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Joyce DD, Wallis CJD, Luckenbaugh AN, Huelster HL, Zhao Z, Hoffman KE, Huang LC, Koyama T, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, Neil BBO, Kaplan SH, Greenfield S, Penson DF, Barocas DA. Sexual function outcomes of radiation and androgen deprivation therapy for localized prostate cancer in men with good baseline function. Prostate Cancer Prostatic Dis 2021; 25:238-247. [PMID: 34108648 DOI: 10.1038/s41391-021-00405-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sexual dysfunction, including erectile dysfunction and loss of libido, are common among men undergoing treatment for localized prostate cancer. Both local treatments and systemic androgen deprivation therapy may contribute to these outcomes and are differentially indicated based on disease characteristics. We sought to compare sexual function through 5 years after radiation treatment with and without androgen deprivation therapy in men with good baseline sexual function to better understand long-term effects in this understudied subset of patients. METHODS We retrospectively reviewed a prospectively assembled population-based cohort of men who underwent radiation with and without androgen deprivation therapy for intermediate or high-risk localized prostate cancer. Sexual function was assessed longitudinally over 5 years. Men with erections sufficient for intercourse at baseline were selected for inclusion. RESULTS Out of 167 patients included, 73 underwent radiation alone and 94 received androgen deprivation therapy plus radiation (51 with intermediate and 43 with high-risk disease). Androgen deprivation therapy use was associated with worse sexual function through 1 year regardless of disease risk. This difference was no longer statistically significant at 3 years in the intermediate-risk group. Compared to radiation alone, androgen deprivation therapy in high-risk disease was associated with worse sexual function at 3 years (effect: -20.3 points, CI [-31.8, -8.8], p < 0.001) but not at 5 years (effect: -3.4, CI [-17.2, 10.5], p = 0.63). CONCLUSIONS Androgen deprivation therapy plus radiation is associated with worse sexual function through 3-years follow-up in men with high-risk prostate cancer compared to radiation alone. The addition of androgen deprivation therapy in the treatment of intermediate-risk disease does not appear to result in worse sexual function at 3 or 5-year follow-up compared to radiation alone.
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Affiliation(s)
- Daniel D Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather L Huelster
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA
| | - Lisa E Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock B O' Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT, USA
| | - Sherrie H Kaplan
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Sheldon Greenfield
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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Laviana AA, Zhao Z, Huang LC, Koyama T, Conwill R, Hoffman K, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O'Neil BB, Kaplan SH, Greenfield S, Penson DF, Barocas DA. Development and Internal Validation of a Web-based Tool to Predict Sexual, Urinary, and Bowel Function Longitudinally After Radiation Therapy, Surgery, or Observation. Eur Urol 2020; 78:248-255. [PMID: 32098731 DOI: 10.1016/j.eururo.2020.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/06/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Shared decision making to guide treatment of localized prostate cancer requires delivery of the anticipated quality of life (QOL) outcomes of contemporary treatment options (including radical prostatectomy [RP], intensity-modulated radiation therapy [RT], and active surveillance [AS]). Predicting these QOL outcomes based on personalized features is necessary. OBJECTIVE To create an easy-to-use tool to predict personalized sexual, urinary, bowel, and hormonal function outcomes after RP, RT, and AS. DESIGN, SETTING, AND PARTICIPANTS A prospective, population-based cohort study was conducted utilizing US cancer registries of 2563 men diagnosed with localized prostate cancer in 2011-2012. INTERVENTION Patient-reported urinary, sexual, and bowel function up to 5 yr after treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient-reported urinary, sexual, bowel, and hormonal function through 5 yr after treatment were collected using the 26-item Expanded Prostate Index Composite (EPIC-26) questionnaire. Comprehensive models to predict domain scores were fit, which included age, race, D'Amico classification, body mass index, EPIC-26 baseline function, treatment, and standardized scores measuring comorbidity, general QOL, and psychosocial health. We reduced these models by removing the instrument scores and replacing D'Amico classification with prostate-specific antigen (PSA) and Gleason score. For the final model, we performed bootstrap internal validation to assess model calibration from which an easy-to-use web-based tool was developed. RESULTS AND LIMITATIONS The prediction models achieved bias-corrected R-squared values of 0.386, 0.232, 0.183, 0.214, and 0.309 for sexual function, urinary incontinence, urinary irritative, bowel, and hormonal domains, respectively. Differences in R-squared values between the comprehensive and parsimonious models were small in magnitude. Calibration was excellent. The web-based tool is available at https://statez.shinyapps.io/PCDSPred/. CONCLUSIONS Functional outcomes after treatment for localized prostate cancer can be predicted at the time of diagnosis based on age, race, PSA, biopsy grade, baseline function, and a general question regarding overall health. Providers and patients can use this prediction tool to inform shared decision making. PATIENT SUMMARY In this report, we studied patient-reported sexual, urinary, hormonal, and bowel function through 5 yr after treatment with radical prostatectomy, radiation therapy, or active surveillance for localized prostate cancer. We developed a web-based predictive tool that can be used to predict one's outcomes after treatment based on age, race, prostate-specific antigen, biopsy grade, pretreatment baseline function, and a general question regarding overall health. We hope both patients and providers can use this tool to better understand expected outcomes after treatment, further enhancing shared decision making between providers and patients.
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Affiliation(s)
- Aaron A Laviana
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen Hoffman
- Department of Radiation Oncology, University of Texas M. D. Anderson Center, Huston, TX, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA
| | - Lisa E Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock B O'Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT, USA
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Sheldon Greenfield
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
Prostate cancer (CaP) incidence, morbidity, and mortality rates vary substantially by race and ethnicity, with African American men experiencing among the highest CaP rates in the world. The causes of these disparities are multifactorial and complex, and likely involve differences in access to screening and treatment, exposure to CaP risk factors, variation in genomic susceptibility, and other biological factors. To date, the proportion of CaP that can be explained by environmental exposures is small and differences in the role factors play by race or ethnicity is poorly understood. In the absence of additional data, it is likely that environmental factors do not contribute greatly to CaP disparities. In contrast, CaP has one of the highest heritabilities of all major cancers and many CaP susceptibility genes have been identified. Some CaP loci, including the risk loci found at chromosome 8q24, have consistent effects in all racial/ethnic groups studied to date. However, replication of many susceptibility loci across race or ethnicity remains limited. It is likely that inequities in health care access strongly influences CaP disparities. CaP is a disease with a complex multifactorial etiology, and therefore any approach attempting to address racial/ethnic disparities in CaP must consider the many sources that influence risk, outcomes, and disparities.
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Affiliation(s)
- Timothy R Rebbeck
- Dana Farber Cancer Institute and Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02215
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Avedisova AS, Zhabin MO, Akzhigitov RG, Gudkova AA. [The problem of multiple somatic and/or psychiatric pathology basic concepts and prevalence]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:5-13. [PMID: 29927396 DOI: 10.17116/jnevro2018118515] [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] [Indexed: 01/22/2023]
Abstract
The literature of the last decades shows the growing interest to multiple pathologies in medicine including psychiatry and neurology. Multiple pathology is often determined as multimorbidity or comorbidity. Multiple pathology is a common phenomenon, which is the rule rather than the exception. In the medical care system, it is burden for the patient and for the physician in clinical, organizational and economic aspects. The review addresses all these issues in the aspect of terminology and prevalence.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - M O Zhabin
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A A Gudkova
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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Flanders SC, Kim J, Wilson S, Braziunas J, Greenfield S, Billimek J, Lechpammer S, Lin DW, Karsh L, Quinn DI, Shevrin D, Shore ND, Symanowski JT, Penson DF. Validating the total illness burden index for prostate cancer (TIBI-CaP) in men with castration-resistant prostate cancer: data from TRUMPET. Future Oncol 2018; 14:527-536. [PMID: 29417827 PMCID: PMC5941708 DOI: 10.2217/fon-2017-0438] [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: 08/31/2017] [Accepted: 11/21/2017] [Indexed: 11/21/2022] Open
Abstract
AIM To validate the total illness burden index for prostate cancer (TIBI-CaP) in castration-resistant prostate cancer (CRPC) patients. PATIENTS & METHODS Baseline comorbidity scores collected using the TIBI-CaP were compared with the baseline patient-reported health-related quality of life using the SF-12v2 and FACT-P questionnaires in 302 patients enrolled in the Treatment Registry for Outcomes in CRPC Patients (TRUMPET). RESULTS Baseline TIBI-CaP scores were negatively correlated with all baseline SF-12v2 domain/composite (p < 0.001) and FACT-P subscale/total (p < 0.020) scores. There was a significant decreasing linear trend in SF12v2 and FACT-P scores over the categories based on TIBI-CaP quartiles of comorbidity burden (from 'least' to 'severe'). CONCLUSION The TIBI-CaP is a valid measure of comorbidity burden in patients with CRPC in the real world.
