101 results on '"Talcott JA"'
Search Results
2. Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia.
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Elting LS, Lu C, Escalante CP, Giordano SH, Trent JC, Cooksley C, Avritscher EB, Shih YC, Ensor J, Bekele BN, Gralla RJ, Talcott JA, Rolston K, Elting, Linda S, Lu, Charles, Escalante, Carmelita P, Giordano, Sharon H, Trent, Jonathan C, Cooksley, Catherine, and Avritscher, Elenir B C
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- 2008
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3. Assessing a prostate cancer brachytherapy technique using early patient-reported symptoms: a potential early indicator for technology assessment?
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Seo PH, D'Amico AV, Clark JA, Kaplan I, Manola JB, Mitchell SP, and Talcott JA
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- 2004
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4. Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer.
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Godley PA, Schenck AP, Amamoo MA, Schoenbach VJ, Peacock S, Manning M, Symons M, Talcott JA, Godley, Paul A, Schenck, Anna P, Amamoo, M Ahinee, Schoenbach, Victor J, Peacock, Sharon, Manning, Michelle, Symons, Michael, and Talcott, James A
- Abstract
Background: Prostate cancer mortality is higher among black American men than among white American men. We investigated whether racial disparities in outcomes of clinically localized prostate cancer vary by treatment (surgery, radiation therapy, or nonaggressive treatment).Methods: Merged Surveillance, Epidemiology, and End Results Program (SEER) and Medicare files provided data (on treatment modality, age, race, cancer stage, tumor grade, census tract socioeconomic status, and date of death) on 5747 black and 38 242 white patients diagnosed at age 65-84 years with clinically localized prostate cancer between 1986 and 1996 in five SEER sites. Patients were followed through 1998. Racial differences in survival outcomes were assessed using Kaplan-Meier survival curves and Cox regression models.Results: The median survival time for black patients was 1.7 years (95% confidence interval [CI] = 1.6 to 1.9 years) less than that for white patients. Median survival in black patients relative to white patients was 1.8 years (95% CI = 1.5 to 2.0 years) less among those who had surgery, 0.7 years (95% CI = 0.5 to 1.0 years) less among those who had radiation therapy, and 1.0 years (95% CI = 0.7 to 1.1 years) less among those who had nonaggressive treatment. Racial disparities were evident both in overall survival and in prostate cancer-specific survival, before and after statistical adjustment for covariates.Conclusions: Black patients' poorer overall survival from localized prostate cancer varies by initial treatment, with the survival gap being largest among patients undergoing surgery. Investigating these treatment-specific differences may clarify the mechanisms underlying worse outcomes for black patients in the health care system. [ABSTRACT FROM AUTHOR]- Published
- 2003
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5. Measuring patients' perceptions of the outcomes of treatment for early prostate cancer.
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Clark JA, Bokhour BG, Inui TS, Silliman RA, Talcott JA, Clark, Jack A, Bokhour, Barbara G, Inui, Thomas S, Silliman, Rebecca A, and Talcott, James A
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Background: Compared with careful attention to the physical (eg, urinary, bowel, sexual) dysfunction that may follow treatment, little attention has been given to the behavioral, emotional, and interpersonal changes that the diagnosis of early prostate cancer and subsequent physical dysfunction may bring.Objective: To construct patient-centered measures of the outcomes of treatment for early prostate cancer.Research Design: Qualitative study followed by survey of early prostate cancer patients and group of comparable patients with no history of prostate cancer. Analysis of focus groups identified relevant domains of quality of life, which were represented by Likert scale items included in survey questionnaires. Psychometric analyses of survey data defined scales evaluated with respect to internal consistency and validity.Results: Qualitative analysis identified three domains: urinary control, sexuality, and uncertainty about the cancer and its treatment. Psychometric analysis defined 11 scales. Seven were generically relevant to most older men: urinary control (eg, embarrassment with leakage), sexual intimacy (eg, anxiety about completing intercourse), sexual confidence (eg, comfort with sexuality), marital affection (eg, emotional distance from spouse/partner), masculine self esteem (eg, feeling oneself a whole man), health worry (eg, apprehensiveness about health changes), and PSA concern (eg, closely attending to one's PSA). Four scales were specific to the treatment experience: perceived cancer control, quality of treatment decision making, regret of treatment choice, and cancer-related outlook.Conclusion: The scales provide definition and metrics for patient-centered research in this area. They complement measures of physical dysfunction and bring into resolution outcomes of treatment that have gone unnoticed in previous studies. [ABSTRACT FROM AUTHOR]- Published
- 2003
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6. Symptom indexes to assess outcomes of treatment for early prostate cancer.
