Добірка наукової літератури з теми "Prostate Cancer, Survivorship, Unmet needs, Decision Making"

Background After a prostate cancer diagnosis, men want information about their disease and treatment options. The internet offers a convenient means to deliver health information to patients with prostate cancer. However, there are concerns about the use of the internet among this largely senior population. Objective This study aimed to determine the patterns and factors associated with the use of the internet as a source of health information among Canadian men with prostate cancer and the features and information required in a website. Methods Population surveys were conducted in four Canadian provinces (British Columbia, Alberta, Saskatchewan, and Ontario) in 2014-2015. Data analyses included descriptive, bivariable, and multivariable analyses. The Pearson Chi-square and univariable regression were used to examine associations between independent variables and health-related internet use. Correlates of health-related internet use were analyzed using multivariable logistic regression. Results A total of 1362 patients responded across the four provinces. The mean age of respondents was 69 years (SD 8.2). In addition, 82% (n=1071) were internet users and 71% (n=910) used the internet daily. Further, 65% (n=784) used the internet as a source of prostate cancer information, and 40% (n=521) were confident about using information obtained from the internet to make health decisions. Men who used the internet to obtain prostate cancer information were more likely to be active information seekers (odds ratio [OR]: 4.5, 95% CI 2.6-7.8), be confident using information from the internet to make health decisions (OR: 3.6, 95% CI 2.3-5.7), have broadband internet access (OR: 1.8, 95% CI 1.2-2.7), and have more unmet supportive care needs (OR: 1.05, 95% CI 1.0-1.1). Top features wanted in a website, reported by more than 50% of respondents, were a library of resources (n=893, 65.6%), tools to support treatment decision making (n=815, 59.8%), and tools to help navigate the prostate cancer journey (n=698, 51.2%). Top three topics of information wanted in such a website were treatment options (n=916, 67.3%), disease progression (n=904, 66.4%), and management of side effects (n=858, 63%). Conclusions Over two-thirds of Canadian patients with prostate cancer surveyed use the internet as a source of health information about prostate cancer, but over half did not feel confident using information from the internet to make health decisions. Being an active information seeker, having confidence in using information from the internet to make health decisions, having broadband internet, and having more unmet supportive care needs were significantly associated with health-related internet use. Future work should examine electronic health literacy interventions as a means to boost men’s confidence in using information from the internet and design websites that include information and features that help men navigate the prostate cancer journey and support treatment decision making and management of side effects.

Abstract Introduction: Prostate cancer is the most common and second most deadly non-skin cancer among American men. Prostate cancer outcomes are especially detrimental for African-American men. While prostate cancer treatment can prolong life, it can also produce debilitating results that can impact men’s ability to perform some jobs/work-related tasks, cause decisional regret, and affect their overall quality of life. Objective: To improve prostate cancer treatment decision-making and survivorship experiences of actively employed prostate cancer survivors, we asked survivors with jobs to provide advice for men facing prostate cancer treatment and their families/friends, employers/co-workers, and healthcare providers. Methods: African-American and White prostate cancer survivors were recruited primarily from support groups and two southeastern cancer centers: Inclusion criteria included having (1) had a prostatectomy or radiation therapy less than 36 months ago, (2) worked for pay within one month prior to treatment, and (3) expected at time of treatment initiation to be working 6 months later. Survivors were engaged in 60-to-90-minute in-depth interviews. Interview transcripts were analyzed using a content analysis approach to ascertain prominent themes within and between races. Results: Forty-five prostate cancer survivors (44% black and 55% white) had a mean age of 61. Over half of men from either racial group had a bachelor’s degree. Approximately 63% and 47% from both racial groups had undergone a prostatectomy or radiation therapy, respectively. Prominent themes related to advice for prostate cancer survivors included the importance of: conducting thorough research on treatment options and gaining awareness of the treatment side effects; identifying survivors or survivor support groups; and informing family, employers, and others about support needs. Advice for family and friends emphasized the significance of providing instrumental and emotional support to survivors. Employer and co-worker advice most often related to providing work-related accommodations/support (e.g., additional time or adapted work tasks) and avoiding stigmatizing treatment of the survivor. Most advice for healthcare providers focused on presenting survivors with honest, thorough, and plain-language communication about treatment options and side effects. No major differences existed in themes by race. Conclusion: Overarching needs of employed prostate cancer survivors commonly relate to the need for detailed information about their treatment process and their desire for social support from family/friends, employers/co-workers, and healthcare providers. The most vital concern for survivors is understanding how, and to what extent, side effects can affect them personally and professionally. Future research should determine what strategies might be effective for preparing these stakeholder groups to support employed prostate cancer survivors. Citation Format: Otis L. Owens, Joanne Sandberg, Andy Mayfield, Emily Dressler, Melyssa Foust. A qualitative exploration of prostate cancer treatment and survivorship advice from employed prostate cancer survivors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B051.