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Affiliation(s)
| | - Janet Kim
- Astellas Pharma, Inc., Northbrook, IL 60062, USA
| | | | | | - Sheldon Greenfield
- Health Policy Research Institute, University of California, Irvine, CA 90024, USA
| | - John Billimek
- Health Policy Research Institute, University of California, Irvine, CA 90024, USA
| | - Stanislav Lechpammer
- Medivation, Inc., which was acquired by Pfizer, Inc. in September 2016, San Francisco, CA 94105, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA 98195, USA
| | | | - David I Quinn
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Daniel Shevrin
- Medical Oncology, North Shore University Health System, Evanston, IL 60201, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC 29572, USA
| | - James T Symanowski
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC 28025, USA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37250, USA
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6
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Tyson MD, Koyama T, Lee D, Hoffman KE, Resnick MJ, Wu XC, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Paddock LE, Stroup A, Chen V, Conwill R, McCollum D, Penson DF, Barocas DA. Effect of Prostate Cancer Severity on Functional Outcomes After Localized Treatment: Comparative Effectiveness Analysis of Surgery and Radiation Study Results. Eur Urol 2018; 74:26-33. [PMID: 29501451 DOI: 10.1016/j.eururo.2018.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/12/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Whether prostate cancer severity modifies patient-reported functional outcomes after radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer is unknown. OBJECTIVE The purpose of this study was to determine whether differences in predicted function over time between RP and EBRT varied by risk group. DESIGN, SETTING, AND PARTICIPANTS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study that enrolled men with localized prostate cancer in 2011-2012. Among 2117 CEASAR participants who underwent RP or EBRT, 817 had low-risk, 902 intermediate-risk, and 398 high-risk disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient-reported, disease-specific function was measured using the 26-item Expanded Prostate Index Composite (at baseline and 6, 12, and 36 mo). Predicted function was estimated using regression models and compared by disease risk. RESULTS AND LIMITATIONS Low-risk EBRT patients reported 3-yr sexual function scores 12 points higher than those of low-risk RP patients (RP, 39 points [95% confidence interval {CI}, 37-42] vs EBRT, 52 points [95% CI, 47-56]; p<0.001). The difference in 3-yr scores for high-risk patients was not clinically significant (RP, 32 points [95% CI, 28-35] vs EBRT, 38 points [95% CI, 33-42]; p=0.03). However, when using a commonly used binary definition of sexual function (erections firm enough for intercourse), no major differences were noted between RP and EBRT at 3 yr across low-, intermediate-, and high-risk disease strata. No clinically significant interactive effects between treatment and cancer severity were observed for incontinence, bowel, irritative voiding, and hormone domains. The primary limitation is the lack of firmly established thresholds for clinically significant differences in Expanded Prostate Index Composite domain scores. CONCLUSIONS For men with low-risk prostate cancer, EBRT was associated with higher sexual function scores at 3 yr than RP; however, for men with high-risk prostate cancer, no clinically significant difference was noted. Men with high-risk prostate cancer should be counseled that EBRT and RP carry similar sexual function outcomes at 3 yr. PATIENT SUMMARY In this report, we studied the urinary, sexual, bowel, and hormonal functions of patients 3 yr after undergoing prostate cancer surgery or radiation. We found that for patients with high-risk disease, sexual function was similar between surgery and radiation. We conclude that high-risk patients undergoing radiation therapy should be counseled that sexual function may not be as good as low-risk patients undergoing radiation.
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Affiliation(s)
- Mark Douglas Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Urology, Mayo Clinic Hospital, Phoenix, AZ, USA.
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan Lee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sheldon Greenfield
- Center for Health Policy Research, University of California, Irvine, CA, USA; Department of Medicine, University of California, Irvine, CA, USA
| | - Ann S Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mia Hashibe
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey (Drs Paddock and Stroup), Rutgers University, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Rutgers Cancer Institute of New Jersey (Drs Paddock and Stroup), Rutgers University, New Brunswick, NJ, USA
| | - Vivien Chen
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Ralph Conwill
- Prostate Cancer Patient Advocate, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan McCollum
- Prostate Cancer Patient Advocate, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Avulova S, Zhao Z, Lee D, Huang LC, Koyama T, Hoffman KE, Conwill RM, Wu XC, Chen V, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Paddock LE, Stroup A, Resnick MJ, Penson DF, Barocas DA. The Effect of Nerve Sparing Status on Sexual and Urinary Function: 3-Year Results from the CEASAR Study. J Urol 2017; 199:1202-1209. [PMID: 29253578 DOI: 10.1016/j.juro.2017.12.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Nerve sparing contributes to the recovery of sexual and urinary function after radical prostatectomy but it may be ineffective in some patients or carry the risk of a positive surgical margin. We evaluated sexual and urinary function outcomes according to the degree of nerve sparing in patients with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS The CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study is a prospective, population based, observational study of men diagnosed with localized prostate cancer in 2011 to 2012. Patient reported sexual and urinary functions were measured using the 26-item Expanded Prostate Index Composite at baseline within 6 months after diagnosis, and 6, 12 and 36 months after enrollment. Study inclusion criteria included radical prostatectomy as primary treatment, documentation of nerve sparing status and absent androgen deprivation therapy. Nerve sparing status was defined as none, unilateral or bilateral according to the operative report. RESULTS The final analytical cohort included 991 men. The 11 men treated with unilateral nerve sparing and the 75 treated with a nonnerve sparing procedure were grouped together. In the multivariable model there was a significant difference in the sexual function score 3 years after radical prostatectomy in the bilateral nerve sparing group compared with the unilateral and nonnerve sparing group (6.1 points, 95% CI 2.0-10.3, p = 0.004). This was more pronounced in men with high baseline sexual function (8.23 points, 95% CI 1.6-14.8, p = 0.014) but not in those with low baseline function (4.0 points, 95% CI -0.6-8.7, p = 0.090). Similar effects were demonstrated on urinary incontinence scores. CONCLUSIONS Bilateral nerve sparing resulted in better sexual and urinary function outcomes than unilateral or nonnerve sparing but the difference was not significant in men with low baseline sexual function.
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Affiliation(s)
- Svetlana Avulova
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Daniel Lee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ralph M Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vivien Chen
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Matthew R Cooperberg
- Department of Urology, University of California-San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California-Irvine, Irvine, California
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mia Hashibe
- Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Antoinette Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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8
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Barocas DA, Alvarez J, Resnick MJ, Koyama T, Hoffman KE, Tyson MD, Conwill R, McCollum D, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Penson DF. Association Between Radiation Therapy, Surgery, or Observation for Localized Prostate Cancer and Patient-Reported Outcomes After 3 Years. JAMA 2017; 317:1126-1140. [PMID: 28324093 PMCID: PMC5782813 DOI: 10.1001/jama.2017.1704] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [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] [Indexed: 01/13/2023]
Abstract
Importance Understanding the adverse effects of contemporary approaches to localized prostate cancer treatment could inform shared decision making. Objective To compare functional outcomes and adverse effects associated with radical prostatectomy, external beam radiation therapy (EBRT), and active surveillance. Design, Setting, and Participants Prospective, population-based, cohort study involving 2550 men (≤80 years) diagnosed in 2011-2012 with clinical stage cT1-2, localized prostate cancer, with prostate-specific antigen levels less than 50 ng/mL, and enrolled within 6 months of diagnosis. Exposures Treatment with radical prostatectomy, EBRT, or active surveillance was ascertained within 1 year of diagnosis. Main Outcomes and Measures Patient-reported function on the 26-item Expanded Prostate Cancer Index Composite (EPIC) 36 months after enrollment. Higher domain scores (range, 0-100) indicate better function. Minimum clinically important difference was defined as 10 to 12 points for sexual function, 6 for urinary incontinence, 5 for urinary irritative symptoms, 5 for bowel function, and 4 for hormonal function. Results The cohort included 2550 men (mean age, 63.8 years; 74% white, 55% had intermediate- or high-risk disease), of whom 1523 (59.7%) underwent radical prostatectomy, 598 (23.5%) EBRT, and 429 (16.8%) active surveillance. Men in the EBRT group were older (mean age, 68.1 years vs 61.5 years, P < .001) and had worse baseline sexual function (mean score, 52.3 vs 65.2, P < .001) than men in the radical prostatectomy group. At 3 years, the adjusted mean sexual domain score for radical prostatectomy decreased more than for EBRT (mean difference, -11.9 points; 95% CI, -15.1 to -8.7). The decline in sexual domain scores between EBRT and active surveillance was not clinically significant (-4.3 points; 95% CI, -9.2 to 0.7). Radical prostatectomy was associated with worse urinary incontinence than EBRT (-18.0 points; 95% CI, -20.5 to -15.4) and active surveillance (-12.7 points; 95% CI, -16.0 to -9.3) but was associated with better urinary irritative symptoms than active surveillance (5.2 points; 95% CI, 3.2 to 7.2). No clinically significant differences for bowel or hormone function were noted beyond 12 months. No differences in health-related quality of life or disease-specific survival (3 deaths) were noted (99.7%-100%). Conclusions and Relevance In this cohort of men with localized prostate cancer, radical prostatectomy was associated with a greater decrease in sexual function and urinary incontinence than either EBRT or active surveillance after 3 years and was associated with fewer urinary irritative symptoms than active surveillance; however, no meaningful differences existed in either bowel or hormonal function beyond 12 months or in in other domains of health-related quality-of-life measures. These findings may facilitate counseling regarding the comparative harms of contemporary treatments for prostate cancer.
