Prostate Cancer Survivorship Care Research Articles

Abstract C038: Science of Cancer Survivorship Advocacy: Perspectives from Black Prostate Cancer Survivors

Abstract Background: Prostate cancer remains a significant health concern, particularly among Black men who experience higher incidence rates and poorer outcomes compared to other racial and ethnic groups. Despite advances in survivorship care, disparities persist in the survivorship experiences, underlying the urgent need for research focusing on the unique needs of Black men in prostate cancer survivorship. By understanding the advocacy efforts and experiences of Black men who have completed prostate cancer treatment, we can identify strategies to better support this vulnerable population and inform interventions aimed at improving survivorship outcomes. Our study explored the advocacy efforts, experiences, and skills of Black men post-prostate cancer treatment to inform targeted interventions aimed at improving survivorship outcomes. Methods: Qualitative interviews were used to obtain information from 31 Black prostate cancer survivors who have completed treatment to explore their insights on survivorship and advocacy. Grounded Theory approach was utilized to analyze participants’ narratives. We employed open and axial coding techniques to extract themes from audio-recorded interviews that were then transcribed, verified and deidentified. Results: We identified several significant themes among Black men who completed prostate cancer treatment. First, participants actively engaged in "spreading the word," advocating for awareness and early detection within their communities through various channels. Second, they emphasized "the importance of advocacy," advocating for themselves and policy changes to address healthcare disparities. Third, participants were committed to "sharing information," openly discussing experiences and providing support to others navigating prostate cancer. Additionally, they highlighted the significance of "reflecting back," drawing from their life stories to offer valuable insights and guidance. Conclusion: This study sheds light on the advocacy efforts and experiences of Black men who have completed prostate cancer treatment, offering valuable insights into their perspectives and actions within their communities. Through the identification of five significant themes, including spreading awareness, advocacy importance, information sharing, and reflective support, this research underscores the proactive engagement of participants in addressing the challenges of prostate cancer. By amplifying the voices and experiences of these individuals, this study contributes to a deeper understanding of the multifaceted nature of prostate cancer survivorship within marginalized communities, ultimately informing future interventions and policies aimed at improving outcomes and reducing disparities in prostate cancer survivorship care. Citation Format: Fullwood, Mary Ellen Young, Folakemi T. Odedina. Science of Cancer Survivorship Advocacy: Perspectives from Black Prostate Cancer Survivors [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C038.

EHealth Platforms Facilitate Prostate Cancer Shared Care: A Systematic Review.

Prostate cancer survivorship care is essential for the early identification of cancer recurrence and progression and the monitoring of adverse effects. Prostate cancer survivorship programs have enabled care to be shared between specialists using digital healthcare platforms. We systematically reviewed the literature to examine if prostate cancer survivorship care had been successfully digitalised. English language articles were searched on PubMed, Embase, and Cochrane Libraries. The search terms included combinations of "eHealth", "digital health", "prostate cancer", "shared care", and related keywords (studies published between [1 January 1946 and 20 March 2023]). Our search strategy yielded 1722 publications, of which 17 studies were included in our final review. Diverse eHealth interventions (web platforms, apps, patient portals) for digital prostate cancer shared care enabled communication, symptom management, and holistic assessment, with potential for reducing anxiety, enhancing outcomes, and increasing engagement. The studies (9 months to 5 years duration) involved participants across different care phases (16 to 3521 participants). We identified ten eHealth platforms, which provided successful symptom tracking, needs assessment, and communications. The platform-based interventions improved some aspects of communication, symptom management, and care delivery. The ongoing clinical need for a robust digital platform that caters to all domains of shared care was identified. eHealth will certainly play a central role in digital prostate cancer shared care, providing better health outcomes and care delivery. Future larger studies in this field should address the implementation barriers, including cost-effectiveness and primary care remuneration. It is also crucial to refine application useability and workflow, focusing on standardization and patient-centred approaches.

Voices of Black men: reflecting on prostate cancer survivorship care plans.

