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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedTallman JE, Wallis CJD, Zhao Z
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
The purpose of this study was to assess the relationship between prostate volume (PV) and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer. The researchers identified 1,647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer. The primary study outcomes were treatment choice and health-related quality of life (HRQOL) assessed at pre-specified intervals up to 5 years. The study found that median baseline PV was 36 mL (IQR 27-48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75-100). The study did not find any observed clinically meaningful relationship between PV and treatment choice or post-treatment urinary function. In participants with poor baseline urinary function, treatment with radiation or surgery was related with statistically and clinically significant improvement in urinary function at 6 months which endured through 5 years.
AHRQ-funded; HS019356; HS022640.
Citation: Tallman JE, Wallis CJD, Zhao Z .
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
Prostate Cancer Prostatic Dis 2023 Dec; 26(4):787-94. doi: 10.1038/s41391-022-00627-1..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health
Jayadevappa R, Malkowicz SB, Vapiwala N
Association between hospital competition and quality of prostate cancer care.
The purpose of this retrospective study was to explore the relationship between hospital competition and outcomes in elderly with localized prostate cancer (PCa). The researchers also evaluated whether race moderated the relationship. The researchers applied the Hirschman-Herfindahl index (HHI) to measure hospital competition. The study outcomes were emergency room (ER) visits, hospitalizations, Medicare expenditure and mortality assessed in acute survivorship phase (two years post-PCa diagnosis), and long-term mortality. The study found that among 253,176 patients, percent change in incident rate of ER visit was 17% higher for one unit increase in HHI. Incident rate of ER was 24% higher for whites and 48% higher for African Americans. For one unit increase in HHI, hazard of short-term all-cause mortality was 7% higher for whites and 11% lower for African Americans. The hazard of long-term all-cause mortality was 10% higher for whites and 13% higher for African Americans.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Malkowicz SB, Vapiwala N .
Association between hospital competition and quality of prostate cancer care.
BMC Health Serv Res 2023 Aug 5; 23(1):828. doi: 10.1186/s12913-023-09851-4..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Hospitals, Quality of Care
Chen LW, Usinger DS, Katz AJ
Telehealth use and perceptions among prostate cancer survivors.
Researchers surveyed a sociodemographically diverse population-based cohort of prostate cancer survivors about their usage and perceptions of telehealth during the COVID-19 pandemic. While less than a third of survivors used telehealth at the time of survey and only 10% thought telehealth care was comparable an in-person visit, more than half felt telehealth was a good option for initial consultations or basic care. Survivors with lower education had marginally lower use of telehealth. The researchers concluded that differences in survivor perceptions of telehealth by education level highlighted underlying disparities in telehealth use and offered potential targets for interventions.
AHRQ-funded; 29020050040.
Citation: Chen LW, Usinger DS, Katz AJ .
Telehealth use and perceptions among prostate cancer survivors.
Cancer Med 2023 Aug; 12(16):17308-12. doi: 10.1002/cam4.6328..
Keywords: Telehealth, Health Information Technology (HIT), Cancer: Prostate Cancer, Cancer
Hill D, Kaufman SR, Oerline MK
In-office dispensing of oral targeted agents by urology practices in men with advanced prostate cancer.
Researchers investigated the dispensing oral targeted agents for advanced prostate cancer treatment directly to patients in urologists’ offices, and whether this delivery model improves access to these agents especially for Black men who are historically undertreated. Their retrospective cohort study used national Medicare data for men with advanced prostate cancer managed by urology practices with and without in-office dispensing. They concluded that this model of delivery could improve access to this class of medications.
AHRQ-funded; HS025707.
Citation: Hill D, Kaufman SR, Oerline MK .
In-office dispensing of oral targeted agents by urology practices in men with advanced prostate cancer.
JNCI Cancer Spectr 2023 Jul 3; 7(5). doi: 10.1093/jncics/pkad062..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Medication
Jayadevappa R, Guzzo T, Vapiwala N
Continuity of care and advanced prostate cancer.
This study’s objective was 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. This retrospective study used SEER-Medicare data of African American and white Medicare beneficiaries aged 66 or older and diagnosed with advanced prostate cancer between 2000 and 2011. The authors used at least 5 years of follow-up data. Short-term outcomes examined 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. They 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. They performed similar analysis for continuity of care in the 2-year period following acute survivorship phase. They found that a one unit increase in COCI was associated with reduction in short-term ER visits (incidence rate ratio [IRR] = 0.65), hospitalizations (IRR = 0.65), and cost (0.64) and lower hazard of long-term mortality. The benefits of higher continuity of care were greater for African Americans than white patients.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Guzzo T, Vapiwala N .
Continuity of care and advanced prostate cancer.
