Cancer Screening Decisions Research Articles

Shared Decision-Making for Cancer Screening: Visual Tools and a 4-Step Method.

Shared Decision-Making for Cancer Screening: Visual Tools and a 4-Step Method.

Evaluation of a Personalized, Web-Based Decision Aid for Lung Cancer Screening

Informed decision making has been highlighted as an important aspect of lung cancer screening programs. This study seeks to assess the efficacy of a web-based patient decision aid for lung cancer screening, www.shouldiscreen.com. A before-and-after study (August through December 2014) was conducted where participants navigated a web-based decision aid that provided information about low-dose computed tomography lung cancer screening. Using an established prediction model, the decision aid computed baseline lung cancer risk and an individual's chances of benefiting from, and risk of being harmed by, screening. Outcome measures included knowledge of lung cancer risk factors and lung cancer screening, decisional conflict, concordance, and acceptability of the decision aid. Data were collected from 60 participants who were current or former smokers, had no history of lung cancer, and had not received a chest computed tomographic scan in the previous year. Analysis took place in 2015. Knowledge increased after seeing the decision aid compared with before (p<0.001), whereas the score on the Decisional Conflict Scale decreased (p<0.001). Concordance between a participant's preference to screen and the U.S. Preventive Services Task Force recommendation improved after seeing the decision aid (p<0.001). Risk perceptions among the screen-ineligible group changed (n=49), contrary to those who were eligible (n=11). Ninety-seven percent of the participants reported that the decision aid was likely useful for lung cancer screening decision making. The web-based decision aid should be a helpful resource for individuals considering lung cancer screening, as well as for practitioners and health systems with lung cancer screening programs.

Personalizing Colonoscopy Screening for Elderly Individuals Based on Screening History, Cancer Risk, and Comorbidity Status Could Increase Cost Effectiveness

Colorectal cancer (CRC) screening decisions for elderly individuals are often made primarily on the basis of age, whereas other factors that influence the effectiveness and cost effectiveness of screening are often not considered. We investigated the relative importance of factors that could be used to identify elderly individuals most likely to benefit from CRC screening and determined the maximum ages at which screening remains cost effective based on these factors. We used a microsimulation model (Microsimulation Screening Analysis-Colon) calibrated to the incidence of CRC in the United States and the prevalence of adenomas reported in autopsy studies to determine the appropriate age at which to stop colonoscopy screening in 19,200 cohorts (of 10 million individuals), defined by sex, race, screening history, background risk for CRC, and comorbidity status. We applied a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) gained. Less intensive screening history, higher background risk for CRC, and fewer comorbidities were associated with cost-effective screening at older ages. Sex and race had only a small effect on the appropriate age to stop screening. For some individuals likely to be screened in current practice (for example, 74-year-old white women with moderate comorbidities, half the average background risk for CRC, and negative findings from a screening colonoscopy 10 years previously), screening resulted in a loss of QALYs, rather than a gain. For some individuals unlikely to be screened in current practice (for example, 81-year-old black men with no comorbidities, an average background risk for CRC, and no previous screening), screening was highly cost effective. Although screening some previously screened, low-risk individuals was not cost effective even when they were 66 years old, screening some healthy, high-risk individuals remained cost effective until they reached the age of 88 years old. The current approach to CRC screening in elderly individuals, in which decisions are often based primarily on age, is inefficient, resulting in underuse of screening for some and overuse of screening for others. CRC screening could be more effective and cost effective if individual factors for each patient are considered.

Health literacy-listening skill and patient questions following cancer prevention and screening discussions.

ObjectivePatient question‐asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question‐asking as a function of health literacy with respect to spoken information (health literacy–listening).MethodsFour‐hundred and thirty‐three (433) adults listened to simulated physician–patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy–listening was assessed using the Cancer Message Literacy Test‐Listening (CMLT‐Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT‐Listening asked a similar variety of questions.ResultsQuestions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT‐Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education.ConclusionPatients' health literacy–listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.