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Affiliation(s)
- Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn Alvarez
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J. Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark D. Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralph Conwill
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Dan McCollum
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Matthew R. Cooperberg
- Department of Urology, University of California, San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California, Irvine, Irvine, California
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, Utah
| | - Sherrie H. Kaplan
- Health Policy Research Institute, University of California, Irvine, Irvine, California
| | - Lisa E. Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Antoinette M. Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Tennessee Valley Veterans Administration Health System, Nashville, TN
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Lang MF, Tyson MD, Alvarez JR, Koyama T, Hoffman KE, Resnick MJ, Cooperberg MR, Wu XC, Chen V, Paddock LE, Hamilton AS, Hashibe M, Goodman M, Greenfield S, Kaplan SH, Stroup A, Penson DF, Barocas DA. The Influence of Psychosocial Constructs on the Adherence to Active Surveillance for Localized Prostate Cancer in a Prospective, Population-based Cohort. Urology 2017; 103:173-8. [PMID: 28189554 DOI: 10.1016/j.urology.2016.12.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/01/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the influence of psychosocial factors such as prostate cancer (PCa) anxiety, social support, participation in medical decision-making (PDM), and educational level on patient decisions to discontinue PCa active surveillance (AS) in the absence of disease progression. METHODS The Comparative Effectiveness Analysis of Surgery and Radiation study is a prospective, population-based cohort study of men with localized PCa diagnosed in 2011-2012. PCa anxiety, social support, PDM, educational level, and patient reasons for discontinuing AS were assessed through patient surveys. A Cox proportional hazards model examined the relationship between psychosocial variables and time to discontinuation of AS. RESULTS Of 531 patients on AS, 165 (30.9%) underwent treatment after median follow-up of 37 months. Whereas 69% of patients cited only medical reasons for discontinuing AS, 31% cited at least 1 personal reason, and 8% cited personal reasons only. Patients with some college education discontinued AS significantly earlier (hazard ratio: 2.0, 95% confidence interval: 1.2, 3.2) than patients with less education. PCa anxiety, social support, and PDM were not associated with seeking treatment. CONCLUSION We found that 31% of men who choose AS for PCa discontinue AS within 3 years. Eight percent of men who sought treatment did so in the absence of disease progression. Education, but not psychosocial factors, seems to influence definitive treatment-seeking. Future research is needed to understand how factors unrelated to disease severity influence treatment decisions among patients on AS to identify opportunities to improve adherence to AS.
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Tyson MD, Alvarez J, Koyama T, Hoffman KE, Resnick MJ, Wu XC, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Paddock LE, Stroup A, Chen VW, Penson DF, Barocas DA. Racial Variation in Patient-Reported Outcomes Following Treatment for Localized Prostate Cancer: Results from the CEASAR Study. Eur Urol 2016; 72:307-314. [PMID: 27816300 DOI: 10.1016/j.eururo.2016.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/09/2016] [Accepted: 10/20/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Relatively little is known about the relationship between race/ethnicity and patient-reported outcomes after contemporary treatments for localized prostate cancer. OBJECTIVE To test the hypothesis that treatment-related changes in urinary, bowel, sexual, and hormonal function vary by race/ethnicity. DESIGN, SETTING, AND PARTICIPANTS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study that enrolled 3708 men diagnosed with localized prostate cancer in 2011-2012. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient-reported disease-specific function was measured using the 26-item Expanded Prostate Index Composite (EPIC) at baseline and 6 and 12 mo after enrollment. Mean treatment differences in function were compared by race using risk-adjusted generalized estimating equations. RESULTS AND LIMITATIONS While all race/ethnic groups reported considerable declines in scores for urinary incontinence after radical prostatectomy (RP) when compared to active surveillance, African-American men reported a greater difference than white men did (adjusted difference-in-differences 8.4 points, 95% confidence interval 2.0-14.8; p=0.01). No difference in bother scores was noted and the overall proportion of explained variation attributable to race/ethnicity was relatively small in comparison to primary treatment and baseline function. No clinically significant racial variation was noted for the sexual, bowel, irritative voiding, or hormone domains. Limitations include the lack of well-established thresholds for clinical significance using the EPIC instrument. CONCLUSION While these data demonstrate that incontinence at 1 yr after RP may be worse for African-American compared to white men, the difference appears to be modest overall. Treatment selection and baseline function explain a much greater proportion of the variation in function after treatment. PATIENT SUMMARY We observed that the effect of treatment for prostate cancer on patient-reported function did not vary dramatically by race/ethnicity. Compared to white men, African-American men experienced a somewhat more pronounced decline in urinary continence after radical prostatectomy, but the corresponding changes in bother scores were not significantly different between the two groups.
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Affiliation(s)
- Mark D Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - JoAnn Alvarez
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco Medical Center, San Francisco, CA, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California, Irvine, CA, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mia Hashibe
- Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Vivien W Chen
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Kalra S, Basourakos S, Abouassi A, Achim M, Volk RJ, Hoffman KE, Davis JW, Kim J. The implications of ageing and life expectancy in prostate cancer treatment. Nat Rev Urol 2016; 13:289-95. [PMID: 27001016 DOI: 10.1038/nrurol.2016.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In patients diagnosed with prostate cancer, the selection of treatment, including the type of therapy and its aggressiveness, is often based on a patient's age and life expectancy. Life expectancy estimates are too often calculated solely on the patient's chronological age, overlooking comorbid conditions and their severity, which can greatly affect life expectancy. If, in addition to chronological age, comorbid conditions are used to assess a patient's life expectancy, the most appropriate treatment options are more likely to be selected. Older, healthy patients might be able to tolerate more aggressive treatment than would be administered on the basis of their age alone, and younger patients with numerous comorbid conditions could avoid harsh therapy that might not be appropriate given their current state of health. The key idea to consider in treatment selection is what a patient's quality of life would be like with or without a particular treatment option. In an era of precision medicine, decisions regarding the provision of health care should be made rationally and on the basis of objective estimates of the threat of disease and the benefits and costs of intervention and within the context of the patient's characteristics and desires.
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Sorkin DH, Billimek J, August KJ, Ngo-Metzger Q, Kaplan SH, Reikes AR, Greenfield S. Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes. Fam Pract 2015; 32:317-22. [PMID: 25846216 PMCID: PMC4542807 DOI: 10.1093/fampra/cmv014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS To examine the relative contribution of glycaemic control (HbA1C) and depressive symptoms on diabetes-related symptom burden (hypoglycaemia and hyperglycaemia) in order to guide medication modification. METHODS Secondary analysis of medical records data and questionnaires collected from a racially/ethnically diverse sample of adult patients with type 2 diabetes (n = 710) from seven outpatient clinics affiliated with an academic medical centre over a 1-year period as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. RESULTS Results from linear regression analysis revealed that patients with high levels of depressive symptoms had more diabetes-related symptom burden (both hypoglycaemia and hyperglycaemia) than patients with low levels of depressive symptoms (βs = 0.09-0.17, Ps < 0.02). Furthermore, results from two logistic regression analyses suggested that the odds of regimen intensification at 1-year follow-up was marginally associated with patient-reported symptoms of hypoglycaemia [adjusted odds ratio (aOR) = 1.24, 95% CI: 0.98-1.58; P = 0.08] and hyperglycaemia (aOR = 1.21, 95% CI: 1.00-1.46; P = 0.05), after controlling for patients' HbA1C, comorbidity, insulin use and demographics. These associations, however, were diminished for patients with high self-reported hypoglycaemia and high levels of depressive symptoms, but not low depressive symptoms (interaction terms for hypoglycaemia by depressive symptoms, aOR = 0.98, 95% CI: 0.97-0.99; P = 0.03). CONCLUSIONS Mental health symptoms are associated with higher levels of patient-reported of diabetes-related symptoms, but the association between diabetes-related symptoms and subsequent regimen modifications is diminished in patients with greater depressive symptoms. Clinicians should focus attention on identifying and treating patients' mental health concerns in order to address the role of diabetes-related symptom burden in guiding physician medication prescribing behaviour.
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Affiliation(s)
- Dara H Sorkin
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - John Billimek
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | | | - Quyen Ngo-Metzger
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - Sherrie H Kaplan
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - Andrew R Reikes
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - Sheldon Greenfield
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
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Barocas DA, Chen V, Cooperberg M, Goodman M, Graff JJ, Greenfield S, Hamilton A, Hoffman K, Kaplan S, Koyama T, Morgans A, Paddock LE, Phillips S, Resnick MJ, Stroup A, Wu XC, Penson DF. Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study. J Comp Eff Res 2014; 2:445-60. [PMID: 24236685 DOI: 10.2217/cer.13.34] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND While randomized controlled trials represent the highest level of evidence we can generate in comparative effectiveness research, there are clinical scenarios where this type of study design is not feasible. The Comparative Effectiveness Analyses of Surgery and Radiation in localized prostate cancer (CEASAR) study is an observational study designed to compare the effectiveness and harms of different treatments for localized prostate cancer, a clinical scenario in which randomized controlled trials have been difficult to execute and, when completed, have been difficult to generalize to the population at large. METHODS CEASAR employs a population-based, prospective cohort study design, using tumor registries as cohort inception tools. The primary outcome is quality of life after treatment, measured by validated instruments. Risk adjustment is facilitated by capture of traditional and nontraditional confounders before treatment and by propensity score analysis. RESULTS We have accrued a diverse, representative cohort of 3691 men in the USA with clinically localized prostate cancer. Half of the men invited to participate enrolled, and 86% of patients who enrolled have completed the 6-month survey. CONCLUSION Challenging comparative effectiveness research questions can be addressed using well-designed observational studies. The CEASAR study provides an opportunity to determine what treatments work best, for which patients, and in whose hands.