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Clark JA, Talcott JA, Clark, J A, and Talcott, J A
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- 2001
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7. Prostate cancer practice patterns and quality of life: the Prostate Cancer Outcomes Study.
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Potosky AL, Harlan LC, Stanford JL, Gilliland FD, Hamilton AS, Albertsen PC, Eley JW, Liff JM, Deapen D, Stephenson RA, Legler J, Ferrans CE, Talcott JA, Litwin MS, Potosky, A L, Harlan, L C, Stanford, J L, Gilliland, F D, Hamilton, A S, and Albertsen, P C
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- 1999
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8. Patient-reported symptoms after primary therapy for early prostate cancer: Results of a prospective cohort study
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Talcott, JA, Rieker, P, Clark, JA, Propert, KJ, Weeks, JC, and Beard, CJ
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- 2000
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9. Prostate cancer quality of life: beyond initial treatment and the patient.
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Talcott JA
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- 2007
10. Measuring perceived effects of drinking an extract of basidiomycetes Agaricus blazei murill: a survey of Japanese consumers with cancer
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Lee Insu P, Clark Jack A, and Talcott James A
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Other systems of medicine ,RZ201-999 - Abstract
Abstract Background To survey cancer patients who consume an extract of the Basidiomycetes Agaricus blazei Murill mushroom (Sen-Sei-Ro) to measure their self-assessment of its effects and to develop an instrument for use in future randomized trials. Methods We designed, translated and mailed a survey to 2,346 Japanese consumers of Sen-Sei-Ro self-designated as cancer patients. The survey assessed consumer demographics, cancer history, Sen-Sei-Ro consumption, and its perceived effects. We performed exploratory psychometric analyses to identify distinct, multi-item scales that could summarize perceptions of effects. Results We received completed questionnaires from 782 (33%) of the sampled Sen-Sei-Ro consumers with a cancer history. Respondents represented a broad range of cancer patients familiar with Sen-Sei-Ro. Nearly all had begun consumption after their cancer diagnosis. These consumers expressed consistently positive views, though not extremely so, with more benefit reported for more abstract benefits such as emotional and physical well-being than relief of specific symptoms. We identified two conceptually and empirically distinct and internally consistent summary scales measuring Sen-Sei-Ro consumers' perceptions of its effects, Relief of Symptoms and Functional Well-being (Cronbach's alpha: Relief of Symptoms, α = .74; Functional Well-Being, α = .91). Conclusion Respondents to our survey of Sen-Sei-Ro consumers with cancer reported favorable perceived effects from its use. Our instrument, when further validated, may be a useful outcome in trials assessing this and other complementary and alternative medicine (CAM) substances in cancer patients.
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- 2007
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11. Measuring perceived effects of drinking an extract of basidiomycetes Agaricus blazei murill: a survey of Japanese consumers with cancer.
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Talcott JA, Clark JA, and Lee IP
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- 2007
12. Rectal dose-volume histogram parameters are associated with long-term patient-reported gastrointestinal quality of life after conventional and high-dose radiation for prostate cancer: a subgroup analysis of a randomized trial.
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Nguyen PL, Chen RC, Hoffman KE, Trofimov A, Efstathiou JA, Coen JJ, Shipley WU, Zietman AL, and Talcott JA
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- 2010
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13. Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update: ASCO Guideline Q and A.
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Virgo KS, Rumble RB, and Talcott JA
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- Humans, Male, Practice Guidelines as Topic, Prostatic Neoplasms therapy
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- 2023
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14. Risk Assessment Models for Febrile Neutropenia: The Reification of Clinical Decision Making.
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Talcott JA
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- Humans, Risk Assessment, Clinical Decision-Making, Febrile Neutropenia complications
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- 2022
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15. Reply to A. K. Tewari et al.
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Talcott JA and Virgo KS
- Abstract
Competing Interests: James TalcottEmployment: NantHealthOpen Payments Link: https://openpaymentsdata.cms.gov/physician/1242101/No other potential conflicts of interest were reported.
