By ~ 20

Author(s):

M. Maney ◽

C.-L. Tseng ◽

M. M. Safford ◽

D. R. Miller ◽

L. M. Pogach

Keyword(s):

Glycemic Control ◽

Patient Characteristics ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration

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Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation

BMJ ◽

10.1136/bmj.m283 ◽

2020 ◽

pp. m283 ◽

Cited By ~ 12

Author(s):

Elizabeth M Oliva ◽

Thomas Bowe ◽

Ajay Manhapra ◽

Stefan Kertesz ◽

Jennifer M Hah ◽

...

Keyword(s):

Opioid Analgesic ◽

Veterans Health Administration ◽

Fiscal Year ◽

Veterans Health ◽

Health Administration ◽

Opioid Treatment ◽

Risk Of Death ◽

Length Of Treatment ◽

Increased Risk ◽

Stopping Treatment

Abstract Objective To examine the associations between stopping treatment with opioids, length of treatment, and death from overdose or suicide in the Veterans Health Administration. Design Observational evaluation. Setting Veterans Health Administration. Participants 1 394 102 patients in the Veterans Health Administration with an outpatient prescription for an opioid analgesic from fiscal year 2013 to the end of fiscal year 2014 (1 October 2012 to 30 September 2014). Main outcome measures A multivariable Cox non-proportional hazards regression model examined death from overdose or suicide, with the interaction of time varying opioid cessation by length of treatment (≤30, 31-90, 91-400, and >400 days) as the main covariates. Stopping treatment with opioids was measured as the time when a patient was estimated to have no prescription for opioids, up to the end of the next fiscal year (2014) or the patient’s death. Results 2887 deaths from overdose or suicide were found. The incidence of stopping opioid treatment was 57.4% (n = 799 668) overall, and based on length of opioid treatment was 32.0% (≤30 days), 8.7% (31-90 days), 22.7% (91-400 days), and 36.6% (>400 days). The interaction between stopping treatment with opioids and length of treatment was significant (P<0.001); stopping treatment was associated with an increased risk of death from overdose or suicide regardless of the length of treatment, with the risk increasing the longer patients were treated. Hazard ratios for patients who stopped opioid treatment (with reference values for all other covariates) were 1.67 (≤30 days), 2.80 (31-90 days), 3.95 (91-400 days), and 6.77 (>400 days). Descriptive life table data suggested that death rates for overdose or suicide increased immediately after starting or stopping treatment with opioids, with the incidence decreasing over about three to 12 months. Conclusions Patients were at greater risk of death from overdose or suicide after stopping opioid treatment, with an increase in the risk the longer patients had been treated before stopping. Descriptive data suggested that starting treatment with opioids was also a risk period. Strategies to mitigate the risk in these periods are not currently a focus of guidelines for long term use of opioids. The associations observed cannot be assumed to be causal; the context in which opioid prescriptions were started and stopped might contribute to risk and was not investigated. Safer prescribing of opioids should take a broader view on patient safety and mitigate the risk from the patient’s perspective. Factors to address are those that place patients at risk for overdose or suicide after beginning and stopping opioid treatment, especially in the first three months.

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Bone modifying agents in veterans with castration-resistant prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6582 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6582-6582

Author(s):

Jordan Bauman ◽

Kyle Kumbier ◽

Jennifer A. Burns ◽

Jordan Sparks ◽

Phoebe A. Tsao ◽

...

Keyword(s):