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Nagarajan R, Zhang S, Cobb Payton F, Massarweh S. Inferring breast cancer concomitant diagnosis and comorbidities from the Nationwide Inpatient Sample using social network analysis. Health Syst (Basingstoke) 2014; 3:136-142. [DOI: 10.1057/hs.2014.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Choi IY, Park S, Park B, Chung BH, Kim CS, Lee HM, Byun SS, Lee JY. Development of prostate cancer research database with the clinical data warehouse technology for direct linkage with electronic medical record system. Prostate Int 2013; 1:59-64. [PMID: 24223403 PMCID: PMC3814112 DOI: 10.12954/pi.12015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/21/2013] [Indexed: 11/05/2022] Open
Abstract
Purpose: In spite of increased prostate cancer patients, little is known about the impact of treatments for prostate cancer patients and outcome of different treatments based on nationwide data. In order to obtain more comprehensive information for Korean prostate cancer patients, many professionals urged to have national system to monitor the quality of prostate cancer care. To gain its objective, the prostate cancer database system was planned and cautiously accommodated different views from various professions. Methods: This prostate cancer research database system incorporates information about a prostate cancer research including demographics, medical history, operation information, laboratory, and quality of life surveys. And, this system includes three different ways of clinical data collection to produce a comprehensive data base; direct data extraction from electronic medical record (EMR) system, manual data entry after linking EMR documents like magnetic resonance imaging findings and paper-based data collection for survey from patients. Results: We implemented clinical data warehouse technology to test direct EMR link method with St. Mary’s Hospital system. Using this method, total number of eligible patients were 2,300 from 1997 until 2012. Among them, 538 patients conducted surgery and others have different treatments. Conclusions: Our database system could provide the infrastructure for collecting error free data to support various retrospective and prospective studies.
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Affiliation(s)
- In Young Choi
- Department of Medical Informatics, The Catholic University of Korea College of Medicine, Seoul, Korea
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17
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Liss MA, Billimek J, Osann K, Cho J, Moskowitz R, Kaplan A, Szabo RJ, Kaplan SH, Greenfield S, Dash A. Consideration of comorbidity in risk stratification prior to prostate biopsy. Cancer 2013; 119:2413-8. [PMID: 23619920 DOI: 10.1002/cncr.28044] [Citation(s) in RCA: 5] [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] [Received: 10/16/2012] [Revised: 01/03/2013] [Accepted: 01/28/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previously, the patient-reported Total Illness Burden Index for Prostate Cancer (TIBI-CaP) questionnaire and/or the physician-reported Charlson Comorbidity Index (CCI) have provided assessments of competing comorbidity during treatment decisions for patients with prostate cancer. In the current study, the authors used these assessments to determine comorbidity and prognosis before prostate biopsy and the subsequent diagnosis of prostate cancer to identify those patients least likely to benefit from treatment. METHODS A prospective observational cohort study was performed of 104 participants aged 64.0 years ± 6.5 years from 3 institutions representing different health care delivery systems. Patients were identified before undergoing transrectal ultrasound-guided prostate biopsy and followed for a median of 28 months. Associations between the comorbidity scores and nonelective hospital admissions were investigated using logistic regression and Cox proportional hazards models. RESULTS Among the 104 patients who underwent prostate biopsy, 2 died during the follow-up period. The overall hospital admission rate was 20% (21 of 104 patients). Higher scores on both the TIBI-CaP (≥ 9) and CCI (≥ 3) were found to be significantly associated with an increased odds for hospital admission (odds ratio, 11.3 [95% confidence interval (95% CI), 2.4-53.6] and OR, 5.7 [95% CI, 1.4-22.4]) and hazards ratios (HRs) for time to hospital admission (HR, 3.8 [95% CI, 1.3-11.2] and HR, 3.2 [95% CI, 1.1-9.1]), respectively. CONCLUSIONS TIBI-CaP and CCI scores were found to successfully predict which patients were at high risk for nonelective hospital admission. These patients are likely to have poorer health and a potentially shortened lifespan. Therefore, comorbidity analysis using these tools may help to identify those patients who are least likely to benefit from prostate cancer therapy and should avoid prostate biopsy.
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Affiliation(s)
- Michael A Liss
- Department of Urology, University of California at Irvine, Irvine, California, USA
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18
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Malik S, Billimek J, Greenfield S, Sorkin DH, Ngo-Metzger Q, Kaplan SH. Patient complexity and risk factor control among multimorbid patients with type 2 diabetes: results from the R2D2C2 study. Med Care 2013; 51:180-5. [PMID: 23047130 DOI: 10.1097/MLR.0b013e318273119b] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Among patients with type 2 diabetes, it is not known whether risk factor control is better or worse for those who also have heart disease, depression, multiple other comorbidities, and associated management challenges. OBJECTIVE To examine the relationship between this complex constellation of multimorbidities, adherence to treatment and risk factor control among patients with type 2 diabetes, independent of regimen intensity. RESEARCH DESIGN Observational cross-sectional study. SUBJECTS A total of 1314 patients with diabetes from the Reducing Racial Disparities in Diabetes Coached Care (R2D2C2) Study. MEASURES A composite cardiometabolic risk factor profile was the dependent variable. Independent variables included a composite measure of patient complexity, patient-reported adherence to treatment, history of coronary heart disease (CHD), and intensity of medication regimen. RESULTS A higher proportion of the most complex patient-reported problems with adherence compared with the least complex patients (83.5% vs. 43.3%, P<0.001). Compared with those without a history of CHD, fewer patients with CHD-reported problems with medication adherence (59.3% vs. 69.3%, P<0.01) and had better risk factor control, independent of complexity and regimen intensity. Better risk factor control was independently associated with less patient complexity (P=0.003) and to history of CHD (P=0.01). CONCLUSIONS The presence of a complex illness profile was associated with poorer control of risk factors. Those with CHD were more adherent to treatment and had better risk factor control. The occurrence of CHD may present an opportunity for physicians to emphasize risk factor management. Diabetes patients with a complex illness profile may be at highest risk for cardiovascular events and in greatest need of prevention of cardiac disease. TRIAL REGISTRATION Clinicaltrial.gov identifier: NCT01123239.
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Gardiner RFA, Yaxley J, Baade PD. Integrating disparate snippets of information in an approach to PSA testing in Australia and New Zealand. BJU Int 2012. [PMID: 23194123 DOI: 10.1111/j.1464-410x.2012.11616.x] [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: 11/28/2022]
Abstract
• An invited response to 'Stricker PD, Frydenberg M, Kneebone A, Chopra S. Informed prostate cancer risk-adjusted testing: a new paradigm'.
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Affiliation(s)
- Robert Frank A Gardiner
- Department of Urology, University of Queensland Centre for Clinical Research and Royal Brisbane and Women's Hospital, and Cancer Council Queensland, Brisbane, Australia.
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20
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Olomu AB, Corser WD, Stommel M, Xie Y, Holmes-Rovner M. Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly? BMC Health Serv Res 2012; 12:398. [PMID: 23151237 PMCID: PMC3538524 DOI: 10.1186/1472-6963-12-398] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/23/2012] [Indexed: 12/04/2022] Open
Abstract
Background The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used. The purpose of this study was to evaluate the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity, quality of life (QOL) health outcomes compared to CCI medical records data. Method An SCQ-score was generated from patient interview, and the CCI score was generated by medical record review for 525 patients hospitalized for Acute Coronary Syndrome (ACS) at baseline, three months and eight months post-discharge. Linear regression models assessed the extent to which there were differences in the ability of comorbidity measures to predict functional capacity (Activity Status Index [ASI] scores) and quality of life (EuroQOL 5D [EQ5D] scores). Results The CCI (R2 = 0.245; p = 0.132) did not predict quality of life scores while the SCQ self-report method (R2 = 0.265; p < 0.0005) predicted the EQ5D scores. However, the CCI was almost as good as the SCQ for predicting the ASI scores at three and six months and performed slightly better in predicting ASI at eight-month follow up (R2 = 0.370; p < 0.0005 vs. R2 = 0.358; p < 0.0005) respectively. Only age, gender, family income and Center for Epidemiologic Studies-Depression (CESD) scores showed significant association with both measures in predicting QOL and functional capacity. Conclusions Although our model R-squares were fairly low, these results show that the self-report SCQ index is a good alternative method to predict QOL health outcomes when compared to a CCI medical record score. Both measures predicted physical functioning similarly. This suggests that patient self-reported comorbidity data can be used for predicting physical functional capacity and QOL and can serve as a reliable risk adjustment measure. Self-report comorbidity data may provide a cost-effective alternative method for risk adjustment in clinical research, health policy and organizational improvement analyses. Trial registration Clinical Trials.gov NCT00416026
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Affiliation(s)
- Adesuwa B Olomu
- College of Human Medicine, Clinical Center Building, Michigan State University, 788 Service Road, Room B329, East Lansing, MI 48824, USA.
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Abstract
BACKGROUND The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults. METHODS Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927). RESULTS Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week. CONCLUSIONS No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients' assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.