PEP Talk: Prostate Education Program, "Cutting Through the Uncertainty of Prostate Cancer for Black Men Using Decision Support Instruments in Barbershops".

The objective of this study was to investigate the effectiveness of using decision support instruments (DSI) to assist African-American (AA) men in making a prostate cancer (CaP) screening decision. This nonrandomized pretest-posttest comparisonstudy assessed two DSI that were either culturally tailored or culturally nonspecific. CaP knowledge, intention to screen, and preferences were assessed before and after exposure to DSI using a convenience sample of 120 AA men aged 40years and above. Participants interested in screening were referred to healthcare providers through a community-based patient navigator to obtain prostate-specific antigen (PSA) testing. We followed up 3months after to determine if participants screened for CaP. CaP knowledge increased following exposure to both DSI in equivalent proportions. While similar proportions of men ultimately intended on having a PSA test following both DSI, bivariate analysis revealed that the culturally tailored DSI demonstrated a statistically significant increase in intention to screen. Participants' degree of certainty in their decision-making process with regard to CaP screening increased following the culturally tailored DSI (p < .001). The majority of participants planned on discussing CaP screening with a healthcare provider upon completion of the study. Barbershop-based health education can change the knowledge, preferences, intentions, and behaviors of this at-risk population. At 3months follow-up, half (n = 58) of the participants underwent PSA testing, which led to the diagnosis of CaP in one participant. Community-led interventions for CaP, such as cluster-randomized designs in barbershops, are needed to better assess the efficacy of DSI in community settings.

Towards informed decisions on breast cancer screening: Development and pilot testing of a decision aid for Chinese women

ObjectiveTo pilot-test a novel, self-use breast cancer (BC) screening decision aid (DA) targeting Hong Kong (HK) Chinese women at average risk of BC. MethodsWomen were recruited through a population-based telephone survey using random digit dialling between October 2013 and January 2014. Eligible participants completed our baseline survey and then received the DA by post. Participants (n=90) completed follow-up telephone interviews one month later. ResultsMost participants thought that all/most DA content was presented clearly (86.7%), and was useful in helping women make screening-related decisions (88.9%). It also achieved its expected impact of improving informed decision-making and increasing shared-participation preference without increasing participants’ anxiety levels. Participants showed a modest non-statistical increase in their screening knowledge scores. Older women rated the perceived severity of a BC diagnosis as significantly lower, and more educated women reported significantly lower perceived anxiety about the disease. ConclusionOur DA appears acceptable and feasible for self-use by HK Chinese women who need to make an informed decision about BC screening without increasing overall anxiety levels. Practice implicationsThis study supports the potential of self-use DAs for cancer screening-related decision support in a Chinese population.

Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women.

The Cultural Cancer Screening Scale (CCSS) was developed to identify cultural factors relevant to breast and cervical cancer screening in a sample of Hispanic and white women in Southern California. This scale identified 5 distinct cultural factors as relevant in cancer screening decision making. The purpose of this study was to consider psychometric estimates of the validity and reliability of this scale in a sample of African American women residing in an urban area of New Jersey. A total of 122 women, aged 40 to 90 years, with no history of breast cancer participated in the study. Internal consistency, reliability, construct, and predictive validity were assessed. Exploratory factor analysis resulted in the formation of 5 subsets: cancer screening fatalism, negative beliefs about health professionals, catastrophic disease expectations, symptomatic deterrents, and sociocultural deterrents, all clearly independent of each other. The Cronbach's α for the composite score of the scale was .89. Predictive validity of the composite scale score was not significant, but 4 cultural items were significant: problems making an appointment, lack of transportation, discomfort with health professionals, and health professionals inappropriately touch their patients. Overall, the CCSS demonstrated acceptable preliminary values of reliability and validity in this population. Cultural and social factors relevant to cancer screening are very important for all women. The CCSS has not yet been used in nursing research but would be very appropriate for nurses to use to better understand why women choose to access cancer screening services.