Abstract BACKGROUND Prostate cancer represents the most common non–skin cancer type in men. Unmet needs include understanding prognosis to determine when intervention is needed and what type, prediction to guide the choice of a systemic therapy, and response indicators to determine whether a treatment is working. Over the past decade, the “liquid biopsy,” characterized by the analysis of tumor cells and tumor cell products such as cell-free nucleic acids (DNA, microRNA) or extracellular vesicles circulating in the blood of cancer patients, has received considerable attention. CONTENT Among those biomarkers, circulating tumor cells (CTCs) have been most intensively analyzed in prostate cancer. Here we discuss recent studies on the enumeration and characterization of CTCs in peripheral blood and how this information can be used to develop biomarkers for each of these clinical contexts. We focus on clinical applications in men with metastatic castration-resistant prostate cancer, in whom CTCs are more often detected and at higher numbers, and clinical validation for different contexts of use is most mature. SUMMARY The overall goal of CTC-based liquid biopsy testing is to better inform medical decision-making so that patient outcomes are improved.

14 Background: Less than 10% of qualifying PC patients receive primary management with AS. Qualitative research aimed at identifying patient acceptance of AS has been identified as a national health research priority. The primary objective of this study was to determine if NLP of anonymous internet conversations (ICs) could be utilized to identify unmet public needs regarding AS. Methods: After obtaining IRB approval, English-language ICs regarding PC treatment with AS from 2002-2012 were identified using a novel internet search methodology. Web spiders were developed to identify, mine, and gather content from the internet for ICs centered on AS. All ICs identified were screened programmatically to remove any not-on-topic ICs. Collection of ICs was not restricted to any specific geographic region of origin. NLP was used to evaluate content and perform a sentiment analysis. Conversations were scored as positive, negative, or neutral. A sentiment index (SI) was subsequently calculated according to the following formula to compare temporal trends in public sentiment towards AS: [(#Positive IC/#Total IC) – (#Negative IC/#Total IC) x 100]. Results: A total of 464 ICs were identified. Sentiment increased from -13 to +2 over the study period. The increase sentiment has been driven by increased patient emphasis on quality-of-life factors and endorsement of AS by national medical organizations. Unmet needs identified in these ICs include: a gap between quantitative data regarding long-term outcomes with AS versus conventional treatments, desire for treatment information from an unbiased specialist, and absence of public role models managed with AS. Conclusions: This study demonstrates the potential utility of NLP to analyze ICs in order to provide insight into patient preferences and decision-making. Based on our findings, we recommend that multidisciplinary clinics consider including an unbiased specialist to present treatment options and that future decision tools for AS include quantitative data regarding outcomes after AS, so that patients can make decisions with an amount of information that is more similar to the resources available regarding radiation or surgery.