Prostate Cancer ◽

Zoledronic Acid ◽

Bone Metastases ◽

Specific Antigen ◽

Veterans Health ◽

Health Administration ◽

Castration Resistant Prostate Cancer ◽

National Guidelines ◽

Castration Resistant ◽

Unit Increase

6582 Background: Skeletal related events (SREs) are a known complication for the 80% of men with metastatic prostate cancer who have bone metastases. Previous studies have demonstrated that bone modifying agents (BMAs) such as zoledronic acid and denosumab reduce SREs in men with metastatic castration-resistant prostate cancer who have bone metastases and are now recommended by national guidelines. We sought to investigate factors associated with use of BMAs in Veterans with CRPC across the Veterans Health Administration (VA). Methods: Using the VA Corporate Data Warehouse, consisting of aggregated medical record data from 130 facilities, we used an algorithm previously published to identify men with a diagnosis of castration-resistant prostate cancer (CRPC) based on rising prostate specific antigen (PSA) levels while on androgen deprivation therapy and who received systemic treatment for CRPC with one of the commonly used therapies: abiraterone, enzalutamide, docetaxel, ketoconazole between 2010 and 2017. To account for clustering among facilities, we used a multilevel multivariable logistic regression to determine the association of patient and disease-specific variables on the odds of a patient receiving a BMA after they started treatment for CRPC. Results: Of 4,998 patients with CRPC in our cohort, 2223 (44%) received either zoledronic acid or denosumab at some point after they were initiated on treatment for CRPC. After adjusting for other variables and accounting for a facility, the odds of receiving a BMA decreased by 3% for every additional year of age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96-0.98), and decreased significantly with increasing comorbid conditions (OR 0.94, 95% CI 0.72-0.98 for Charlson Comorbidity Index [CCI] of 1; OR 0.69, 95% CI 0.59-0.81 for CCI 2+). Patients who were Black had 25% lower odds of receiving a BMA than patients who were White (OR 0.75, 95% CI 0.65-0.87). PSA at time of CRPC treatment start had a small but not significant effect on receipt of a BMA (OR 1.04, 95% CI 1.00-1.08) for every unit increase of PSA on the log scale. PSA doubling time was not associated with receipt of a BMA. The presence of a diagnosis code for bone metastases was far lower than expected in this cohort of patients with CRPC (40.7%), and thus was not included in the model. We did not expect the presence of bone metastases to vary significantly among the other independent variables. Conclusions: Despite most patients with CRPC historically having bone metastases, less than half of patients with CRPC received a BMA. Patients who are older, had more comorbidities, or were Black were less likely to receive a BMA after starting treatment for CRPC. Understanding factors that lead to different patterns of treatment can guide initiatives toward more guideline-concordant care.

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Practice patterns in metastatic castration-resistant prostate cancer (mCRPC): Evidence from the veterans health administration

Annals of Oncology ◽

10.1093/annonc/mdx370.021 ◽

2017 ◽

Vol 28 ◽

pp. v277-v278 ◽

Cited By ~ 1

Author(s):

A. Halwani ◽

Z. Burningham ◽

K.M. Rasmussen ◽

V. Patil ◽

S. Narayanan ◽

...

Keyword(s):

Prostate Cancer ◽

Practice Patterns ◽

Veterans Health Administration ◽

Veterans Health ◽

Health Administration ◽

Castration Resistant Prostate Cancer ◽

Castration Resistant

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Determinants of quality prostate cancer survivorship care across the primary and specialty care interface: Lessons from the Veterans Health Administration

Cancer Medicine ◽

10.1002/cam4.2106 ◽

2019 ◽

Vol 8 (5) ◽

pp. 2686-2702 ◽

Cited By ~ 1

Author(s):

Archana Radhakrishnan ◽

Jennifer Henry ◽

Kevin Zhu ◽

Sarah T. Hawley ◽

Brent K. Hollenbeck ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Survivorship ◽

Veterans Health Administration ◽

Specialty Care ◽

Veterans Health ◽

Survivorship Care ◽

Health Administration

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The Use of Rifampin Therapy to Treat Diabetic Patients with Osteomyelitis of the Foot in the Veterans Health Administration: Patient Characteristics and Clinical Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.086 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S101-S101

Author(s):

Brigid Wilson ◽

Elie Saade ◽

Gheorghe Doros ◽

John Hermos ◽

Mary Bessesen ◽

...

