Prostate Cancer Foundation-Department of Veterans Affairs Partnership: A Model of Public-Private Collaboration to Advance Treatment and Care of Invasive Cancers

PURPOSE Prostate cancer (PCa) is among the leading causes of cancer deaths. While localized PCa has a 5-year survival rate approaching 100%, this rate drops to 31% for metastatic prostate cancer (mPCa). Thus, timely identification of mPCa is a crucial step toward measuring and improving access to innovations that reduce PCa mortality. Yet, methods to identify patients diagnosed with mPCa remain elusive. Cancer registries provide detailed data at diagnosis but are not updated throughout treatment. This study reports on the development and validation of a natural language processing (NLP) algorithm deployed on oncology, urology, and radiology clinical notes to identify patients with a diagnosis or history of mPCa in the Department of Veterans Affairs. PATIENTS AND METHODS Using a broad set of diagnosis and histology codes, the Veterans Affairs Corporate Data Warehouse was queried to identify all Veterans with PCa. An NLP algorithm was developed to identify patients with any history or progression of mPCa. The NLP algorithm was prototyped and developed iteratively using patient notes, grouped into development, training, and validation subsets. RESULTS A total of 1,144,610 Veterans were diagnosed with PCa between January 2000 and October 2020, among which 76,082 (6.6%) were identified by NLP as having mPCa at some point during their care. The NLP system performed with a specificity of 0.979 and sensitivity of 0.919. CONCLUSION Clinical documentation of mPCa is highly reliable. NLP can be leveraged to improve PCa data. When compared to other methods, NLP identified a significantly greater number of patients. NLP can be used to augment cancer registry data, facilitate research inquiries, and identify patients who may benefit from innovations in mPCa treatment.

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Education predicts quality of life among men with prostate cancer cared for in the department of Veterans affairs

Cancer ◽

10.1002/cncr.22597 ◽

2007 ◽

Vol 109 (9) ◽

pp. 1769-1776 ◽

Cited By ~ 42

Author(s):

Sara J. Knight ◽

David M. Latini ◽

Stacey L. Hart ◽

Natalia Sadetsky ◽

Christopher J. Kane ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Veterans Affairs ◽

Department Of Veterans Affairs

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Racial Differences in the Role of the PSA Bounce in Predicting Prostate Cancer Outcomes after Radiotherapy: Evidence from the Department of Veterans Affairs

Brachytherapy ◽

10.1016/j.brachy.2019.04.041 ◽

2019 ◽

Vol 18 (3) ◽

pp. S17

Author(s):

Alexander N. Slade ◽

Bassam Dahman ◽

Michael G. Chang

Keyword(s):

Prostate Cancer ◽

Racial Differences ◽

Veterans Affairs ◽

Department Of Veterans Affairs ◽

Cancer Outcomes ◽

Psa Bounce

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The use of DNA promoter methylation testing for prostate cancer diagnosis in the Department of Veterans Affairs.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.394 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 394-394

Author(s):

Kyung Min Lee ◽

Jeffrey A. Jones ◽

Olga Efimova ◽

Scott L. DuVall ◽

Julie Ann Lynch

Keyword(s):

Prostate Cancer ◽

Cancer Diagnosis ◽

Promoter Methylation ◽

Clinical Decision Making ◽

Prostate Cancer Risk ◽

Veterans Affairs ◽

Molecular Diagnostic ◽

Department Of Veterans Affairs ◽

Multiple Biopsies ◽

The Impact

394 Background: It is essential to study real-world evidence of novel molecular diagnostic tests to measure their impact on clinical decision-making and health outcomes. Studying test utilization within the Department of Veterans Affairs (VA) informs about clinical validity in a racially diverse population. This study analyzed the impact of DNA promoter methylation (ConfirmDx), on the diagnostic workup of Veterans. Methods: The VA Corporate Data Warehouse (CDW) was used to identify all incident prostate biopsies and cancers from 1/2014-10/2019. We captured patient clinical characteristics, including number and date of biopsies, date of cancer diagnosis, dates and values of PSA tests, comorbidities, demographics, whether the patient underwent DNA promoter methylation testing, and the results of that test. Results: Each year an average of 25,299 biopsies are conducted in the VA. Between 2014 and 2019, 151,794 biopsies were performed. 98,155 (70%) Veterans underwent first-time biopsies and 54,447 (55%) were positive for carcinoma. 8,062 (8.2%) underwent multiple biopsies, among whom 3,589 (44%) were subsequently diagnosed with cancer. 34 Veterans underwent 5 or more biopsies before being diagnosed. 33,878 (35%) did not undergo another biopsy in the study period. 328 (0.3%) of the 98,155 Veterans underwent the DNA promoter methylation test. 55 (17%) of these Veterans were eligible for Medicare coverage of the test. Of the 328 tested for DNA methylation, 217 (66%) were minorities. 132/328 (40%) tested positive for carcinoma and 168/328 (51%) were negative. Conclusions: Most Veterans referred for prostate biopsy have detectable cancer, and a large number are minorities with potential increased prostate cancer risk. DNA promoter methylation may improve care by reducing the need for multiple biopsies, limiting exposure to infection, and reducing time to diagnosis and treatment.

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