ObjectivesWith novel antiandrogen treatments of varying clinical benefits and risks becoming available, this study investigates how patients with castration-resistant prostate cancer (CRPC) value differences in treatment characteristics.DesignCross-sectional observational study.SettingA discrete choice experiment was conducted. Patients chose between two hypothetical non-metastatic CRPC (nmCRPC) treatments defined by six attributes: risk of fatigue, falls or fracture, cognitive impairment, hypertension, rashes as side effects to treatment and extension of time until cancer-related pain occurs.ParticipantsA total of 137 adult male patients with CRPC with no prior experience with chemotherapy and with Eastern Cooperative Oncology Group status 0–1 were recruited. Patients were excluded if they participated in an investigational programme outside of routine clinical practice, had a clinically relevant medical or psychiatric condition, or diagnosis of visceral/other metastases not related to the prostate, or were otherwise deemed ineligible by the referring physician.Primary outcome measuresRelative preference weights and relative importance of the attributes was estimated by hierarchical Bayesian logistic regression.ResultsAmong the treatment attributes, ‘risk of cognitive impairment as a side effect of treatment’ was the most important attribute (relative importance (RI) (95% CI): 27.47% (24.80% to 30.14%)), followed by ‘extension of time until cancer-related pain occurs’ (RI (95% CI): 17.87% (15.49% to 20.25%)) and the ‘risk of falls or fracture’ (RI (95% CI): 15.99% (14.73% to 17.25%)). The ‘risk of hypertension as a side effect of treatment’ (RI (95% CI): 13.77% (12.73% to 14.81%)) had similar RI as ‘risk of rashes as a side effect of treatment’ (RI (95% CI): 13.17% (12.15% to 14.19%)), followed by the ‘risk of fatigue as a side effect of treatment’ (RI (95% CI): 11.74% (10.75% to 12.73%)).ConclusionsPatients consider the risk of cognitive impairment as a side effect of treatment as the most important attribute in nmCRPC, followed by the extension of time until cancer-related pain occurs, and the risk of falls and fracture. These features should be considered in treatment decision making for nmCRPC in Japan.

Abstract Background: Most men with prostate cancer lack sufficient knowledge of their illness at the time they are diagnosed to make informed decisions about treatment. The ways patients interact with physicians can influence the quality of treatment-related information that is received and impact emotional well-being. Regret is a common negative affect that patients, providers, and care givers seek to avoid. This study investigated the relationship between patient communication efficacy, treatment information seeking behaviors, and decision regret within a sample of early-stage prostate cancer survivors. Methods: Sixty-three men diagnosed with early-stage prostate cancer (Stage T1 or T2) completed self-administered questionnaires. Men who were actively monitoring or undergoing definitive treatment were eligible for inclusion. The 67-item data collection tool captured patient demographics, cancer treatment information seeking behaviors, and psychosocial characteristics. Communication efficacy was measured using the validated Perceived Efficacy Patient Physicians Interaction (PEPPI-10, α=.94) scale. Decision regret was assessed using a validated 5-item measure (Brehaut et al., 2003). Descriptive and comparative analyses were conducted using SPSS Version 25. Results: A majority of participants were White (58.7%), married/partnered (79.4%), privately insured (54.2%) and graduated college (75.0%). More than two-thirds (77.8%) wanted to assume an active role during treatment decision-making. Most respondents (58.1%) fell within the high efficacy communication group (+/- 1/2 s.d. of the mean). A majority of men did not regret their initial treatment choice (82.5%). Men who regretted their initial treatment choice reported significantly more unmet treatment information needs (Mean= 5.63) than those who did not regret (Mean= 2.78) their treatment decision [t(60) = 2.084, p = .041]. Independent samples t-test results showed a statistically significant relationship between regret and communication efficacy [t(60) = -2.38, p =.021]. The two situations where men who regretted their decisions reported lower levels of communication efficacy were getting doctors to pay attention to what they have to say [t(60) = -3.39, p = .001] and making the most of their visit with the doctor [t(60) = -2.22, p = .030]. Perceived communication efficacy marginally differentiated men who regretted and did not regret their treatment decisions in two more clinical situations [t(60) = -1.92, p = .060; t(60) = -1.97, p = .054]. Conclusion: Communication efficacy appears to impact patient treatment information seeking behaviors and decision regret. Communication interventions need to be developed to increase early stage prostate cancer patients’ level of confidence when seeking treatment information to enhance their emotional well-being and quality of life. Citation Format: Levi Ross, Jordan S. Young, Jala Lockhart, Torhonda Lee, Ashley Bowers, Guleer Shabab, Michael A. Preston. Patient communication efficacy, information seeking, and treatment regret among early-stage prostate cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3220.

