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Sun Hee Rim1, Ingrid J Hall1, Megan E Fairweather2, Catherine R Fedorenko2, Donatus U Ekwueme1, Judith Lee Smith1, Ian M Thompson3, Thomas E Keane4, David F Penson5, Carol M Moinpour2, Steven B Zeliadt2,6, Scott D Ramsey21Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; 2Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 3Department of Urology, University of Texas Health Science Center at San Antonio, TX, USA; 4Urology Services, Medical University of South Carolina, Charleston, SC, USA; 5Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA; 6Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USAAbstract: Prostate cancer is the most commonly diagnosed cancer among American men. The multiple treatment options for localized prostate cancer and potential side effects can complicate the decision-making process. We describe the level of engagement and communication among the patient, family member, and physician (the decision-making “triad”) in the decision process prior to treatment. Using the Family and Cancer Therapy Selection (FACTS) study baseline survey data, we note racial/ethnic variations in communication among the triad. Sensitivity to and awareness of decision-making styles of both the patient and their family member (or caregiver) may enable clinicians to positively influence communication exchanges about important clinical decisions.Keywords: decision-making, treatment-related decisions, ethnicity

Purpose: We surveyed prostate cancer patients about complementary and alternative medicine (CAM) use and evaluated patient factors that correlated with CAM use 6 months following diagnosis.Methods: The Prostate CAncer Therapy Selection study was a prospective, observational multi-site study of men's treatment decision-making process after a diagnosis of local stage prostate cancer. Recruitment occurred in community urology practices in Washington State, hospital-based urology clinics affiliated with the University of Southern California, and Kaiser Permanente in Northern California. Eligible study participants included men over age 21 diagnosed with local stage prostate cancer between May 1, 2005 and December 31, 2006.Results: Fifty-two percent of survey respondents (379) reported using one or more types of CAM. Of the patients, 51% used one CAM method, 26% used two methods, and 23% used three or more methods. The most commonly reported category was mind-body therapies (65%). Only 43% of patients discussed their CAM use with a health professional; of those, 20% informed their primary care physician and 30% told the doctor managing their prostate cancer care. Less than half thought the CAM they used was "very helpful", but a majority thought it was somewhat helpful for their condition.Conclusions: Further research is needed to characterize the goals prostate cancer patients have for CAM, whether the treatments met those goals, and how this translates into the perceived helpfulness of these therapies. The implications of patients not discussing CAM use with health professionals at the time of prostate cancer treatment need further studies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to obtain estimates of trends in initial treatment costs during the prostate-specific antigen (PSA) era that account for the changing patient case-mix associated with screening. SUBJECTS: We used reimbursement claims for Medicare-eligible subjects diagnosed with nonmetastatic prostate cancer between 1991 and 1999. Patients were grouped by initial treatment, with 17,846 receiving radical prostatectomy (RP), 25,933 receiving external beam radiotherapy (XRT), and 4525 receiving brachytherapy (BT). METHODS: Cancer-attributable costs were computed by subtracting noncancer costs from total Medicare reimbursements among newly diagnosed cancer patients. Noncancer costs were estimated in 2 ways: (1) average costs among age-matched, cancer-free control subjects (control method) and (2) projections based on claims from subjects before diagnosis (prediagnosis method). Adjusted annual percent change in cancer-attributable costs was calculated using multivariate generalized linear models. RESULTS: Noncancer costs increased at a much lower rate among men prior to diagnosis (3.8% annually) than among the general Medicare population (10.9%). The 2 approaches yielded different results; RP costs declined by 2.4% annually (prediagnosis method) versus 6.2% (control method); XRT costs declined by 1.5% versus 5.8%; and BT costs declined by 4.1% versus 8.3%. CONCLUSIONS: Because of self-selection of PSA screening, men diagnosed with prostate cancer today are now healthier overall than men in the general population and are considerably healthier than men diagnosed previously. Estimates of cancer-attributable costs that do not account for this healthy selection effect are likely to be biased. Declines in cancer-attributable treatment costs are evident even after accounting for a healthy screenee effect, suggesting that there has been a real reduction in cancer treatment costs. [ABSTRACT FROM AUTHOR]

Background: The National Cancer Institute has published consensus guidelines for universal screening for hereditary nonpolyposis colorectal cancer (HNPCC) in patients with newly diagnosed colorectal cancer.Objective: To determine the cost-effectiveness of screening compared with standard care in eligible patients with colorectal cancer and their siblings and children.Design: Cost-effectiveness analysis.Data Sources: National colorectal cancer registry data, the Creighton International Hereditary Colorectal Cancer Registry, Medicare claims records, and published literature.Target Population: Patients with newly diagnosed colorectal cancer and their siblings and children.Time Horizon: Lifetime (varies depending on age at screening).Perspective: Societal.Interventions: Initial office-based screening to determine eligibility (based on personal and family cancer history), followed by tumor testing for microsatellite instability. Those with microsatellite instability were offered genetic testing for HNPCC. Siblings and children of patients with cancer and the HNPCC mutation were offered genetic testing, and those who were found to carry the mutation received lifelong colorectal cancer screening.Measurements: Life-years gained.Results Of Base-case Analysis: When only the patients with cancer were considered, cost-effectiveness of screening was $42 210 per life-year gained. When patients with cancer and their siblings and children were considered together, cost-effectiveness increased to $7556 per life-year gained.Results Of Sensitivity Analysis: The model was most sensitive to the estimated survival gain from screening siblings and children, to the prevalence of HNPCC mutations among patients with newly diagnosed cancer, and to the discount rate. In probabilistic analysis, the 90% CI for the cost-effectiveness of screening patients with cancer plus their relatives was $4874 to $21 576 per life-year gained.Conclusion: Screening patients with newly diagnosed colorectal cancer for HNPCC is cost-effective, especially if the benefits to their immediate relatives are considered. [ABSTRACT FROM AUTHOR]

Willingness to pay (WTP) has been used in Sweden to evaluate the value of antihypertensive therapy. The Swedish studies indicate that hypertensive patients are willing to pay between $107 and $120 per month for their therapy. We conducted a similar study in a population of hypertensive patients in a large, staff-model, managed care organization (Group Health Cooperative of Puget Sound). Participants returned a postal survey containing a WTP question with 10 'bids' ranging from $25 to $250. Respondents recorded whether they would accept or reject each bid at the stated dollar value. Demographic information such as age, income, and perceived health status was also collected. Results were analyzed with ordinary least squares regression, controlling for the demographic data. The estimated parameters were significant and indicated an adjusted mean WTP of $93 per month for antihypertensive therapy. The close similarity of the Swedish and U.S. results appears to support the use of WTP as a measure of health state preferences. [ABSTRACT FROM AUTHOR]