Health Literacy and Computer-Assisted Instruction: Usability and Patient Preference

The authors investigated the feasibility of using computer-assisted instruction in patients of varying literacy levels by examining patients’ preferences for learning and their ability to use 2 computer-based educational programs. A total of 263 participants 50–74 years of age with varying health literacy levels interacted with 1 of 2 educational computer programs as part of a randomized trial of a colorectal cancer screening decision aid. A baseline and postprogram evaluation survey were completed. More than half (56%) of the participants had limited health literacy. Regardless of literacy level, doctors were the most commonly used source of medical information—used frequently by 85% of limited and adequate literacy patients. In multivariate logistic regression, only those with health insurance (OR = 2.35, p = .06) and computer use experience (OR = 0.39, p = .03) predicted the ability to complete the programs without assistance compared with those without health insurance or prior computer use, respectively. Although patients with limited health literacy had less computer experience, the majority completed the programs without any assistance and stated that they learned more than they would have from a brochure. Future research should investigate ways that computer-assisted instruction can be incorporated in medical care to enhance patient understanding.

Measuring the Preferences of Homeless Women for Cervical Cancer Screening Interventions: Development of a Best-Worst Scaling Survey.

Despite having multiple risk factors, women experiencing homelessness are screened for cervical cancer at a lower rate than women in the general US population. We report on the design of a stated preference study to assess homeless women's preferences for cervical cancer screening interventions, to inform efforts to overcome this disparity. We conducted focus groups with homeless women (n = 8) on cervical cancer screening decisions and analyzed the data using thematic analysis. We applied inclusion criteria to select factors for a stated preference survey: importance to women, relevance to providers, feasibility, and consistency with clinical experience. We conducted pretests (n = 35) to assess survey procedures (functionality, recruitment, administration) and content (understanding, comprehension, wording/language, length). We chose best-worst scaling (BWS)-also known as object scaling-to identify decision-relevant screening intervention factors. We chose an experimental design with 11 "objects" (i.e., factors relevant to women's screening decision) presented in 11 subsets of five objects each. Of 25 objects initially identified, we selected 11 for the BWS instrument: provider-related factors: attitude, familiarity, and gender; setting-related factors: acceptance and cost; procedure-related factors: explanation during visit and timing/convenience of visit; personal fears and barriers: concerns about hygiene, addiction, and delivery/fear of results; and a general factor of feeling overwhelmed. Good practices for the development of stated preference surveys include considered assessment of the experimental design that is used and the preference factors that are included, and pretesting of the presentation format. We demonstrate the development of a BWS study of homeless women's cervical cancer screening intervention preferences. Subsequent research will identify screening priorities to inform intervention design.

Decision-making and cancer screening: a qualitative study of older adults with multiple chronic conditions.

To understand how older persons with multiple chronic conditions (MCC) approach decisions about cancer screening. We conducted interviews with adults >65 years old with at least two chronic conditions who were taking ≥five medications daily. Patients were first asked how age and multimorbidity influence their cancer screening decisions. After showing them an educational prompt that explained the relationship between life expectancy and the benefits of cancer screening, respondents were then asked about screening in the context of specific health scenarios. Using grounded theory, three independent readers coded responses for salient themes. Sample size was determined by thematic saturation. Most respondents (26 of 28) initially indicated that their overall health or medical conditions do not influence their cancer screening decisions. After viewing the educational prompt, respondents described two broad approaches to cancer screening in the setting of increasing age or multi-morbidity. The first was a "benefits versus harms" approach in which participants weighed direct health benefits (e.g. reducing cancer incidence or mortality) and harms (e.g. complications or inconvenience). The second was a heuristic approach. Some heuristics favored screening, such as a persistent belief in unspecified benefits from screening, value of knowledge about cancer status, and not wanting to "give up", whereas other heuristics discouraged screening, such as fatalism or a reluctance to learn about their cancer status. When considering cancer screening, some older persons with MCC employ heuristics which circumvent the traditional quantitative comparison of risks and benefits, providing an important challenge to informed decision making.