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- 2021
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16. Decision Rules in a Guideline: Allow the Science to Speak.
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Talcott JA
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- 2018
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17. Long-term quality of life after definitive treatment for prostate cancer: patient-reported outcomes in the second posttreatment decade.
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Jang JW, Drumm MR, Efstathiou JA, Paly JJ, Niemierko A, Ancukiewicz M, Talcott JA, Clark JA, and Zietman AL
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- Aged, Aged, 80 and over, Combined Modality Therapy adverse effects, Combined Modality Therapy methods, Humans, Male, Middle Aged, Neoplasm Staging, Patient Reported Outcome Measures, Prospective Studies, Prostatic Neoplasms diagnosis, Prostatic Neoplasms therapy, Time Factors, Treatment Outcome, Prostatic Neoplasms epidemiology, Quality of Life
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Definitive treatment for prostate cancer includes radical prostatectomy (RP), external beam radiation therapy (EBRT), and brachytherapy (BT). The different side effect profiles of these options are crucial factors for patients and clinicians when deciding between treatments. This study reports long-term health-related quality of life (HRQOL) for patients in their second decade after treatment for prostate cancer. We used a validated survey to assess urinary, bowel, and sexual function and HRQOL in a prospective cohort of patients diagnosed with localized prostate cancer 14-18 years previously. We report and compare the outcomes of patients who were initially treated with RP, EBRT, or BT. Of 230 eligible patients, the response rate was 92% (n = 211) and median follow-up was 14.6 years. Compared to baseline, RP patients had significantly worse urinary incontinence and sexual function, EBRT patients had worse scores in all domains, and BT patients had worse urinary incontinence, urinary irritation/obstruction, and sexual function. When comparing treatment groups, RP patients underwent larger declines in urinary continence than did BT patients, and EBRT and BT patients experienced larger changes in urinary irritation/obstruction. Baseline functional status was significantly associated with long-term function for urinary obstruction and bowel function domains. This is one of the few prospective reports on quality of life for prostate cancer patients beyond 10 years, and adds information about the late consequences of treatment choices. These data may help patients make informed decisions regarding treatment choice based on symptoms they may experience in the decades ahead., (© 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)
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- 2017
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18. The Health Effects of Masculine Self-Esteem Following Treatment for Localized Prostate Cancer Among Gay Men.
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Allensworth-Davies D, Talcott JA, Heeren T, de Vries B, Blank TO, and Clark JA
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Purpose: To identify factors associated with masculine self-esteem in gay men following treatment for localized prostate cancer (PCa) and to determine the association between masculine self-esteem, PCa-specific factors, and mental health factors in these patients., Methods: A national cross-sectional survey of gay PCa survivors was conducted in 2010-2011. To be eligible for the study, men needed to be age 50 or older, reside in the United States, self-identify as gay, able to read, write, and speak English, and to have been treated for PCa at least 1 year ago. One hundred eleven men returned surveys., Results: After simultaneously adjusting for the factors in our model, men aged 50-64 years and men aged 65-74 years reported lower masculine self-esteem scores than men aged 75 years or older. Lower scores were also reported by men who reported recent severe stigma. Men who reported feeling comfortable revealing their sexual orientation to their doctor reported higher masculine self-esteem scores than men who were not. The mental component score from the SF-12 was also positively correlated with masculine self-esteem., Conclusion: PCa providers are in a position to reduce feelings of stigma and promote resiliency by being aware that they might have gay patients, creating a supportive environment where gay patients can discuss specific sexual concerns, and engaging patients in treatment decisions. These efforts could help not only in reducing stigma but also in increasing masculine self-esteem, thus greatly influencing gay patients' recovery, quality of life, and compliance with follow-up care.
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- 2016
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19. In the Clinic. Prostate Cancer.
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Talcott JA
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- Decision Making, Early Detection of Cancer, Humans, Male, Mass Screening, Neoplasm Staging, Patient Education as Topic, Prostate-Specific Antigen blood, Prostatic Neoplasms diagnosis, Prostatic Neoplasms prevention & control, Prostatic Neoplasms therapy
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- 2015
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20. Impact of comorbidity on health-related quality of life after prostate cancer treatment: combined analysis of two prospective cohort studies.