This study addresses the critical issue of survivorship care for Black prostate cancer survivors. The aim was to explore their awareness of survivorship care plans to improve prostate cancer care and survivorship within this high-risk group. Utilizing a thematic analysis approach, we conducted in-depth interviews focused on analyzing post-treatment experiences of Black prostate cancer survivors by applying interpretive explanations to data collected from participants. Participants reported a significant gap in survivorship care plan communication post-treatment, as these plans were seldom discussed. Survivors highlighted the adoption of post-treatment strategies and self-education as means to enhance their comprehension of the survivorship process. Black survivors demonstrated an intrinsic motivation, after feeling "discarded," to find suitable resources to enhance their survivorship care for a better quality of life. The prioritization of post-treatment care for Black prostate cancer survivors is important. By offering comprehensive post-treatment education, improving symptom transparency, and establishing safe spaces for open discussion, the quality of life of Black survivors may be substantially improved. There is a pressing need for dynamic post-treatment care coordination tailored to Black prostate cancer survivors. A lack of crucial post-treatment education for this population that experiences disproportionate burden of prostate cancer may exacerbate cancer health disparities. Addressing this care coordination gap may improve support systems, survivor well-being, and better cancer outcomes.

Acceptability of a virtual prostate cancer survivorship care model in rural Australia: A multi-methods, single-centre feasibility pilot.

A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study. A rural Australian hospital and health service. Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting. Primary outcome: program acceptability. quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3). Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.

Abstract 808: iCCaRE engagement of faith-based organizations to co-create and co-disseminate infographics addressing disparities in prostate cancer literacy and clinical and biospecimen studies

Abstract Black men hold the highest prostate cancer burden among all ethnicities; thus, there is an urgent need for research to inform the development and implementation of a culturally tailored intervention to reduce disparities and improve outcomes. In response, the Inclusive Cancer Care Research Equity (iCCaRE) Consortium was created to advance health equity and reduce disparities in prostate cancer. Addressing the unique needs of Black men require a genuine bidirectional relationship between scientist and the community. In the Black community, faith-based organizations are respected institutions advocating for health equity and justice. Given their vital role as community health gatekeepers, the iCCaRE Consortium partners with faith-based organizations. Rooted in community engaged research (CER), we conducted an environmental scan through stakeholder meetings to discuss the prevailing challenges and opportunities to meet the needs of the Black community along the prostate cancer care continuum. iCCaRE investigators including Partnership Engagement Services (PES) core partnered with faith-based organizations to ensure and advance community responsive cancer prevention. Together, with our faith-based leaders (N=18), we identified gaps including issues associated with the care continuum from screening to diagnosis and from treatment to survivorship; disparities according to health coverage and social determinants of health, and best practices to assist patients including care coordination, patient navigation, digital innovations, and programs offered by patient advocacy organizations. In response to the needs of the community and the strengths of faith-based organization, we prioritized our initial focus on increasing community prostate cancer literacy and activation using co-design educational infographics for both traditional and technology-based communication platforms. The infographics provided evidence-based facts about prostate cancer burden in the Black community; and using a call to action approach, we emphasized the importance of taking action for life saving screening, prevention and healthy lifestyle. Taking action in prostate cancer symptom recognition, survivorship care, and quality care. Also, co-designed infographics were created for clinical studies and biospecimen awareness and participation and the importance of advocacy and equitable care. Another component incorporated face to face trainings and presentations to enhance their knowledge of cancer screening tools, epidemiology of prostate cancer, and pathways to care. This presentation highlighted the first step towards community based intervention development, implementation and dissemination towards equity and justice for prostate cancer prevention and patient/survivor improvements for Black men. Citation Format: James C. Morrison, Kimlin T. Ashing, Gaole Song, Timethia J. Bonner, Che Ngufor, Getachew Dagne, Arnold Merriweather, John McCall, Ewan Cobran, Cassandra N. Moore, Fornati Bedell, Rotimi Oladapo, Floyd B. Willis, Runcie Chidebe Chidebe, Noreen A. Stephenson, JoAnne S. Oliver, Vinessa Gordon, Folakemi Odedina. iCCaRE engagement of faith-based organizations to co-create and co-disseminate infographics addressing disparities in prostate cancer literacy and clinical and biospecimen studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 808.