Decisions about medication use and cancer screening across age groups in the United States

ObjectiveTo describe decision process and quality for common cancer screening and medication decisions by age group. MethodsWe included 2941 respondents to a national Internet survey who made at least one decision about colorectal, breast, and prostate cancer screening, blood pressure or cholesterol medications. Respondents were queried about decision processes. ResultsAcross the five decisions considered, decision process scores were similar (and generally low) across age groups for medication and cancer screening, indicating that all groups had poor involvement in medical decision making. Overall knowledge scores were low across age groups, with elderly (75+) having slightly higher knowledge about medications vs. younger respondents. Elderly respondents reported similar goals and concerns when making decisions, though placed greater importance of having peace of mind from a normal result for cancer screening vs. younger respondents. ConclusionAcross age groups, respondents reported poor decision processes about common medications and cancer screening, despite little evidence of benefit for some interventions (cancer screening, cholesterol lowering medicines in low risk elderly) and possibility of harm in the elderly. Practice implicationsParticular care should be taken to help patients understand both benefit and risk of screening tests and routine medications.

Patient and physician factors associated with overuse and underuse of cancer screening: A factorial, cluster-randomized trial.

206 Background: Cancer screening, like other interventions, requires close patient-provider collaboration. By patient recall, key elements are often omitted from informed consent discussions. Most screening guideline compliance efforts focus on reducing underuse, but overuse is also harmful and may be influenced by distinct factors. Therefore, we are performing a prospective randomized trial of educational interventions to improve screening compliance for breast, cervical, colorectal, lung and prostate cancer at an urban academic medical center. Our hypothesis is that gender, age, prior screening experience, provider recommendations, anticipated benefit and distress, communication and informational support will affect compliance. Our primary data collection will be complete before the Symposium. Methods: We will enroll an age- and sex-stratified sample of 216 patients aged 40 to 89 years, 18 each treated by 12 primary care physicians at two affiliated hospitals, undergoing an annual physical examination in a cluster-randomized prospective trial of educational supports for screening. Screening guideline format (color-coding) and academic detailing will be randomly assigned independently. Patients and providers are surveyed immediately after the encounter to record their recollections of screening discussions and recommendations and their plans. Follow-up surveys at 3, 6 and 12 months assess concordance between expressed screening intentions and behaviors. Results: Pilot results indicate patient gender, age, anticipated screening-related distress and benefit, and prior screening experience affect screening recommendations and intentions. These factors vary by cancer. Patients recall less discussion than providers. Reasons not to screen are infrequently discussed. Conclusions: Cancer screening decisions are complex and vary by screening modality, patient and provider factors and communication. Improving underuse and overuse compliance may require distinct strategies. Screening overuse may be a “lower-stakes” environment to develop strategies to reduce overuse of cancer interventions of marginal or negative benefit, including treatment.

Capsule commentary on Tomko et al., A comparison of web- versus print-based decision AIDS for prostate cancer screening: participants' evaluation and utilization.