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Reeve BB, Chen RC, Moore DT, Deal AM, Usinger DS, Lyons JC, and Talcott JA
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- Aged, Aged, 80 and over, Brachytherapy adverse effects, Comorbidity, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Prospective Studies, Prostatectomy adverse effects, Prostatic Neoplasms epidemiology, Prostatic Neoplasms psychology, Sexual Dysfunction, Physiological etiology, Treatment Outcome, Urinary Incontinence etiology, Prostatic Neoplasms therapy, Quality of Life psychology
- Abstract
Objective: To improve and individualise estimates of treatment outcomes for men diagnosed with prostate cancer, we examined the impact of baseline comorbidity on health-related quality of life (HRQL) outcomes in an analysis of two pooled, prospective cohort studies., Patients and Methods: We studied 697 patients from three academic hospitals who received radical prostatectomy (RP), external beam radiation therapy (EBRT), or brachytherapy (BT). Measures of patient-reported bowel, urinary, and sexual symptoms along with physical and mental health were prospectively collected before treatment and 3, 12, 24, and 36 months after treatment. We assessed baseline comorbidity by the validated Index of Co-Existent Disease (ICED), abstracted from medical records. Regression mixed-models were built for each treatment group and HRQL outcome controlling for baseline age, education, marital status, risk group and patient-reported general health., Results: About 71% of patients had one or more comorbid conditions at baseline. After adjusting for covariates, we found baseline comorbidity was independently associated with poorer sexual function after BT (P = 0.04) and RP (P = 0.03) but not EBRT (P = 0.35). Physical health was significantly worse for men receiving BT with more comorbidities (P = 0.02). Baseline comorbid conditions were not associated with urinary incontinence or bowel functioning., Conclusions: Comorbidity at baseline is significantly associated with poorer sexual function after prostate BT or RP. This information may help patients and their physicians anticipate outcomes after surgical and radiation treatments., (© 2014 The Authors. BJU International © 2014 BJU International.)
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- 2014
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21. Primary care physician-led health reform.
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Talcott JA
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- Humans, Accountable Care Organizations, Health Care Reform, Leadership, Physician's Role
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- 2014
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22. Using patient-reported outcomes to assess and improve prostate cancer brachytherapy.
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Talcott JA, Manola J, Chen RC, Clark JA, Kaplan I, D'Amico AV, and Zietman AL
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- Aged, Aged, 80 and over, Brachytherapy methods, Catheters, Indwelling, Cohort Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Reproducibility of Results, Urinary Catheterization, Urination Disorders etiology, Brachytherapy adverse effects, Patient Outcome Assessment, Prostatic Neoplasms radiotherapy, Quality Improvement, Self Report, Urination Disorders prevention & control
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Objective: To describe a successful quality improvement process that arose from unexpected differences in control groups' short-term patient-reported outcomes (PROs) within a comparative effectiveness study of a prostate brachytherapy technique intended to reduce urinary morbidity., Patients and Methods: Patients planning prostate brachytherapy at one of three institutions were enrolled in a prospective cohort study. Patients were surveyed using a validated instrument to assess treatment-related toxicity before treatment and at pre-specified intervals. Unexpectedly, urinary PROs were worse in one of two standard brachytherapy technique control populations (US-BT1 and US-BT2 ). Therefore, we collaboratively reviewed treatment procedures, identified a discrepancy in technique, made a corrective modification, and evaluated the change., Results: The patient groups were demographically and clinically similar. In the first preliminary analysis, US-BT2 patients reported significantly more short-term post-treatment urinary symptoms than US-BT1 patients. The study's treating physicians reviewed the US-BT1 and US-BT2 treatment protocols and found that they differed in whether they used an indwelling urinary catheter. After adopting the US-BT1 approach, short-term urinary morbidity in US-BT2 patients decreased significantly. Brachytherapy procedures were otherwise unchanged., Conclusion: Many procedures in cancer treatments are not evaluated, resulting in practice variation and suboptimal outcomes. Patients, the primary medical consumers, provide little direct input in evaluations of their care. We used PROs, a sensitive and valid measure of treatment-related toxicity, for quality assessment and quality improvement (QA/QI) of prostate brachytherapy. This serendipitous patient-centred QA/QI process may be a useful model for empirically evaluating complex cancer treatment procedures and for screening for substandard care., (© 2013 The Authors. BJU International © 2013 BJU International.)