A qualitative study on healthcare professional and patient perspectives on nurse-led virtual prostate cancer survivorship care

BackgroundVirtual nurse-led care models designed with health care professionals (HCPs) and patients may support addressing unmet prostate cancer (PCa) survivor needs. Within this context, we aimed to better understand the optimal design of a service model for a proposed nurse-led PCa follow-up care platform (Ned Nurse).MethodsA qualitative descriptive study exploring follow-up and virtual care experiences to inform a nurse-led virtual clinic (Ned Nurse) with an a priori convenience sample of 10 HCPs and 10 patients. We provide a health ecosystem readiness checklist mapping facilitators onto CFIR and Proctor’s implementation outcomes.ResultsWe show that barriers within the current standard of care include: fragmented follow-up, patient uncertainty, and long, persisting wait times despite telemedicine modalities. Participants indicate that a nurse-led clinic should be scoped to coordinate care and support patient self-management, with digital literacy considerations.ConclusionA nurse-led follow-up care model for PCa is seen by HCPs as acceptable, feasible, and appropriate for care delivery. Patients value its potential to provide role clarity, reinforce continuity of care, enhance mental health support, and increase access to timely and targeted care. These findings inform design, development, and implementation strategies for digital health interventions within complex settings, revealing opportunities to optimally situate these interventions to improve care.

Nutrition services during prostate cancer androgen deprivation therapy

ObjectiveDietary interventions are effective strategies to mitigate multiple side effects from androgen deprivation therapy (ADT) in prostate cancer, however the perception of, and access to, nutrition services is relatively unknown.MethodsA...

Continuity of care and advanced prostate cancer.

Continuity of care is an important element of advanced prostate cancer care due to the availability of multiple treatment options, and associated toxicity. However, the association between continuity of care and outcomes across different racial groups remains unclear. To assess the association of provider continuity of care with outcomes among Medicare fee-for-service beneficiaries with advanced prostate cancer and its variation by race. Retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. African American and white Medicare beneficiaries aged 66 or older, and diagnosed with advanced prostate cancer between 2000 and 2011. At least 5 years of follow-up data for the cohort was used. Short-term outcomes were emergency room (ER) visits, hospitalizations, and cost during acute survivorship phase (2-year post-diagnosis), and mortality (all-cause and prostate cancer-specific) during the follow-up period. We calculated continuity of care using Continuity of Care Index (COCI) and Usual Provider Care Index (UPCI), for all visits, oncology visits, and primary care visits in acute survivorship phase. We used Poisson models for ER visits and hospitalizations, and log-link GLM for cost. Cox model and Fine-Gray competing risk models were used for survival analysis, weighted by propensity score. We performed similar analysis for continuity of care in the 2-year period following acute survivorship phase. One unit increase in COCI was associated with reduction in short-term ER visits (incidence rate ratio [IRR]=0.65, 95% confidence interval [CI] 0.64, 0.67), hospitalizations (IRR=0.65, 95% CI 0.64, 0.67), and cost (0.64, 95% CI 0.61, 0.66) and lower hazard of long-term mortality. Magnitude of these associations differed between African American and white patients. We observed comparable results for continuity of care in the follow-up period. Continuity of care was associated with improved outcomes. The benefits of higher continuity of care were greater for African Americans, compared to white patients. Advanced prostate cancer survivorship care must integrate appropriate strategies to promote continuity of care.

Acceptability of a virtual prostate cancer survivorship care model in regional Australia: A qualitative exploratory study.