Cancer Med 2023 May; 12(10):11795-805. doi: 10.1002/cam4.5845..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Medicare
Agochukwu-Mmonu N, Qin Y, Kaufman S
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
This study examined the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. The authors used a 20% sample of national Medicare data to identify beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. They then linked urologists to their practices with tax identification numbers and patients to their practices based on their primary urologist. They identified 54,443 patients with incident prostate cancer, with most (87%) White and 9% Black. They found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years). Black patients had lower odds of definitive therapy and underwent less treatment than White patients in every practice context. Black patients had lower predicted probability of treatment (66%) than White patients (69%).
AHRQ-funded; HS025707.
Citation: Agochukwu-Mmonu N, Qin Y, Kaufman S .
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
JCO Oncol Pract 2023 May; 19(5):e763-e72. doi: 10.1200/op.22.00147..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Disparities, Racial and Ethnic Minorities
Gupta N, Zebib L, Wittmann D
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
The adverse effects of prostate cancer (PCa) and its treatment can critically undermine the sexual well-being of patients and couples. However, limited research has been dedicated to understanding the influence of PCa-induced sexual dysfunction on the female partners of survivors. The purpose of this study was to carry out a qualitative investigation to comprehensively capture the perceptions of female partners regarding the repercussions of PCa on their sex lives, and their partners’ sexual health concerns and unfulfilled needs. The researchers conducted semi-structured telephonic interviews concerning sexual health and unfulfilled needs with female partners of PCa survivors. Participants were recruited from multiple clinical sites and PCa caregivers' support groups from September 2021 to March 2022. Interviews were recorded, transcribed, and independently coded. The study outcomes were on the sexual health concerns and unfulfilled needs of the female partners. Of the 12 participants, the median age was 65 (between 53 and 81), nine identified as White, the median duration since their partner's PCa diagnosis was 2.25 years (ranging from 11 months to 20 years), and most reported their partner had undergone radical prostatectomy, radiation, and/or hormonal therapy. Major themes emerging from the study concerned the substantial effect of age- and PCa-related sexual dysfunction on the sexual quality of life for women, the joint nature of sexual dysfunction and recovery, the partner's role in managing and adapting to sexual dysfunction, communication barriers regarding sexual dysfunction within an intimate relationship, the absence of sexual health counseling and support from physicians, and the advantage of peer interactions and proactive information seeking in addressing unfulfilled sexual health needs. The study concluded that female partners perceive PCa-related sexual dysfunction as a shared issue for couples, express sorrow due to age- and PCa-related sexual losses, and experience a void in physician-led sexual health counseling and information.
AHRQ-funded; HS026120.
Citation: Gupta N, Zebib L, Wittmann D .
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
J Sex Med 2023 Apr 27; 20(5):651-60. doi: 10.1093/jsxmed/qdad027..
Keywords: Cancer: Prostate Cancer, Cancer, Sexual Health, Women
Katz AJ, Chen RC, Usinger DS
Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors.
This study examined receipt of preventive care and management of pre-existing cardiovascular disease (CVD) in a prospective cohort of men newly diagnosed with prostate cancer between 2011 and 2013 throughout North Carolina linked to Medicare and private insurance claims and clinical data from the Veterans Affairs (VA). Primary outcome for patients with pre-existent CVD was a composite measure of annual preventive care (blood glucose screening, cholesterol level testing, and ≥ 1 primary care provider visit). The sample comprised 492 patients successfully linked to insurance claims and/or VA data, among whom 103 (20.9%) had pre-existent CVD. Receipt of preventive care declined from 52.7% during the first year after prostate cancer diagnosis to 40.8% during the third year. Among patients with pre-existent CVD, only 23.4% saw a cardiologist in all 3 years. Black men were more likely than White men to visit a cardiologist during the first year after diagnosis.
AHRQ-funded; 29020050040I.
Citation: Katz AJ, Chen RC, Usinger DS .
Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors.
J Cancer Surviv 2023 Apr;17(2):351-59. doi: 10.1007/s11764-022-01229-5.
Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Cancer, Prevention
JE Wallis, CJD Huang, LC
AHRQ Author: Tallman
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Researchers evaluated the impact of compliance with nationally recognized radiation therapy quality measures on patient-reported health-related quality of life outcomes in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) population-based, prospective cohort study of men with localized prostate cancer. Eight quality measures were identified based on national guidelines. In multivariable analyses, no clinically significant associations were discovered between compliance with evaluated radiation therapy quality measures and patient-reported outcomes such as urinary irritation, urinary incontinence, bowel, sexual or hormonal function. The researchers concluded that further work would be needed to identify patient-centered quality measures of prostate cancer care.
AHRQ-funded; HS019356.
Citation: JE Wallis, CJD Huang, LC .
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):80-87. doi: 10.1038/s41391-022-00518-5.
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Measures
Gong F, Loeb S, Siu K
Sleep disturbances are underappreciated in prostate cancer survivorship.