Abstract Introduction: Although prostate cancer (CaP) mortality rates are low, higher morbidity rates have been reported in Black men. In addition, the transition from treatment to survivorship can be burdensome and negatively impact quality of life (QoL). However, informal and formal support networks and resources, particularly spousal support, help enhance the sense of self and patient’s activities of daily living. Community, family involvement, and interaction with other survivors have also been found to be beneficial to survivors during diagnosis and treatment. Thus, we convened a town hall event for CaP survivors and those who care for and love them to explore the multidimensional impact of CaP and better understand the clinical and psychosocial needs of ethnically diverse Black CaP survivors. Methods: The virtual inaugural town hall meeting, organized by the University of Oklahoma (OU) Health and Stephenson Cancer Center, was held on April 28, 2022. The panelists included ethnically diverse CaP survivors, a radiation oncologist and urologist, and the spouse of a survivor. The town hall also served as a means to provide informational resources to attendees. A post-town hall survey was made available to all attendees to evaluate the town hall session and collect clinical and sociodemographic variables. Quantitative data were analyzed using SPSS v27. The event was audio recorded, and the transcript was content-analyzed to identify emergent themes. Results: Twenty-one out of the 43 attendees completed the survey (response rate of 49%). The respondents were aged 31-74 years old (mean±SD, 58±13), mostly males (67%), married (68%), CaP survivors (52%), and college graduates (43%). More than 80% rated the town hall to be very good/excellent and educational in light of varied approaches, perspectives, stories, and experiences shared by all the panelists. Participants appreciated updated information conveyed on anatomy, screening, signs and symptoms, diagnosis, stages of CaP, treatment, and short-term and long-term side effects shared by the oncologist. Results highlighted the physical and psychosocial impacts and stresses of CaP diagnosis on a family as a unit, especially intergenerational communication of perceived susceptibility and risk. Panelists also highlighted the burden of CaP survivorship on relationships, especially with their partners/spouses with impending functional distress. Results also underscored the positive influence CaP survivors can have on other survivors via peer advocacy and support. Finally, giving more time to panelists, extending the Q&A session, including other caregivers as panelists, and having more town hall events were top recommendations offered by participants. Conclusion: The town hall format allowed panelists, especially CaP survivors, to freely express their experiences with CaP. Overall, more awareness was raised about the importance of CaP prevention, treatment decision-making, survivorship, and advocacy: invaluable discussions needed to engage this hard-to-reach population regarding CaP prevention and care. Citation Format: Motolani E. Ogunsanya, Ernie Kaninjing, Maleeha Shahid, Darla Kendzor, Kathleen Dwyer, Mary Ellen Young, Folakemi T. Odedina. Prostate cancer survivorship and advocacy in ethnically diverse Black men: Findings from a town hall event [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A041.