C. Tomko et al.1 compares web-based and print-based decision tools for prostate cancer screening. Using an already supported prostate cancer screening decision aid, they asked the practical question of how these tools are best implemented. In their cohort of 1,235 adults, decision aid use was independently influenced by race, education, and the decision aid medium. The best choice based on preference and utilization was print medium. Thus, in an increasingly digitized age, there is still a role for paper and pencil. Decision aids are helpful when patients are faced with complex decisions with no clear-cut “best answer” and uncertain ramifications. There has been much discussion regarding the utility of prostate cancer screening with digital rectal exam and a serum prostate specific antigen (PSA), with most organizations recommending against routine screening.2 However, patients are still being screened under the rubric that this should be a shared decision thaht occurs after discussion between patient and provider. However, this decision has been shown to be biased by multiple factors on the part of the provider and patients,3 and the accuracy and amount of information provided is variable.4 Decision tools may be helpful and effective in these situations, by providing accurate evidence-based information to support decision-making. The current study is interesting not so much in that it adds to the support of using decision aids, but that it addresses how best to implement these effective tools. If we are to work to impact patient experience, we need to understand how best to apply evidence-supported methodology to real-world scenarios.5 Our medical systems have turned increasingly to electronic health records, and informational web portals; yet, this study concludes that print may be a preferred medium for many patients. An important factor for some patients is still internet access and computer skills. The “digital divide” still exists and requires recognition as these tools are implemented. The clearest implication from this study is that in an age of patient choice, even the format of the decision aid should be up to the patient.

Development and evaluation of a new survey instrument to measure the quality of colorectal cancer screening decisions.

BackgroundGuidelines for colorectal cancer screening recommend that patients be informed about options and be able to select preferred method of screening; however, there are no existing measures available to assess whether this happens.MethodsColorectal Cancer Screening Decision Quality Instrument (CRC-DQI) includes knowledge items and patients' goals and concerns. Items were generated through literature review and qualitative work with patients and providers. Hypotheses relating to the acceptability, feasibility, discriminant validity and retest reliability of the survey were examined using data from three studies: (1) 2X2 randomized study of participants recruited online, (2) cross-sectional sample of patients recruited in community health clinics, and (3) cross-sectional sample of providers recruited from American Medical Association Master file.Results338 participants were recruited online, 94 participants were recruited from community health centers, and 115 physicians were recruited. The CRC-DQI was feasible and acceptable with low missing data and high response rates for both online and paper-based administrations. The knowledge score was able to discriminate between those who had seen a decision aid or not (84% vs. 64%, p < 0.001) and between providers, online patients and clinic patients (89% vs. 74% vs. 41%, p < 0.001 for all comparisons). The knowledge score and most of the goals had adequate retest reliability. About half of the participants received a test that matched their goals (47% and 51% in online and clinic samples respectively). Many respondents who had never been screened had goals that indicated a preference for colonoscopy. A minority of respondents in the online (21%) and in clinic (2%) samples were both well informed and received a test that matched their goals.ConclusionsThe CRC-DQI demonstrated good psychometric properties in diverse samples, and across different modes of administration. Few respondents made high quality decisions about colon cancer screening.

Development and evaluation of a new survey instrument to measure the quality of colorectal cancer screening decisions

Development and evaluation of a new survey instrument to measure the quality of colorectal cancer screening decisions

Use of a web-based survey to facilitate shared decision making for patients eligible for cancer screening.

Our aim was to facilitate shared decision making (SDM) during preventive visits by utilizing a web-based survey system to offer colorectal cancer (CRC) and prostate cancer screening decision aids (DAs) to appropriately identified patients prior to the visit. Patients completed a web-based questionnaire before their preventive medicine appointment. Age- and gender-appropriate patients completed additional questions to determine eligibility for CRC or prostate-specific antigen (PSA) screening. Eligible patients were offered a choice of video or print DA, and completed questions assessing their knowledge, values, and preferences regarding the screening decision. Responses were summarized and fed forward to clinician and patient reports. Overall, 11,493 CRC and 4,384 PSA questionnaires were completed. Patient responses were used to identify those eligible for cancer-screening DAs: 2,187 (19%) for CRC and 2,962 (68%) for PSA; 15% of eligible patients requested a DA. Many patients declined a DA because they indicated they "already know enough to make their decision" (34% for CRC, 46% for PSA). A web-based questionnaire provides an efficient means to identify patients eligible for cancer screening decisions and to offer them DAs before an appointment. Pre-visit use of DAs along with reports giving feedback to patients and clinicians provides an opportunity for SDM to occur at the visit.

Lack of shared decision making in cancer screening discussions: results from a national survey.