To assess the acceptability of a nurse-led prostate cancer survivorship intervention adapted for virtual delivery and tailored to post-surgical care, in a regional Australian hospital and health service. A qualitative exploratory study using the Theoretical Framework of Acceptability (TFA). Twenty-two participants took part in a semistructured interview comprising men who had completed the program (n=16) and health professionals/service stakeholders involved in program delivery (n=6). Acceptability of this virtual prostate cancer survivorship care program was very high across all constructs of the TFA, from the perspectives of both program recipients and those delivering the program. The quality of care received was seen as superior to what men had experienced previously (burden, opportunity costs). The time afforded by the regularly scheduled video-consultations allowed men to come to terms with the recovery process in theirown time (self-efficacy), and provided an ongoing sense of support and access tocareoutside the consultation (ethicality). Clinically, the program improved careco-ordination, expedited identification of survivorship care needs, and met servicepriorities of providing quality care close to home (burden, perceived effectiveness). Findings from this study suggest virtual post-surgical care delivered via videoconferencing is highly acceptable to prostate cancer survivors in a regional setting. Future research exploring virtual program implementation at scale and long-term patient and service outcomes is warranted.

A Vanguard Approach to the Design and Delivery of Nurse-Led Survivorship Care

ObjectivesSurvivorship care is an essential component of quality cancer care. Although nurses are uniquely positioned to deliver effective and efficient nurse-led survivorship care, they report that their experiences of survivorship care provision are fragmented, under-resourced, and often distressing for the patient. Data SourcesHere we report the culmination of a 4-year program of research and more than a decade of nurse-led work, to improve the survivorship care experience for men with prostate cancer comprising of: (1) the evolution of a national specialist prostate cancer nursing service; (2) a nursing Delphi study to determine prostate cancer survivorship care experiences and priorities; (3) the development of the Prostate Cancer Survivorship Essentials Framework, which provides a road map for improving quality prostate cancer survivorship care across a variety of settings; and (4) the translation of the framework into nursing practice through the development of My Personal Plan, a person-centered, evidence-informed survivorship care plan. ConclusionThrough the leadership of a national prostate cancer specialist nursing service, the provision of a coordinated, evidence-informed person-centered survivorship care service is now achievable. This program of work has demonstrated that irrespective of the setting or mode of delivery, specialist nurses involved in the care of men with prostate cancer and their families are leading best practice through the translation of evidence into everyday clinical practice. Implications for Nursing PracticeThere is an urgent need to address the significant challenges that a prostate cancer diagnosis can bring, and nurses are at the forefront and lead survivorship care delivery, which includes: (1) routine distress screening and referral to tailored evidence-based psychological care; (2) the provision of person-centered care that connects to effective symptom management; (3) self-management support; and (4) signposting to additional services which extend beyond the acute care setting.

Prostate cancer survivor capacity to engage in survivorship self-management: a comparison of perceptions between oncology specialists, primary care, and survivors.

The rapidly increasing number of prostate cancer survivors in tandem with a forthcoming shortage of oncology specialists in our health system poses a barrier to ensuring that high-quality survivorship care is available to support this population. As such, there is a need to consider ways to optimize survivorship care, while taking health system constraints into account. The purpose of this study is to explore the perceptions of survivorship self-management between oncology specialists, primary care providers (PCPs), and survivors themselves. A single cross-sectional survey, relating to how prostate cancer survivorship care could be improved, was administered to each group. Two hundred forty-three participants (N = 206 survivors, N = 10 oncology specialists, N = 27 PCPs) completed the study survey. Most PCPs (90%) and oncology specialists (84%) perceived that an opportunity for prostate cancer survivors to have an expanded role in their care would be beneficial. Nearly half (49%) of survivors reported that it would be beneficial to have an expanded role in their survivorship care with only 11% indicating that it would not be beneficial at all. Barriers to developing this model involve limited oncology specialist time to execute survivorship plans, limited communication between oncology specialists and PCPs, and a lack of primary care and survivor education targeted specifically to prostate cancer survivorship.