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Affiliation(s)
- Takashi Yamashita
- Scripps Gerontology Center Department of Sociology and Gerontology, Miami University, Oxford, Ohio 45056-1879, USA
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Groome PA, Rohland SL, Siemens DR, Brundage MD, Heaton J, Mackillop WJ. Assessing the impact of comorbid illnesses on death within 10 years in prostate cancer treatment candidates. Cancer 2011; 117:3943-52. [DOI: 10.1002/cncr.25984] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/06/2010] [Accepted: 11/22/2010] [Indexed: 11/11/2022]
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Daskivich TJ, van de Poll-franse LV, Kwan L, Sadetsky N, Stein DM, Litwin MS. From bad to worse: comorbidity severity and quality of life after treatment for early-stage prostate cancer. Prostate Cancer Prostatic Dis 2010; 13:320-7. [DOI: 10.1038/pcan.2010.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaplan SH, Billimek J, Sorkin DH, Ngo-Metzger Q, Greenfield S. Who can respond to treatment? Identifying patient characteristics related to heterogeneity of treatment effects. Med Care 2010; 48:S9-16. [PMID: 20473205 DOI: 10.1097/MLR.0b013e3181d99161] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Interest in comparative effectiveness research and the rising number of negative or "small effect" trials have stimulated research into differential response to treatment among subgroups of patients. OBJECTIVE To develop and test the Potential for Benefit Scale (PBS), a composite measure to identify subgroups of patients with differential potential for response to treatment, using diabetes as a model. DESIGN Cross-sectional and longitudinal cohort study. SUBJECTS AND SETTING Type 2 diabetes patients (n = 1361) were identified from 7 outpatient clinics serving a diverse population. Of these, 611 completed a 1-year follow-up. MEASURES To represent patients' health status, we used the Total Illness Burden Index, the Physical Function Index of the SF-36, the Center for Epidemiologic Studies Depression Scale, and the Diabetes Burden Scale. To represent personality characteristics related to health, we used the Provider-Dependent Health Care Orientation scale. We assessed the contribution of these measures to a composite scale of patients' potential for treatment response in terms of self-reported medication adherence and glycemic control. RESULTS Principal components analysis confirmed associations among these measures. The internal consistency reliability of the PBS was adequate (Cronbach alpha = 0.65). Patients in the lowest versus highest quartile of the PBS reported poorer adherence (18% vs. 55%, P < 0.001) and poorer glycemic control at baseline (mean hemoglobin A1c values: 7.75 vs. 7.39, P < 0.001). Those in the highest quartile of the PBS also were more likely to reach target values for glycemic control (HbA1c <7%) at 1-year follow-up, (adjusted OR = 1.61, P < 0.05). CONCLUSIONS The PBS, a composite scale, may be helpful in identifying patients with differential potential for response to treatment.
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Baron M, Schieir O, Hudson M, Steele R, Janelle-Montcalm A, Bernstein J, Starr M, Gagné M, Stein M, Kang H, Kapusta M, Couture F, Fitzcharles MA, Garfield B, Ménard HA, Berkson L, Pineau C, Gutkowski A, Zummer M, Mathieu JP, Mercille S, Ligier S, Krasny J, Bertrand C, Yuen SY, Schulz J. Evaluation of the clinimetric properties of the Early Inflammatory Arthritis--self-administered comorbidity questionnaire. Rheumatology (Oxford) 2009; 48:390-4. [PMID: 19193697 DOI: 10.1093/rheumatology/ken504] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To adapt the self-administered comorbidity questionnaire (SCQ) into the Early Inflammatory Arthritis-SCQ (EIA-SCQ) and assess its clinimetric properties in EIA. METHODS The EIA-SCQ and indices of disease activity, function, pain, health-related quality of life (HRQoL) and health resource utilization were administered to 320 patients with EIA. Twenty patients completed the EIA-SCQ a second time 1 week later. Construct validity was evaluated by testing the hypotheses that a valid comorbidity index would correlate well with age, weakly with HRQoL and recent resource utilization and poorly with indices of disease activity, function and pain. RESULTS The intra-class correlation coefficient between repeat scores was 0.93 (95% CI 0.83-0.97). Kappa values for individual items ranged from 0.64 to 1.0. EIA-SCQ scores correlated moderately with age (Tau B = 0.29, P < 0.001) and weakly with function (HAQ-DI Tau B = 0.09, P = 0.03), pain (McGill Pain Questionnaire Tau B = 0.09, P = 0.05), some measures of HRQoL [the SF-36 mental component score (MCS) Tau B = - 0.08, P < 0.05; World Health Organization Disease Assessment Schedule II score Tau B = 0.09, P = 0.03] and a measure of resource utilization (number of tests in the last 4 months Tau B = 0.10, P = 0.04). The EIA-SCQ did not correlate with other measures of disease activity, another HRQoL measure [SF-36 physical component score (PCS)] or other measures of resource utilization. CONCLUSIONS The EIA-SCQ is reliable and valid for use in EIA. It has the potential to become a useful measure of comorbidity in outcome studies of EIA when the resources for a full medical chart review are unavailable.
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Affiliation(s)
- Murray Baron
- Division of Rheumatology, Sir Mortimer B Davis-Jewish General Hospital, McGill University, Montreal, Quebec,Canada.
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Abstract
CONTEXT Preventive medicine has historically favored reducing a risk factor by a small amount in the entire population rather than by a large amount in high-risk individuals. The use of multivariable risk prediction tools, however, may affect the relative merits of this strategy. METHODS This study uses risk factor data from the National Health and Nutrition Examination Survey III to simulate a population of more than 100 million Americans aged thirty or older with no history of CV disease. Three strategies that could affect CV events, CV mortality, and quality-adjusted life years were examined: (1) a population-based strategy that treats all individuals with a low- or moderate-intensity intervention (in which the low-intensity intervention represents a public health campaign with no demonstrable adverse effects), (2) a targeted strategy that treats individuals in the top 25 percent based on a single risk factor (LDL), and (3) a risk-targeted strategy that treats individuals in the top 25 percent based on overall CV risk (as predicted by a multivariable prediction tool). The efficiency of each strategy was compared while varying the intervention's intensity and associated adverse effects, and the accuracy of the risk prediction tool. FINDINGS The LDL-targeted strategy and the low-intensity population-based strategy were comparable for CV events prevented over five years (0.79 million and 0.75 million, respectively), as were the risk-targeted strategy and moderate-intensity population-based strategy (1.56 million and 1.87 million, respectively). The risk-targeted strategy, however, was more efficient than the moderate-intensity population-based strategy (number needed to treat [NNT] 19 vs. 62). Incorporating a small degree of treatment-related adverse effects greatly magnified the relative advantages of the risk-targeted approach over other strategies. Reducing the accuracy of the prediction tool only modestly decreased this greater efficiency. CONCLUSIONS A population-based prevention strategy can be an excellent option if an intervention has almost no adverse effects. But if the intervention has even a small degree of disutility, a targeted approach using multivariable risk prediction can prevent more morbidity and mortality while treating many fewer people.
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Affiliation(s)
- Donna M Zulman
- Robert Wood Johnson Clinical Scholars Program, University of Michigan, 6312 Medical Science Building I, 1150 W. Medical Center Drive, Ann Arbor, MI 48109-5604, USA.
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Hudson M, Bernatsky S, Taillefer S, Fortin PR, Wither J, Baron M. Patients with systemic autoimmune diseases could not distinguish comorbidities from their index disease. J Clin Epidemiol 2008; 61:654-62. [DOI: 10.1016/j.jclinepi.2007.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 07/22/2007] [Accepted: 08/03/2007] [Indexed: 11/28/2022]
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van de Poll-Franse LV, Sadetsky N, Kwan L, Litwin MS. Severity of cardiovascular disease and health-related quality of life in men with prostate cancer: a longitudinal analysis from CaPSURE. Qual Life Res 2008; 17:845-55. [PMID: 18506598 PMCID: PMC2491436 DOI: 10.1007/s11136-008-9356-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 04/28/2008] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the influence of comorbid cardiovascular disease severity on health-related quality of life (HRQL) in men treated with radical prostatectomy (RP) or radiotherapy (RT) for early stage prostate cancer. Methods Subjects (n = 830) with non-metastatic disease who had been diagnosed in 2000–2002 were drawn from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE). We evaluated the influence of cardiovascular disease (CVD) severity on generic and disease-specific HRQL before and 6, 12, 18, and 24 months after treatment with RP or RT. HRQL was measured with the SF-36 and the UCLA Prostate Cancer Index. Results Men with moderate (n = 193) or severe (n = 51) cardiovascular disease had worse pre-treatment HRQL than did men without CVD (n = 293) (P < 0.01); HRQL scores were worse in men referred for RT. During 24 months of follow-up, men with moderate or severe CVD had worse SF-36 physical and mental component summaries and worse bowel function at all time points (P < 0.05). Men with severe CVD also experienced a slower recovery in physical function (P = 0.03) and sexual functioning (P = 0.02) than did men without CVD. Conclusions Prostate cancer patients with moderate to severe CVD have worse HRQL during follow-up. Those with severe CVD recover their physical and sexual functioning more slowly after treatment.
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Affiliation(s)
- Lonneke V van de Poll-Franse
- Comprehensive Cancer Centre South (IKZ), Eindhoven Cancer Registry, P.O. Box 231, 5600 AE Eindhoven, The Netherlands.