Clinicians are encouraged to support patients in achieving shared decision making (SDM) for cancer screening. To describe decision making processes and outcomes for cancer screening discussions. A 2011 national Internet survey of adults aged ≥50 years who made cancer screening decisions (breast, BrCa; colorectal, CRC; prostate, PCa) within the previous 2 years was conducted. Participants were asked about their perceived cancer risk; how informed they felt about cancer tests; whether their healthcare provider addressed pros/cons of testing, presented the option of no testing, and elicited their input; whether they were tested; and their confidence in the screening decision. Data were analyzed in 2013-2014 with descriptive statistics and logistic regression. Overall, 1,134 participants (477 men, 657 women) aged ≥50 years made cancer screening decisions, and 1,098 (354, BrCa; 598, CRC; 146, PCa) decisions were discussed with a healthcare provider. Most discussions (51%-67%) addressed pros of screening some or a lot, but few (7%-14%) similarly addressed cons. For all cancer screening decisions, providers usually (63%-71%) explained that testing was optional, but less often asked women (43%-57%) than men (70%-71%) whether they wanted testing. Only 27%-38% of participants reported SDM, 69%-93% underwent screening, and 55%-76% would definitely make the same decision again. Perceived high/average cancer risk and feeling highly informed were associated with confidence in the screening decision. Discussions often failed to provide balanced information and meet SDM criteria. Supporting SDM could potentially improve the quality of cancer screening decisions.

PCN8 - Is Depression Related to Underuse of Breast Cancer Screening?

1. National Cancer Institute, SEER Stat Fact Sheets: Breast Cancer. Available at: http://seer.cancer.gov/statfacts/html/breast.html, Accessed May 5, 2014. 2. Centers for Disease Control and Prevention, What Screening Tests Are There? Available at: http://www.cdc.gov/cancer/breast/basic_info/screening.htm, Accessed May 5, 2014. 3. Moss SM, Cuckle H, Evans A et al. Trial Management Group. E ect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomized controlled trial. Lancet. 2006;368:2053-2060. 4. Kerlikowske K. E cacy of screening mammography among women aged 40 to 49 years and 50 to 69 years: comparison of relative and absolute bene t. J Natl Cancer Inst Monogr. 1997;22:79–86. 5. Pace LE, Keating NL. A systematic assessment of bene ts and risks to guide breast cancer screening decisions. JAMA. 2014;311:1327-1335. 6. Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease, Arch Intern Med. 2005;165:2508-2513. 7. Lin EH, Katon W, Von Kor M et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care; Diabetes Care. 2004;27:2154–2160. 8. Ziegelstein RC, Fauerbach JA, Stevens SS et al. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction; Arch Intern Med. 2000;160:1818-1823. 9. Manning M, Bettencourt BA. Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour. Psychol Health. 2011;26:1173-1187. 10. Cohen M. First-degree relatives of breast-cancer patients: cognitive perceptions, coping, and adherence to breast self-examination. Behav Med. 2002;28:15-22. 11. Bogner HR, Wittink MN. Depression as a risk factor for underuse of mammography. J Womens Health (Larchmt). 2004;13:739-42. • Summary Depression itself was related to the underuse of mammography in the unadjusted analysis. However, after controlling for demographic and HBM characteristics, depression was not associated with the underuse of mammography. Regarding demographic characteristics, women in the higher level of education and income were more likely to adhere to the U.S. Preventive Services Task Force’s (USPSTF) mammogram guidelines. All HBM constructs were related to mammography use behaviors.