INTRODUCTION:Health professionals often advocate and request innovative health technologies, perceiving Health Technology Assessment (HTA) as a delay or counterargument to their requests. To facilitate engagement of professionals and decision makers in the HTA process and endorsement of process outputs, a system for technology requests submission, based on the European Network for HTA (EUnetHTA) Submission Template, was established and subsequently piloted in a cancer research institute.METHODS:The “EUnetHTA medical devices evidence submission template” for companies (1) was adapted for use by professionals proposing a health technology for acquisition. Adaptation consisted mainly in: re-arrangement of chapters order with emphasis on the health problem, unmet needs, claimed additional benefits of the technology and potential for research; inclusion of information on costs/financial resources; and inclusion of a summary with a pre-defined set of brief statements to inform appraisal. The headings for the nine one-paragraph statements were: relevance of the health problem; degree of innovativeness of the technology; potential clinical impact; potential research relevance; comparative safety and effectiveness; economic impact; organizational impact; availability/quality of scientific literature; and degree of diffusion. Decision makers discussed the appraisal's statements with the proponents before reaching a conclusion.RESULTS:From January 2016 technology requests were examined only if presented through the submission template. Results from submissions of three innovative technologies for prostate cancer treatment, endovascular procedures and cataract surgery will be discussed. Acceptability of the submission template was high and professionals — supported by experts available in their institution (clinical engineers, epidemiologists and others) — were successful in completing the dossier. Decision-makers appraisal proved facilitated and transparent. Concerted decisions were taken within a few weeks from submission.CONCLUSIONS:The EUnetHTA tool proved flexible and valuable to initiate an HTA-based decision-making process. Appraisal was cooperative and proponents were involved in the decisions, through a process requiring a mean total time of 6 months. Participants’ misgivings were overcome by transparency and objectivity of the process.

Over 1.4 million men were diagnosed with prostate cancer worldwide in 2020. Due to increased early testing and detection, higher numbers are being diagnosed with low risk, localised prostate cancer. Active surveillance is the recommended treatment option for patients with low risk, localised prostate cancer, as it provides patients the opportunity to delay definitive treatments until clinically necessary whilst actively monitoring progression. However, there is no global consensus on eligibility criteria, best practice for management, or triggers for discontinuation, and therefore uptake, practice, and patient experiences may vary greatly across clinics and countries. In order to (a) understand patient experiences during active surveillance, (b) inform changes to active surveillance management that align with the needs of patients, and (c) identify critical research areas, consideration of the individual, social and ecological factors that influence patient experiences is required. To reach this aim, this thesis includes four studies using a range of methodologies to investigate patient experiences from diagnosis to active surveillance discontinuation. A fifth study focusing on enhancing methodology in this research domain is also included. Study One used qualitative methods to explore patient and partner experiences after low risk localised prostate cancer diagnosis as they navigated the treatment decision between active surveillance and definitive treatment. Study Two systematically reviewed the literature on patients’ unmet supportive care needs during active surveillance. Data for studies Three and Four were collected together using a mix of methodologies (quantitative survey and qualitative interviews). Given the outcomes of the systematic review (Study Two), in Study Three we investigated the unmet supportive care needs and psychological wellbeing of patients during active surveillance. In Study Four, we explored the personal and/or medical reasons patients discontinue active surveillance and move to definitive treatment. Finally, Study Five was a randomised trial embedded within Studies Three and Four to examine the influence of different unconditional monetary incentives on survey response rates. This body of research demonstrated that whilst patients on active surveillance generally report positive experiences and outcomes, a significant proportion report unmet supportive care needs across informational, sexual, physical, psychological, and patient care domains. Patients on active surveillance frequently report experiencing fear of cancer progression, appear to be greatly influenced by a variety of factors when navigating treatment decision (both at diagnosis and prior to discontinuation), and report uncertainty about active surveillance and their future. In addition, we observed that prostate cancer patients are no more likely to respond to long surveys when provided a larger unconditional monetary incentive ($20AUD) than a smaller unconditional monetary incentive ($10AUD). Further research to inform the development of supportive care interventions which directly address patient needs, align with their preferences, and consider their perspectives, is essential for improving active surveillance uptake, adherence, and overall experience for both patients and their partners/close allies. Doing so will require a strong engagement in research, which may be improved by using a variety of engagement strategies such as unconditional incentives, though further research is required.
Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2022