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Sheikh K, Jiang Y, Bullock CM. Is there a sex or race difference in 30-day mortality after interruption of vena cava in a Medicare population? J Vasc Interv Radiol 2008; 19:677-682. [PMID: 18440455 DOI: 10.1016/j.jvir.2008.01.008] [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: 11/07/2007] [Revised: 01/09/2008] [Accepted: 01/13/2008] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Disparities in health care and its outcome often indicate an opportunity for improving the quality of health care. Sex and rare differences in short-term mortality following interruption of vena cava are not known. The objective of this study was to determine such differences. MATERIALS AND METHODS With use of Medicare administrative data, 1,823 interruption of vena cava procedures performed between 1994 and 1997 were identified among beneficiaries aged 65-99 years residing in Indiana and Kentucky. In Cox proportional hazard regression models, male-to-female and nonwhite-to-white 30-day mortality ratios were adjusted for age, sex or race, weighted Charlson comorbidity score, length of hospital stay, and fatal coexisting conditions (ascertained from death certificate data). RESULTS Altogether, 277 patients died within 30 days after the procedure. Women were older than men. The comorbidity score was associated with male sex and mortality. There was no significant race difference in unadjusted or adjusted 30-day mortality after interruption of the vena cava. Unadjusted mortality was higher in men than in women (odds ratio, 1.49; 95% confidence interval [CI]=1.15, 1.92). Although adjustment for age, race, Charlson score, and length of hospital stay reduced the magnitude of sex difference, it remained significant. Further adjustment for fatal coexistent conditions reduced the sex difference to an insignificant level (odds ratio, 1.22; 95% CI=0.96, 1.56). CONCLUSIONS There was no significant sex or race difference in adjusted 30-day mortality after interruption of vena cava procedure in the elderly Medicare beneficiary population of two states.
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Affiliation(s)
- Kazim Sheikh
- U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, 601 E 12th St, Rm 235, Kansas City, MO 64106, USA.
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van de Poll-Franse LV, Kwan L, Reiter RE, Lee SP, Litwin MS. The influence of cardiovascular disease on health related quality of life in men with prostate cancer: a 4-year followup study. J Urol 2008; 179:1362-7; discussion 1367. [PMID: 18289562 DOI: 10.1016/j.juro.2007.11.086] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Indexed: 11/17/2022]
Abstract
PURPOSE Presence of comorbid conditions has consistently been associated with less aggressive treatment and worse overall survival in men with prostate cancer. However, little is known about the impact of comorbidity on health related quality of life outcomes, which may help men and their physicians facing decisions on primary treatment. MATERIALS AND METHODS We evaluated patterns of health related quality of life in men with both prostate cancer and cardiovascular disease during 4 years of followup in a cohort of 475 prostate cancer survivors. We measured generic and disease specific health related quality of life at diagnosis and 11 times afterward. Repeated measures analyses with mixed modeling were used to examine changes in health related quality of life in subjects with cardiovascular disease and compare outcomes with those of an age, stage and treatment matched sample without cardiovascular disease. RESULTS Men with cardiovascular disease had worse baseline physical health related quality of life (p = 0.003) and showed worse scores over time in this domain than did matched controls (p = 0.003). We found no significant interaction between treatment and cardiovascular disease on physical health related quality of life outcomes, suggesting that cardiovascular disease had the same detrimental effect on health related quality of life in this specific domain for radical prostatectomy, brachytherapy or external beam radiotherapy. The negative effect of cardiovascular disease on physical health related quality of life over time appeared to be stronger for those with worse baseline scores. The presence of cardiovascular disease was also associated with worse baseline sexual function (p = 0.004) and a trend toward worse scores over time (p = 0.07). CONCLUSIONS Our observations suggest that patients with prostate cancer with cardiovascular disease have worse physical and sexual health related quality of life before and following treatment.
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Sheikh K, Jiang Y, Bullock CM. Effect of comorbid and fatal coexistent conditions on sex and race differences in vascular surgical mortality. Ann Vasc Surg 2007; 21:496-504. [PMID: 17628266 DOI: 10.1016/j.avsg.2007.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 03/27/2007] [Accepted: 03/28/2007] [Indexed: 11/24/2022]
Abstract
Many previous studies of vascular procedures have found sex and race differences in surgical mortality that were attributed to differential prevalence of comorbidity. Adjustment for selected comorbid conditions does not entirely remove bias. In addition to adjustments for other covariates, surgical mortality ratios in this study were adjusted for coexistent conditions that caused postoperative death but were unrelated to the procedure. The adjusted mortality was, therefore, attributable to the procedure. Medicare administrative and death certificate data on beneficiaries aged 65-99 years who resided in Indiana and Kentucky and who had 6,016 major vascular procedures in 1994-1997 were used. In Cox proportional hazard models, male-to-female and nonwhite-to-white surgical mortality ratios were adjusted for age, sex, or race; weighted Charlson comorbidity score; length of hospital stay; and fatal coexisting conditions (FCCs). Altogether, 3,333 patients died within 30 postoperative days. There were sex and/or race differences in mortality caused by aortic aneurysm, stroke, and diabetes (P < 0.05). Unadjusted, all-cause 30-day mortality was higher in women and nonwhite patients than in men and white patients following coronary artery bypass graft (CABG) procedure (P < 0.03). Mortality following all non-CABG procedures combined was lower in women than in men (P < 0.02). In multivariate analyses, 30-day mortality following CABG, adjusted for covariates, was lower in men than in women (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.79-0.98), but there was no sex difference after adjustment for only FCC (HR = 0.94, 95% CI 0.85-1.05). Mortality following all non-CABG procedures combined was higher in men than in women, but this difference was insignificant after adjustment for comorbidity and/or FCC (HR = 1.05, 95% CI 0.93-1.17). Age- and sex-adjusted 30-day mortality following CABG was higher in nonwhite patients than in white patients (HR = 1.37, 95% CI 1.08-1.74), and this race difference persisted after further adjustments. There were no significant sex or race differences in surgical mortality following carotid endarterectomy, non-CABG thoracoabdominal procedures, or procedures in the limbs. Adjustments for covariates did not alter race difference in post-CABG surgical mortality. Adjustment for comorbid conditions slightly affected sex differences in mortality following CABG and all non-CABG procedures combined, but adjustment for FCC reduced these differences to insignificant levels.
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Affiliation(s)
- Kazim Sheikh
- Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services, 601 East 12th Street, Kansas City, MO 64106, USA.
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Litwin MS, Greenfield S, Elkin EP, Lubeck DP, Broering JM, Kaplan SH. Assessment of prognosis with the total illness burden index for prostate cancer: aiding clinicians in treatment choice. Cancer 2007; 109:1777-83. [PMID: 17354226 DOI: 10.1002/cncr.22615] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among the most pressing challenges that face physicians who care for men with prostate cancer is evaluating the patient's potential for benefiting from treatment. Because prostate cancer often follows an indolent course, the presence and severity of comorbidities may influence the decision to treat the patient aggressively. The authors adapted the Total Illness Burden Index (TIBI) for use in decision-making among men with prostate cancer at the time of the visit. METHODS An observational study was performed of 2894 participants in the Cancer of the Prostate Strategic Urologic Research Endeavor, a national disease registry of men with prostate cancer, to examine how well the adapted TIBI for prostate cancer (TIBI-CaP) predicted mortality over the subsequent 3.5 years and health-related quality of life over the subsequent 6 months. RESULTS The men who had the highest global TIBI-CaP scores were 13 times more likely to die of causes other than prostate cancer over a 3.5-year period than the men who had the lowest scores (hazard ratio, 13.1, 95% confidence interval, 6.3-27.4) after controlling for age, education, income, and race/ethnicity. Patients who had the highest TIBI-CaP scores had 44% mortality compared with 4.9% mortality for patients who had the lowest scores. Demographic variables explained 16% of the variance in future physical function; TIBI-CaP scores explained an additional 19% of the variance. CONCLUSIONS The TIBI-CaP, a patient-reported measure of comorbidity, identified patients at high risk for nonprostate cancer mortality. It predicted both mortality and future quality of life. The TIBI-CaP may aid physicians and patients in making appropriate treatment decisions.
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Affiliation(s)
- Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Ramsey SD, Zeliadt SB, Hall IJ, Ekwueme DU, Penson DF. On the Importance of Race, Socioeconomic Status and Comorbidity When Evaluating Quality of Life in Men With Prostate Cancer. J Urol 2007; 177:1992-9. [PMID: 17509278 DOI: 10.1016/j.juro.2007.01.138] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Indexed: 01/12/2023]
Abstract
PURPOSE Clear and accurate information about health related quality of life outcomes for men diagnosed with prostate cancer is essential for men and their physicians to make appropriate care decisions. To determine the completeness and quality of available health related quality of life information we performed a review of health related quality of life studies, assessing what information was and was not reported. MATERIALS AND METHODS A structured literature search identified 184 relevant health related quality of life studies representing 40,931 subjects. RESULTS More than 95% of health related quality of life studies did not provide key information about factors known to influence outcomes. The most common omissions included information about treatments received, followup, socioeconomic status or demographic characteristics. Most data were obtained from well educated, high income socioeconomic groups, who are generally quite healthy. More than 60% of subjects were college graduates, 85% were currently married and 43% were currently employed. While black Americans comprised 15% of men studied in the 80% of studies reporting race, little information is available on Hispanic or Asian men. CONCLUSIONS Most of the available prostate cancer health related quality of life literature does not describe or does not account for factors known to influence health outcomes. These omissions limit their interpretability for patients trying to make decisions about treatment. More attention should be given to fully characterizing all dimensions of care that may influence quality of life outcomes and evaluating health related quality of life in Asian and Hispanic populations. Men and physicians should exercise caution when interpreting results that do not fully account for multiple factors that influence health related quality of life.