A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions

Breast cancer is the second leading cause of cancer deaths among US women. Mammography screening may be associated with reduced breast cancer mortality but can also cause harm. Guidelines recommend individualizing screening decisions, particularly for younger women. We reviewed the evidence on the mortality benefit and chief harms of mammography screening and what is known about how to individualize mammography screening decisions, including communicating risks and benefits to patients. We searched MEDLINE from 1960-2014 to describe (1) benefits of mammography, (2) harms of mammography, and (3) individualizing screening decisions and promoting informed decision making. We also manually searched reference lists of key articles retrieved, selected reviews, meta-analyses, and practice recommendations. We rated the level of evidence using the American Heart Association guidelines. Mammography screening is associated with a 19% overall reduction of breast cancer mortality (approximately 15% for women in their 40s and 32% for women in their 60s). For a 40- or 50-year-old woman undergoing 10 years of annual mammograms, the cumulative risk of a false-positive result is about 61%. About 19% of the cancers diagnosed during that 10-year period would not have become clinically apparent without screening (overdiagnosis), although there is uncertainty about this estimate. The net benefit of screening depends greatly on baseline breast cancer risk, which should be incorporated into screening decisions. Decision aids have the potential to help patients integrate information about risks and benefits with their own values and priorities, although they are not yet widely available for use in clinical practice. To maximize the benefit of mammography screening, decisions should be individualized based on patients' risk profiles and preferences. Risk models and decision aids are useful tools, but more research is needed to optimize these and to further quantify overdiagnosis. Research should also explore other breast cancer screening strategies.

MP78-20 OVERALL SURVIVAL AMONG LOW-RISK PROSTATE CANCER PATIENTS TREATED IN THE VA HEALTH CARE SYSTEM

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History III1 Apr 2014MP78-20 OVERALL SURVIVAL AMONG LOW-RISK PROSTATE CANCER PATIENTS TREATED IN THE VA HEALTH CARE SYSTEM Philip Barbosa, I-Chun Thomas, Benjamin Chung, Sandy Srinivas, Todd Wagner, James Brooks, and John Leppert Philip BarbosaPhilip Barbosa More articles by this author , I-Chun ThomasI-Chun Thomas More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Sandy SrinivasSandy Srinivas More articles by this author , Todd WagnerTodd Wagner More articles by this author , James BrooksJames Brooks More articles by this author , and John LeppertJohn Leppert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2503AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Users of the VA health care system (VAHCS) tend to be older and often have comorbid conditions associated with lower baseline health. Studies evaluating outcomes among veterans with prostate cancer, such as the recently published PIVOT trial, demonstrate that veterans suffer from significant competing risks of mortality. A better understanding of overall survival among users of VA health care is critical to inform screening and treatment decisions. We sought to describe patterns of overall survival for all patients treated in the VAHCS with low risk prostate cancer. METHODS We created an analytic cohort of 36,160 patients with low risk prostate cancer, diagnosed at age 75 or less, from the VA Central Cancer Registry (VACCR) diagnosed from 1995-2001. We performed descriptive statistics of patient characteristics (age, race/ethnicity), and exposure history (Agent Orange, tobacco). We created Kaplan-Meier survival estimates to visualize overall survival. RESULTS Mean patient age was 66 years and mean follow-up time was 41 months. 44% of tumors were clinical stage t1c. 22% of patients underwent radical prostatectomy, 26% received primary radiation, and 24.5% were initially treated with androgen deprivation. 2.5% of the cohort had a history of agent orange exposure. Median overall survival of the entire cohort was 73 months. Among patients that received surgery, median overall survival was longer at 89 months (Fig 1a). Overall survival was strongly associated with patient age at diagnosis with a median survival of 87 months for patients diagnosed <50 years, 85 months for 50-60 years, 75 months for 60-70 years, 65 months for 70-80 years. (Fig1b). CONCLUSIONS Overall survival for all patients diagnosed with low risk prostate cancer in the VAHCS is less than general population and single institution reports. These data highlight the importance of population specific life-expectancy estimates in developing high-value prostate cancer screening and treatment decisions. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e929 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Philip Barbosa More articles by this author I-Chun Thomas More articles by this author Benjamin Chung More articles by this author Sandy Srinivas More articles by this author Todd Wagner More articles by this author James Brooks More articles by this author John Leppert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...