PD25-05 CHANGES IN HEALTH BEHAVIORS AMONG LOW-INCOME UNINSURED MEN WITH PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD25-05 CHANGES IN HEALTH BEHAVIORS AMONG LOW-INCOME UNINSURED MEN WITH PROSTATE CANCER Allen E. D. Siapno, Megha D. Tandel, Lorna Kwan, and Mark S. Litwin Allen E. D. SiapnoAllen E. D. Siapno More articles by this author , Megha D. TandelMegha D. Tandel More articles by this author , Lorna KwanLorna Kwan More articles by this author , and Mark S. LitwinMark S. Litwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with prostate cancer from low-income and uninsured backgrounds have poorer health outcomes partly due to higher risk of chronic disease and lower rates of healthy behaviors. We sought to describe the changes in health behaviors of men with prostate cancer participating in a disease-focused treatment program providing free medical care and navigation services. METHODS: We retrospectively reviewed survey data from the UCLA Men’s Health Study, a cohort quantifying patient-reported outcomes, and compared baseline surveys collected at program enrollment to 12–18-month follow-up surveys. Five health behavior domains from the California Health Interview Survey were individually and compositely scored based on adherence to the 2014 American Cancer Society Prostate Cancer Survivorship Care (ACS-PCSC) Guidelines. The scores were categorized into three adherence levels: Low, Moderate, and High. Subjects were grouped by change in adherence levels from baseline to follow-up as Worsened, No Change, or Improved. We compared patient demographics, clinical characteristics, health-related quality of life, and adherence to the five domains at baseline between the three groups. RESULTS: Of the 256 subjects eligible for analysis, 17% worsened, 52% had no change, and 31% improved in overall adherence. Most subjects identified as Hispanic (72%), were foreign born (79%), and had a partner (71%). There were no differences in clinical characteristics among the three adherence change groups. Baseline general and physical health scores were similar, but baseline mental health scores were lower in the worsened group compared to the no change and improved groups (44.3 vs 50.1 vs 47.6, respectively, p=0.0320). Those in the worsened group already had low adherence to physical activity at baseline compared to the no change and improved groups (p=0.0019) (Table 1). CONCLUSIONS: In this cohort of low-income men participating in a free navigation-based prostate cancer treatment program, 31% had improvement in overall adherence to the ACS-PCSC Guidelines for health behaviors. Worsening adherence was associated with lower baseline mental health score and physical activity adherence. Interventions aimed at physical activity may improve overall health behaviors. Source of Funding: Department of Urology, David Geffen School of Medicine, University of California Los Angeles © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e422 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Allen E. D. Siapno More articles by this author Megha D. Tandel More articles by this author Lorna Kwan More articles by this author Mark S. Litwin More articles by this author Expand All Advertisement PDF DownloadLoading ...

Artificial Urinary Sphincter Reverses Weight Gain Associated with Post-Prostatectomy Incontinence

ABSTRACT Introduction Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown. Objective We sought to examine the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion. Methods We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS. Results We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of + 1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p < 0.01, duration 26.0 ± 21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p = 0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p < 0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p = 0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p = 0.04). Conclusions PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast

Prostate cancer patients' perspectives of integrating mHealth and coaching in prostate cancer survivorship care

Prostate cancer patients' perspectives of integrating <scp>mHealth</scp> and coaching in prostate cancer survivorship care

Patients’ perspective on the quality of prostate cancer follow-up care.

175 Background: Information about prostate cancer patients’ perspective on the quality of their follow-up care in the hospital is important to optimize survivorship care. This study assessed the quality of prostate cancer follow-up care as experienced by cancer patients and its association with patients’ sociodemographic and clinical characteristics, and treatment-related symptom burden. Methods: We surveyed 385 (response rate, 100%) patients with localized prostate cancer participating in a randomized controlled trial comparing the (cost)effectiveness of specialist- versus primary care-based prostate cancer follow-up. For this study, we used baseline data that were collected during patients’ first follow-up visit at the hospital (2-34 weeks) after primary treatment (radical prostatectomy or radiotherapy) prior to randomization. We assessed patients’ ratings of the quality of follow-up care using the Assessment of Patient Experiences of Cancer Care survey. This survey consists of thirteen scales: getting needed care, timeliness of care, waiting time in physician’s office, information exchange, physician’s affective behavior, physicians’ knowledge about patients’ life, interaction with nurses, interaction with office staff, symptom management, symptom information provision, health promotion, coordination of care, and overall rating of care. Logistic regression analysis was used to identify factors associated with perceived quality of follow-up care. Results: Patients reported positive experiences with follow-up care for 10 of 13 scales, with mean scores ranging from 72 to 97 (on a 0-100 response scale). The three scales where patients reported suboptimal follow-up care were symptom management (mean score of 43), health promotion (mean score of 45), and physicians’ knowledge about patients’ life (mean score of 66). Overall, patients’ report of suboptimal quality of follow-up care was associated significantly with being more highly educated, not having a partner, being older, having multiple comorbidities, and experiencing symptoms (urinary, bowel, and hormonal symptoms). Conclusions: Prostate cancer patients were generally positive about their initial, hospital-based follow-up care after primary surgery or radiation. However, physicians’ knowledge about patients’ lives, symptom management, and health promotion was rated as suboptimal. The findings point to areas where prostate cancer survivorship care can be improved.