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Affiliation(s)
- Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA.
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Abstract
Randomized controlled trial results are needed for developing guidelines, payment rules, and quality-of-care measures; however, 2 phenomena reduce the usefulness of randomized controlled trial findings. First, these studies now enroll patients with less severe disease, who are less likely to benefit from a drug or treatment. Second, patients are living longer but, as a result, have more chronic diseases. Although randomized controlled trials often exclude these older patients, trial findings continue to be generalized to them. Together, these phenomena impose challenges to the usefulness of the results of randomized controlled trials for clinical and policy applications. The convergence of these phenomena makes the current research paradigm underlying evidence-based medicine, guideline development and quality assessment fundamentally flawed in 2 ways. First, the "evidence" includes patients who may have a minimal benefit from the treatment being tested. This could reduce the power for the trial and yield negative or null results, leading to undertreatment of a group of patients with potential for a greater-than-observed benefit. Second, attempts to generalize the results from positive trials to patients who have been excluded from those trials may result in the overtreatment of those who could not benefit (e.g., because they will die from other causes before the benefit of treatment would occur) and therefore represents a parallel hazard. In this article, we describe sources of heterogeneity of treatment effects (HTE) within trials, which can compromise the interpretation and generalizability of results. We also examine strategies for understanding and managing HTE in practice, to increase the usefulness of trial results.
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Affiliation(s)
- Sheldon Greenfield
- Center for Health Policy Research, Department of Medicine, University of California-Irvine School of Medicine, Irvine, California 92697-5800, USA.
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Ross RH, Callas PW, Sargent JQ, Amick BC, Rooney T. Incorporating injured employee outcomes into physical and occupational therapists' practice: a controlled trial of the Worker-Based Outcomes Assessment System. J Occup Rehabil 2006; 16:607-29. [PMID: 17115273 DOI: 10.1007/s10926-006-9060-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Work related musculoskeletal disorders (WRMSDs) remain costly. The Worker-Based Outcomes Assessment System (WBOAS) is an injury treatment improvement tool. Its purpose is to increase treatment effectiveness and decrease the cost of care delivered in Occupational Health Service clinics. METHODS The study used a non-randomized (parallel cohort) control trial design to test the effects on injured employee outcomes of augmenting the standard care delivered by physical and occupational therapists (PT/OTs) with the WBOAS. The WBOAS works by putting patient-reported functional health status, pain symptom, and work role performance outcomes data into the hands of PT/OTs and their patients. Test clinic therapists were trained to incorporate WBOAS trends data into standard practice. Control clinic therapists delivered standard care alone. RESULTS WBOAS-augmented PT/OT care did improve (p< or =.05) physical functioning and new injury/re-injury avoidance and, on these same dimensions, cost-adjusted outcome. It did not improve (p>.05) mental health or pain symptoms or return-to-work or stay-at-work success nor, on these same dimensions, cost-adjusted outcome. CONCLUSION Training PT/OTs to incorporate patient-reported health status, pain symptom, and work role performance outcomes trends data into standard practice does appear to improve treatment effectiveness and cost on some (e.g. physical functioning) but not other (e.g. mental health, pain symptoms) outcomes.
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Affiliation(s)
- Robert H Ross
- Department of Medical Laboratory and Radiation Sciences, College of Nursing and Health Sciences, University of Vermont, 302 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
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Hayward RA, Kent DM, Vijan S, Hofer TP. Multivariable risk prediction can greatly enhance the statistical power of clinical trial subgroup analysis. BMC Med Res Methodol 2006; 6:18. [PMID: 16613605 PMCID: PMC1523355 DOI: 10.1186/1471-2288-6-18] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 04/13/2006] [Indexed: 11/11/2022] Open
Abstract
Background When subgroup analyses of a positive clinical trial are unrevealing, such findings are commonly used to argue that the treatment's benefits apply to the entire study population; however, such analyses are often limited by poor statistical power. Multivariable risk-stratified analysis has been proposed as an important advance in investigating heterogeneity in treatment benefits, yet no one has conducted a systematic statistical examination of circumstances influencing the relative merits of this approach vs. conventional subgroup analysis. Methods Using simulated clinical trials in which the probability of outcomes in individual patients was stochastically determined by the presence of risk factors and the effects of treatment, we examined the relative merits of a conventional vs. a "risk-stratified" subgroup analysis under a variety of circumstances in which there is a small amount of uniformly distributed treatment-related harm. The statistical power to detect treatment-effect heterogeneity was calculated for risk-stratified and conventional subgroup analysis while varying: 1) the number, prevalence and odds ratios of individual risk factors for risk in the absence of treatment, 2) the predictiveness of the multivariable risk model (including the accuracy of its weights), 3) the degree of treatment-related harm, and 5) the average untreated risk of the study population. Results Conventional subgroup analysis (in which single patient attributes are evaluated "one-at-a-time") had at best moderate statistical power (30% to 45%) to detect variation in a treatment's net relative risk reduction resulting from treatment-related harm, even under optimal circumstances (overall statistical power of the study was good and treatment-effect heterogeneity was evaluated across a major risk factor [OR = 3]). In some instances a multi-variable risk-stratified approach also had low to moderate statistical power (especially when the multivariable risk prediction tool had low discrimination). However, a multivariable risk-stratified approach can have excellent statistical power to detect heterogeneity in net treatment benefit under a wide variety of circumstances, instances under which conventional subgroup analysis has poor statistical power. Conclusion These results suggest that under many likely scenarios, a multivariable risk-stratified approach will have substantially greater statistical power than conventional subgroup analysis for detecting heterogeneity in treatment benefits and safety related to previously unidentified treatment-related harm. Subgroup analyses must always be well-justified and interpreted with care, and conventional subgroup analyses can be useful under some circumstances; however, clinical trial reporting should include a multivariable risk-stratified analysis when an adequate externally-developed risk prediction tool is available.
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Affiliation(s)
- Rodney A Hayward
- Department of Veterans Affairs, VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine & Michigan Diabetes Research & Training Center, University of Michigan School of Medicine, Ann Arbor, MI, USA
- The Robert Wood Johnson Clinical Scholars Program, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - David M Kent
- Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center and Tufts University School of Medicine, Boston, MA, USA
- The Robert Wood Johnson Clinical Scholars Program, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Sandeep Vijan
- Department of Veterans Affairs, VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine & Michigan Diabetes Research & Training Center, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Timothy P Hofer
- Department of Veterans Affairs, VA Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine & Michigan Diabetes Research & Training Center, University of Michigan School of Medicine, Ann Arbor, MI, USA
- The Robert Wood Johnson Clinical Scholars Program, University of Michigan School of Medicine, Ann Arbor, MI, USA
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Harse JD, Holman CDJ. Charlson's Index was a poor predictor of quality of life outcomes in a study of patients following joint replacement surgery. J Clin Epidemiol 2005; 58:1142-9. [PMID: 16223657 DOI: 10.1016/j.jclinepi.2005.02.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2004] [Revised: 11/08/2004] [Accepted: 02/15/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the predictive validity of Charlson's Index as a tool to measure and adjust for comorbidity in studies of health-related quality of life(HRQOL) outcomes after joint replacement surgery. STUDY DESIGN AND SETTING SF-36 physical component summary scores were available for a cohort of patients who underwent primary hip or knee replacement surgery at one hospital over a 12-month period. Baseline comorbidity was assessed for the same group of patients using longitudinal hospital morbidity data from the Western Australia Department of Health. The presence or absence of individual conditions was determined, and Charlson's Index scores were calculated for each patient, using varying look-back periods. RESULTS In regression analysis, Charlson's Index was a poor predictor of the HRQOL outcome scores, explaining a maximum 1.79% of the variance. In contrast, the presence or absence of a small number of individual conditions together explained between 5% and 7% of the variance. CONCLUSION The findings suggest that Charlson's Index should not be used to adjust for HRQOL outcomes, particularly in this patient group with low levels of serious comorbidity. Alternative methods are needed for use in this context.
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Affiliation(s)
- Janis D Harse
- School of Population Health, University of Western Australia, Nedlands.