Limited research exists on the prevalence of sleep issues in prostate cancer (PCa) survivors and the degree of urologist involvement in addressing sleep-related concerns. The researchers conducted a survey with PCa survivors (n = 167) and urologists (n = 145) to examine sleep problems and survivorship care practices. The study found a significant number of PCa survivors experienced sleep difficulties, with 50.9% reporting suboptimal sleep quality, 18.0% suffering from moderate/severe insomnia, and 36.5% at an elevated risk for sleep apnea. However, only a small number of urologists consistently screened for sleep disruptions, as advised in national cancer survivorship guidelines.
AHRQ-funded; HS026120
Citation: Gong F, Loeb S, Siu K .
Sleep disturbances are underappreciated in prostate cancer survivorship.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):210-12. doi: 10.1038/s41391-022-00630-6.
Keywords: Cancer, Cancer: Prostate Cancer, Sleep Problems
Chhatre S, Malkowicz SB, Jayadevappa R
Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients.
This study examined the association between continuity of care and outcomes in Medicare beneficiaries with localized prostate cancer, and the moderating effect of race using SEER – Medicare data between 2000 and 2016. Continuity of care was defined as visits dispersion and density in the acute survivorship phase. Outcomes measured were emergency room visits, hospitalizations, and cost during the acute survivorship phase and mortality over the follow-up phase. Higher continuity of care was associated with improved outcomes. The interaction between race and continuity of care was significant.
AHRQ-funded; HS024106.
Citation: Chhatre S, Malkowicz SB, Jayadevappa R .
Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients.
Prostate 2021 Dec;81(16):1310-19. doi: 10.1002/pros.24228..
Keywords: Cancer: Prostate Cancer, Cancer, Transitions of Care
Lai LY, Shahinian VB, Oerline MK
Understanding active surveillance for prostate cancer.
Understanding active surveillance for prostate cancer.
AHRQ-funded; HS025707.
Citation: Lai LY, Shahinian VB, Oerline MK .
Understanding active surveillance for prostate cancer.
JCO Oncol Pract 2021 Nov;17(11):e1678-e87. doi: 10.1200/op.20.00929..
Keywords: Cancer: Prostate Cancer, Cancer
Erim DO, Bennett AV, Gaynes BN
Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.
The purpose of this study was to create a crosswalk that predicts Short Form 6D (SF-6D) utilities from Memorial Anxiety Scale for Prostate Cancer (MAX-PC) scores. Findings showed that this study provided a crosswalk that converts MAX-PC scores to SF-6D utilities for economic evaluation of clinically significant prostate cancer-related anxiety treatment options for prostate cancer survivors.
AHRQ-funded; 29020050040I.
Citation: Erim DO, Bennett AV, Gaynes BN .
Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.
Qual Life Res 2021 Oct;30(10):2919-28. doi: 10.1007/s11136-021-02871-9..
Keywords: Cancer: Prostate Cancer, Cancer, Research Methodologies
Moazzezi M, Rose B, Kisling K
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
This study’s objective was to assess the new online adaptive radiation therapy technology called Ethos for treating prostate cancer. Twenty-five prostate patients previously treated at the author’s clinic were re-planed using an Ethos emulator. Clinical margins of 3 mm posterior, 5 mm left/right/anterior, and 7 mm superior/inferior were used. Dose metrics were compared to unadapted plans to evaluate clinical target volumes (CTV) and online adaptive radiation (OAR) dose changes. Overall, 96% of fractions required auto-segmentation edits, although they were mostly minor. Adaptation improved CTV 98% for the 24 patients with minor auto-segmentation corrections. However, for one in 25 patients, large contour edits were required.
AHRQ-funded; HS025440.
Citation: Moazzezi M, Rose B, Kisling K .
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
J Appl Clin Med Phys 2021 Oct;22(10):82-93. doi: 10.1002/acm2.13399..
Keywords: Cancer: Prostate Cancer, Cancer, Treatments, Imaging
Marchetti KA, Oerline M, Hollenbeck BK
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
The purpose of this study was to characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. The investigators characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. They indicated that this trend coincided with higher utilization of observation and surgical treatment for prostate cancer.
AHRQ-funded; HS025707.
Citation: Marchetti KA, Oerline M, Hollenbeck BK .
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
Urology 2021 Sep;155:77-82. doi: 10.1016/j.urology.2020.12.051..
Keywords: Cancer: Prostate Cancer, Cancer, Workforce, Practice Patterns
Caram MEV, Burns J, Kumbier K
Factors influencing treatment of veterans with advanced prostate cancer.