Core elements for the implementation of primary care-based prostate cancer follow-up: A process evaluation of a randomized controlled trial.

242 Background: To improve the quality and efficiency of prostate cancer survivorship care, a randomized controlled trial (RCT) is currently comparing the safety and effectiveness of specialist- (usual care) versus primary care-based (intervention) prostate cancer follow-up. This process evaluation assessed the reach and identified constructs for the implementation of primary care-based follow-up in a RCT setting. Methods: A mixed-methods approach was used through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR). We used quantitative data to evaluate the reach of the RCT and qualitative data (interviews) to indicate the perspectives of patients, general practitioners (GPs) and specialists. Thematic analysis was used to analyze the interview transcripts. Results: In total, 569 patients with localized prostate cancer from 12 hospitals were invited to participate in the trial. 18 patients were not eligible, 145 patients declined (of whom most preferred follow-up in the hospital), whereas 21 GPs declined to participate. Finally, 385 patients were randomized to specialist- (n=192) or to primary care-based (n=193) follow-up. In addition, we interviewed 15 patients, 10 GPs and 8 specialists. Participants identified several advantages of primary care- versus specialist-based follow-up: it is closer to home, more accessible, the relationship is more personal, and the hospital can focus on patients undergoing active treatment. Nevertheless, participants also identified challenges: evidence-based guidelines should be implemented, communication and collaboration between primary and secondary care should be accessible and transparent, quality indicators (i.e. PSA levels) should be collected, and GPs expect compensation (money or extra capacity). Conclusions: If the RCT shows that primary care- is equally effective as specialist-based follow-up, this study could enable the transition of prostate cancer follow-up to primary care by presenting information on the reach of an RCT and by providing advantages and challenges of primary care-based prostate cancer follow-up.

PD04-06 ARTIFICIAL URINARY SPHINCTER REVERSES WEIGHT GAIN ASSOCIATED WITH POST-PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I (PD04)1 Sep 2021PD04-06 ARTIFICIAL URINARY SPHINCTER REVERSES WEIGHT GAIN ASSOCIATED WITH POST-PROSTATECTOMY INCONTINENCE Raj Bhanvadia, Benjamin Dropkin, Avery Wolfe, Linley Diao, Sarah Sanders, Gregory Joice, Claus Roehrborn, Steven Hudak, and Allen Morey Raj BhanvadiaRaj Bhanvadia More articles by this author , Benjamin DropkinBenjamin Dropkin More articles by this author , Avery WolfeAvery Wolfe More articles by this author , Linley DiaoLinley Diao More articles by this author , Sarah SandersSarah Sanders More articles by this author , Gregory JoiceGregory Joice More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , Steven HudakSteven Hudak More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001968.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown. We examined the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion. METHODS: We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS. RESULTS: We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of +1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p<0.01, duration 26.0 +21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p=0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p<0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p=0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p=0.04). CONCLUSIONS: PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e51-e52 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Raj Bhanvadia More articles by this author Benjamin Dropkin More articles by this author Avery Wolfe More articles by this author Linley Diao More articles by this author Sarah Sanders More articles by this author Gregory Joice More articles by this author Claus Roehrborn More articles by this author Steven Hudak More articles by this author Allen Morey More articles by this author Expand All Advertisement Loading ...

Prostate cancer survivorship care: if not now, when?