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Janoff DM, Peterson C, Mongoue-Tchokote S, Peters L, Beer TM, Wersinger EM, Mori M, Garzotto M. Clinical outcomes of androgen deprivation as the sole therapy for localized and locally advanced prostate cancer. BJU Int 2005; 96:503-7. [PMID: 16104900 DOI: 10.1111/j.1464-410x.2005.05674.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterize the clinical outcomes of androgen deprivation therapy (ADT) as the sole therapy for localized prostate cancer, and to determine independent predictors of disease progression, as recent studies indicate an increasing use of ADT. PATIENTS AND METHODS The records of all patients with cT1-4NXM0 adenocarcinoma of the prostate treated with ADT as the primary initial therapy at the Portland Veterans Affairs Medical Center between 1993 and 2000 were reviewed. Age, race, Charlson Health Index, family history, prostate-specific antigen (PSA) level, PSA density, digital rectal examination (DRE) findings, Gleason score, and percentage of positive biopsy cores at diagnosis were recorded for 81 patients. Patients had a median (SD, range) age of 73 (5.6, 58-84) years, a PSA level of 14.3 (34.6, 1.4-252) ng/mL and tumours were classified as Gleason score < or = 5 in 9% of patients, 6 in 31%, 7 in 31% and 8-10 in 30%. Outcomes extracted were PSA progression, PSA nadir, bone fractures, local progression, distant progression and overall survival. RESULTS With a median (range) follow-up of 54 (6-115) months, the incidence of local progression, distant progression, bone fractures, PSA progression, and death were 10%, 7%, 25%, 21% and 41% respectively. The percentage of positive biopsy cores > or = 83%, age < 70 years, Gleason score > or = 7, abnormal DRE, and PSA nadir > or = 0.2 ng/mL were significantly associated with PSA progression by univariate analysis. The multivariate analysis identified age < 70 years (hazard ratio 6.52, 95% confidence interval 2.29-18.55) and Gleason score > or = 6 (4.0, 2.0-12.0) as independent risk factors for PSA progression. CONCLUSIONS ADT resulted in modest control of localized prostate cancer, but younger patients and those with Gleason > or = 6 cancers were at higher risk of treatment failure. Toxicity, principally in the form of bone fractures, was high.
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Affiliation(s)
- Daniel M Janoff
- Division of Urology, Oregon Health & Science University and Portland VA Medical Center, Oregon 97239, USA
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Abstract
BACKGROUND The Charlson Comorbidity Index, a popular tool for risk adjustment, often is constructed from medical record abstracts or administrative data. Limitations in both sources have fueled interest in using patient self-report as an alternative. However, little data exist on whether self-reported Charlson Indices predict mortality. OBJECTIVES We sought to determine whether a self-reported Charlson Index predicts mortality, its performance relative to indices derived from administrative data, and whether using study-specific weights instead of Charlson's original weights enhances model fit. METHODS We surveyed 7761 patients admitted to a university medical service over the course of 4 years and extracted their administrative data. We constructed 6 different Charlson indices by using 2 weighting schemes (original Charlson weights and study-specific weights) and 3 different datasources (ICD-9CM data for index hospitalization, ICD-9CM data with a 1-year look-back period, and patient self-report of comorbidities.) Multivariate models were constructed predicting 1-year mortality, log total costs, and log length of stay. RESULTS The 6 measures of the Charlson index all predicted 1-year mortality. Models with age and gender, with or without diagnosis-related group, had approximately the same predictive power regardless of which of the 6 Charlson indices were used. Nevertheless, there were small improvements in model fit using administrative data versus self-report, or study-specific versus original weights. All models obtained areas under the receiver operating curve of 0.70 to 0.77. CONCLUSIONS Overall, self-reported Charlson indices predict 1-year mortality comparably with indices based on administrative data. Administrative data may offer some small improvements in predictive ability and may be preferred when readily available.
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Abstract
There are many conflicting results in the literature comparing quality of life following breast-conserving therapy (BCT) and mastectomy. This study compared long-term quality of life between breast cancer patients treated by BCT or mastectomy in three age groups. Patients (n = 990) completed a quality of life survey, including the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30), at regular intervals over 5 years. In the cross-sectional data, mastectomy patients had significantly (p < 0.01) lower body image, role, and sexual functioning scores and their lives were more disrupted than BCT patients. Emotional and social functioning and financial and future health worries were significantly (p < 0.01) worse for younger patients. There were no differences in body image and lifestyle scores between age groups. There was also no interaction between age and surgery method. Even patients > or =70 years of age reported higher body image and lifestyle scores when treated with BCT. The repeated measures analysis indicated that four functioning scores, half the symptom scores, future health, and global quality of life improved significantly (p < 0.01) over time. All these variables increased significantly for BCT patients and those 50 to 69 years of age. Body image, sexual functioning, and lifestyle disruption scores did not improve over time. BCT should be encouraged in all age groups. Coping with appearance change should be addressed in patient interventions.
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Affiliation(s)
- Jutta Engel
- Munich Field Study, Munich Cancer Registry, Ludwig-Maximilians-University, Munich, Germany.
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Cooperberg MR, Broering JM, Litwin MS, Lubeck DP, Mehta SS, Henning JM, Carroll PR. THE CONTEMPORARY MANAGEMENT OF PROSTATE CANCER IN THE UNITED STATES: LESSONS FROM THE CANCER OF THE PROSTATE STRATEGIC UROLOGIC RESEARCH ENDEAVOR (CAPSURE), A NATIONAL DISEASE REGISTRY. J Urol 2004; 171:1393-401. [PMID: 15017184 DOI: 10.1097/01.ju.0000107247.81471.06] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The epidemiology and treatment of prostate cancer have changed dramatically in the prostate specific antigen era. A large disease registry facilitates the longitudinal observation of trends in disease presentation, management and outcomes. MATERIALS AND METHODS The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10000 men with prostate cancer accrued at 31 primarily community based sites across the United States. Demographic, clinical, quality of life and resource use variables are collected on each patient. We reviewed key findings from the data base in the last 8 years in the areas of disease management trends, and oncological and quality of life outcomes. RESULTS Prostate cancer is increasingly diagnosed with low risk clinical characteristics. With time patients have become less likely to receive pretreatment imaging tests, less likely to pursue watchful waiting and more likely to receive brachytherapy or hormonal therapy. Relatively few patients treated with radical prostatectomy in the database are under graded or under staged before surgery, whereas the surgical margin rate is comparable to that in academic series. CaPSURE data confirm the usefulness of percent positive biopsies in risk assessment and they have further been used to validate multiple preoperative nomograms. CaPSURE results strongly affirm the necessity of patient reported quality of life assessment. Multiple studies have compared the quality of life impact of various treatment options, particularly in terms of urinary and sexual function, and bother. CONCLUSIONS The presentation and management of prostate cancer have changed substantially in the last decade. CaPSURE will continue to track these trends as well as oncological and quality of life outcomes, and will continue to be an invaluable resource for the study of prostate cancer at the national level.
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Affiliation(s)
- Matthew R Cooperberg
- Department of Urology, University of California-San Francisco/Mt Zion Comprehensive Cancer Center, San Francisco, California 94115-1711, USA
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Kennedy L, Craig AM. Global registries for measuring pharmacoeconomic and quality-of-life outcomes: focus on design and data collection, analysis and interpretation. Pharmacoeconomics 2004; 22:551-568. [PMID: 15209525 DOI: 10.2165/00019053-200422090-00001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Disease registries have traditionally been vehicles for the collection of clinical data, in most instances following a large number of patients for a long time period in an observational manner, and enhancing our understanding of disease aetiology and epidemiology. However, over recent decades, the potential for additional data collection and analyses to be conducted within the framework of a registry has been recognised and utilised. This is evident by the sheer number of registries that are now referenced in the medical literature, covering a vast array of therapeutic areas and topics much more varied than incidence, prevalence and survival. The opportunity to collect QOL and pharmacoeconomic data has been utilised within the registry framework as more and more countries have increased their demands for such information for regulatory procedures, including pricing and reimbursement decisions. This increased need for information has led to a marked increase in the number of registries undertaken that are primarily sponsored by the pharmaceutical industry. Disease registries offer tremendous opportunities to realise improvements in care. The length of data collection and the large number of patients involved offer some unusual advantages for QOL and health economic analyses; however, these advantages are not yet fully exploited.
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Affiliation(s)
- Lisa Kennedy
- Quintiles Limited, Market Street, Bracknell RG12 1HX, UK
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Coyne JC, Kruus L, Racioppo M, Calzone KA, Armstrong K. What do ratings of cancer-specific distress mean among women at high risk of breast and ovarian cancer? Am J Med Genet A 2003; 116A:222-8. [PMID: 12503096 DOI: 10.1002/ajmg.a.10844] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Women recruited from a hereditary cancer registry provided ratings of distress associated with different aspects of high-risk status and genetic testing and completed measures of general psychological distress, emotional and social health, and role functioning. Overall, high-risk status was rated as more distressing than undergoing genetic testing. Women without a personal history of cancer rated the level of distress associated with a positive test result to be greater than that associated with high-risk status. In contrast, level of distress associated with a positive test result was not significantly different from that associated with high-risk status for women with a personal history of cancer. Furthermore, women with a personal cancer history also anticipated that if they had an altered gene associated with increased risk of cancer, it would be less distressing than their diagnosis of cancer had been. Women with the highest ratings of cancer-related stress were less inclined to obtain testing, but were not more generally distressed or maladjusted. The need to interpret psychological distress and the stressfulness of genetic testing among high-risk women with respect to relevant comparison data is discussed.
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Affiliation(s)
- James C Coyne
- University of Pennsylvania Health Care System, Philadelphia, Pennsylvania, USA.
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Affiliation(s)
- S H Kaplan
- New England Medical Center, Primary Care Outcomes Research Institute, Boston, Massachusetts 02111, USA.
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