Keyword(s):

Treatment Guidelines ◽

Composite Endpoint ◽

Patient Characteristics ◽

Veterans Health Administration ◽

Foot Ulcers ◽

Diabetic Patients ◽

Veterans Health ◽

Health Administration ◽

Short Treatment ◽

Research Grant

Abstract Background Nearly 25% of Veterans Health Administration (VHA) patients are diagnosed with diabetes mellitus (DM). Among DM patients, the lifetime incidence of foot ulcers is 15%. Infection is a common complication of foot ulcers and 20–60% of infections result in diabetic foot osteomyelitis (DFO). Current treatment guidelines do not endorse any specific antibiotic agent for DFO, but small clinical trials suggest the addition of rifampin to antimicrobial regimens results in improved cure rates for osteomyelitis. Methods Using VHA databases, we identified index DFO cases from 2009 to 2013 and extracted patient and infection characteristics including demographics, comorbidities, chronic medications, antibiotic regimens, and microbiology data when present. We analyzed the subset of patients alive, without high-level amputation, and treated with antibiotics at 90 days after diagnosis. We summarized patient characteristics and compared a composite endpoint of amputation or death within 2 years of DFO diagnosis among those treated with rifampin to those not treated with rifampin. Results In total, 10,736 DFO cases met our criteria (Figure). Of these, 151 were considered treated with rifampin, based on 14 or more days of rifampin initiated within 90 days of diagnosis; 10,551 were unexposed to rifampin; and 34 were excluded for late or short treatment with rifampin. We observed significant differences between patients treated with and without rifampin (Table) and 44% of rifampin-treated patients were seen in 14 facilities. Amputation or death at 2 years was observed in 44 (29%) of patients treated with rifampin and 4,007 (38%) of patients not treated with rifampin (P = 0.03). Conclusion Rifampin was rarely used in the treatment of DFO in the VHA and a few facilities accounted for a large proportion of rifampin-treated cases. We observed higher rates of amputation-free survival in patients treated with rifampin, but in the presence of notable confounders including age, comorbidities, and organism. Disclosures E. Saade, Steris: Grant Investigator, Grant recipient. Janssen: Grant Investigator, Research grant. Sequiris: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. R. A. Bonomo, Entasis: Grant Investigator, Research grant. Allecra: Grant Investigator, Research grant. Wockhardt: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. GSK: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant. Shionogi: Grant Investigator, Research grant

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Expectant management of veterans with early-stage prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.13 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 13-13

Author(s):

Christopher Paul Filson ◽

Jeremy B. Shelton ◽

Hung-Jui Tan ◽

Lorna Kwan ◽

Ted A. Skolarus ◽

...

Keyword(s):

Prostate Cancer ◽

Early Stage ◽

Expectant Management ◽

Veterans Health ◽

Health Administration ◽

Prostate Cancer Treatment ◽

Patient Demographics ◽

Multivariable Regression ◽

Multivariable Regression Models ◽

Administration Methods

13 Background: We evaluated the association between various factors and the use of expectant management (EM) among patients with prostate cancer treated in the Veterans Health Administration. Methods: We identified men diagnosed with prostate cancer in 2008. Outcome of interest was use of EM captured through an in-depth chart review. We fit multivariable regression models to examine associations between EM use and patient demographics, cancer severity, and facility characteristics. We then assessed regional variation across 52 facilities by generating predicted probabilities for receipt of EM. Results: Among our analytic cohort (n=6,540), 34% of men were treated expectantly. EM was more common among patients 75 and older (40% vs. 27% under 55 years, OR 2.57) and with low-risk tumors (49% vs. 20% high-risk, OR 5.35). There was no association between patient comorbidity and receipt of EM (p=0.90) (Table). There were also no significant associations between facility factors and receipt of EM (all p>0.05). Among ideal EM candidates, receipt of expectant management varied considerably across individual facilities (0 – 85%, p<0.001). Conclusions: Patient age and tumor risk were both more strongly associated with the use of expectant EM than patient comorbidity. Though its appears appropriate broadly, there was variation in EM between hospitals, apparently not attributable to facility factors. Research determining the basis of this variation—with a focus on providers—will be critical to help optimize prostate cancer treatment for veterans. [Table: see text]

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