Prostate cancer is the most common cancer diagnosed in Australian men (excluding non-melanoma skin cancer) and it is estimated that there are over 220,000 Australian men living with a diagnosis of prostate cancer [1]. Survival for men with prostate cancer is excellent in countries that have accessible screening and treatment services, and in Australia five-year relative survival is over 95% [1]. High incidence coupled with improving long term survival leads to a corresponding high prevalence rate and high community disease burden. Many men with prostate cancer experience long term decrements in their mental and physical quality of life, overall they have a greater suicide risk that their non-cancer peers, and unmet supportive care needs are pervasive [2].

What are survivorship care plans failing to tell men after prostate cancer treatment?

Survivorship care plans contain important information for patients and primary care physicians regarding appropriate care for cancer survivors after treatment. We describe the completeness of prostate cancer survivorship care plans and evaluate the concordance of follow-up recommendations with guidelines. We analyzed 119 prostate cancer survivorship care plans from one academic and one community cancer center, abstracting demographics, cancer/treatment details, and follow-up recommendations. Follow-up recommendations were compared with the American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) guidelines. Content in >90% of plans included cancer TNM stage; prostate-specific antigen (PSA) at diagnosis; radiation treatment details (98% of men received radiation); and PSA monitoring recommendations. Potential treatment-specific side effects were listed for 82% of men who had surgery, 86% who received androgen deprivation therapy (ADT), and 97% who underwent radiation. The presence of posttreatment symptoms was noted in 71% of plans. Regarding surveillance follow-up, all guidelines recommend an annual digital rectal exam (DRE). No plans specified DRE. However, all 71 plans at the community site recommended at least annual follow-up visits with urology, radiation oncology, and primary care. Only 2/48 plans at the academic site specified follow-up visits. All guidelines recommend PSA testing every 6-12 months for 5 years, then annually. For the first 5 years, 90% of plans were guideline-concordant, 8% suggested oversurveillance, and 2% were incomplete. In men receiving ADT, ACS and ASCO recommend bone density imaging and NCCN recommends testosterone levels. Of 77 men on ADT, 1% were recommended bone density imaging and 16% testosterone level testing. While care plan content is more complete for demographic and treatment summary information, both sites had gaps in reporting posttreatment symptoms and ADT-related testing recommendations. These findings highlight the need to improve the quality of information in care plans, which are important in communicating appropriate follow-up recommendations to patients and primary care physicians.

Cost-Effectiveness of Providing the Depression Care for People With Cancer Program to Patients With Prostate Cancer in the United States

ObjectivesThe Depression Care for People with Cancer program (DCPC) is a cost-effective depression care model for UK patients with cancer. However, DCPC’s cost-effectiveness in the United States is unknown, particularly for patients with prostate cancer in the United States. This study evaluates the health and economic impact of providing DCPC to patients with prostate cancer. MethodsDCPC was compared with usual care in a mathematical model that simulates depression and its outcomes in a hypothetical cohort of US patients with prostate cancer. DCPC was modeled as a sequential combination of universal depression screening, post-screening evaluations, and first-line combination therapy. Primary outcomes were lifetime direct costs of depression care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Secondary outcomes included life expectancy, number of depression-free months and lifetime depressive episodes, duration of depressive episodes, cumulative incidence of depression, lifetime depression diagnoses/misdiagnoses, and the cumulative incidence of maintenance therapy for depression. Sensitivity analyses were used to examine uncertainty. ResultsIn the base case, DCPC dominated usual care by offering 0.11 more QALYs for $2500 less per patient (from averted misdiagnoses). DCPC also offered 5 extra depression-free months, shorter depressive episodes, and a lower chance of maintenance therapy. DCPC’s trade-offs were a higher cumulative incidence of depression and more lifetime depressive episodes. Life expectancy was identical under usual care and DCPC. Sensitivity analyses indicate that DCPC was almost always preferable to usual care. ConclusionCompared with usual care, DCPC may offer more value to US patients with prostate cancer. DCPC should be considered for inclusion in prostate cancer survivorship care guidelines.