This study examined factors influencing treatment of veterans with metastatic castration-resistant prostate cancer (CRPC). Clinician and nonclinical factors associated with the first-line treatment for CPRC using data from the Veterans Health Administration was used. Almost 5000 patients who received abiraterone, enzalutamide, docetaxel, or ketoconazole from 2010 through 2017 were identified. Increasing age was associated with receipt of abiraterone or enzalutamide versus docetaxel. Greater preexisting comorbidity was associated with enzalutamide versus abiraterone. Patients with higher PSA values at the start of treatment were more likely to receive docetaxel than the other three treatments. African American men were more likely to receive ketoconazole.
AHRQ-funded; HS025707.
Citation: Caram MEV, Burns J, Kumbier K .
Factors influencing treatment of veterans with advanced prostate cancer.
Cancer 2021 Jul 1;127(13):2311-18. doi: 10.1002/cncr.33485..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Treatments
Pasalic D, Barocas DA, Huang LC
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
This retrospective cohort study’s objective was to determine if there were differences in treatment-related regret or survival between prostate cancer patients who received external-beam radiation therapy (EBRT) with or without a brachytherapy boost (EBRT-LDR), over a 5-year period. The cohort included 695 men who met inclusion criteria and received either EBRT (n=583) or EBRT-LDR (n=112). Men who received either treatment reported clinically worse urinary irritation and bowel function through 3 years but resolved after 5 years. Men who received EBRT-LDR continued to report moderate- to-big problems with urinary function bother and frequent urination at 5 years. There was no difference in treatment-related regret or survival between patients who received either treatment.
AHRQ-funded; HS019356; HS022640.
Citation: Pasalic D, Barocas DA, Huang LC .
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
Cancer 2021 Jun 1;127(11):1912-25. doi: 10.1002/cncr.33388..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research, Treatments
Danan ER, White KM, Wilt TJ
Reactions to recommendations and evidence about prostate cancer screening among White and Black male veterans.
This study looked at differences in attitudes about recommendations and evidence on prostate cancer screening among White and Black male veterans. The authors provided a draft educational pamphlet about the benefits and harms of Prostate Specific Antigen (PSA) screening to 44 men, ages 55-81 at a midwestern VA medical center in 2013 and 2015. The groups were divided into four White and two Black focus groups. Three universal themes were low baseline familiarity with prostate cancer, surprise and resistance to the guidelines not to test routinely, and negative emotions in response to ambiguity. Discussions in the White groups highlighted the potential benefits of screening, minimized the harms, and emphasized personal choice in screening decisions. Discussions in Black groups devoted almost no time to benefits, considered harms significant, and emphasized personal and collective responsibility for cancer prevention through diet, exercise, and alternative medicine. Discussion in Black groups also emphasized the history of racism and discrimination in healthcare and medical research.
AHRQ-funded; HS026379.
Citation: Danan ER, White KM, Wilt TJ .
Reactions to recommendations and evidence about prostate cancer screening among White and Black male veterans.
Am J Mens Health 2021 May-Jun;15(3):15579883211022110. doi: 10.1177/15579883211022110..
Keywords: Cancer: Prostate Cancer, Cancer, Screening, Prevention, Racial and Ethnic Minorities, Evidence-Based Practice, Health Promotion, Education: Patient and Caregiver
Wilt TJ, Ullman KE, Linskens EJ
Therapies for clinically localized prostate cancer: a comparative effectiveness review.
In this study, the investigators sought to identify new information evaluating clinically localized prostate cancer therapies. The investigators concluded that radical prostatectomy reduced mortality vs watchful waiting in clinically detected localized prostate cancer but caused more harms. Effectiveness may be limited to younger men and those with intermediate risk disease. Active monitoring resulted in little to no mortality difference vs radical prostatectomy or external beam radiation plus androgen deprivation.
AHRQ-funded; 290201500008I.
Citation: Wilt TJ, Ullman KE, Linskens EJ .
Therapies for clinically localized prostate cancer: a comparative effectiveness review.
J Urol 2021 Apr;205(4):967-76. doi: 10.1097/ju.0000000000001578..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Men's Health
Stone BV, Laviana AA, Luckenbaugh AN
Patient-reported financial toxicity associated with contemporary treatment for localized prostate cancer.
Contemporary treatment modalities for localized prostate cancer provide comparable overall and cancer-specific survival. However, the degree of financial burden imposed by treatment, the factors contributing to that burden, and how different treatments compare with regard to financial toxicity remain poorly understood. The investigators sought to explore these factors. They concluded that external beam radiotherapy was associated with the highest financial burden, even when controlling for age, education and income.
AHRQ-funded; HS019356; HS022640.
Citation: Stone BV, Laviana AA, Luckenbaugh AN .
Patient-reported financial toxicity associated with contemporary treatment for localized prostate cancer.
J Urol 2021 Mar;205(3):761-68. doi: 10.1097/ju.0000000000001423..
Keywords: Cancer: Prostate Cancer, Cancer, Healthcare Costs