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- 2014
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23. Ensuring comprehensive assessment of urinary problems in prostate cancer through patient-physician concordance.
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Victorson DE, Brucker PS, Bode RK, Eton DT, Talcott JA, Clark JA, Knight SJ, Litwin MS, Moinpour CM, Reeve BB, Aaronson NK, Bennett CL, Herr HW, McGuire M, Shevrin D, McVary K, and Cella D
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- Aged, Humans, Male, Medical Oncology standards, Middle Aged, Quality of Life, Surveys and Questionnaires, Symptom Assessment, Urinary Bladder Neck Obstruction diagnosis, Urinary Incontinence diagnosis, Urination Disorders diagnosis, Urology standards, Prostatic Neoplasms complications, Prostatic Neoplasms therapy, Urinary Bladder Neck Obstruction etiology, Urinary Incontinence etiology, Urination Disorders etiology
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Objectives: To examine the concordance between clinicians and men diagnosed with prostate cancer on a clinician-derived pathophysiological classification of the following self-reported urinary complications: storage (irritative), voiding (obstructive), and leakage/incontinence., Materials and Methods: Fourteen urology experts classified 37 urinary function questionnaire items into 3 primary conceptual dimensions (e.g., storage [irritative], voiding [obstructive] and urinary leakage/incontinence) that would best reflect each item's content. In addition, 218 patient participants provided responses to the 37 items. Using classifications by experts to develop the conceptual framework, the structure was tested using confirmatory factor analyses with patient data., Results: Expert consensus was achieved in the classification of 31 out of 37 items. Using the 3-factor conceptual framework and patient data, the fit indices for the overall correlated factor model suggested an acceptable overall model fit. The analyses of the separate domains showed acceptable fit for the storage/irritative domain and the leaking/incontinence domain. The dimensionality of the voiding/obstructive domain was too difficult to estimate., Conclusions: Our analysis found items that conceptually and psychometrically support 2 constructs (leaking/incontinence and storage/irritative). The consistency of this support between the groups suggests a clinical relevance that is useful in treating patients. We have conceptual support for a third hypothesis (voiding/obstructive), although there were too few items to assess this psychometrically. Relative motivating factors of bother and urinary complaints were not addressed and remain an unmet need in this field., (Copyright © 2014 Elsevier Inc. All rights reserved.)
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- 2014
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24. Patient-reported outcomes after 3-dimensional conformal, intensity-modulated, or proton beam radiotherapy for localized prostate cancer.
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Gray PJ, Paly JJ, Yeap BY, Sanda MG, Sandler HM, Michalski JM, Talcott JA, Coen JJ, Hamstra DA, Shipley WU, Hahn SM, Zietman AL, Bekelman JE, and Efstathiou JA
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- Aged, Humans, Male, Middle Aged, Prospective Studies, Prostatic Neoplasms physiopathology, Protons, Quality of Life, Prostatic Neoplasms radiotherapy, Radiotherapy methods
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Background: Recent studies have suggested differing toxicity patterns for patients with prostate cancer who receive treatment with 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), or proton beam therapy (PBT)., Methods: The authors reviewed patient-reported outcomes data collected prospectively using validated instruments that assessed bowel and urinary quality of life (QOL) for patients with localized prostate cancer who received 3DCRT (n = 123), IMRT (n = 153) or PBT (n = 95). Clinically meaningful differences in mean QOL scores were defined as those exceeding half the standard deviation of the baseline mean value. Changes from baseline were compared within groups at the first post-treatment follow-up (2-3 months from the start of treatment) and at 12 months and 24 months., Results: At the first post-treatment follow-up, patients who received 3DCRT and IMRT, but not those who received PBT, reported a clinically meaningful decrement in bowel QOL. At 12 months and 24 months, all 3 cohorts reported clinically meaningful decrements in bowel QOL. Patients who received IMRT reported clinically meaningful decrements in the domains of urinary irritation/obstruction and incontinence at the first post-treatment follow-up. At 12 months, patients who received PBT, but not those who received IMRT or 3DCRT, reported a clinically meaningful decrement in the urinary irritation/obstruction domain. At 24 months, none of the 3 cohorts reported clinically meaningful changes in urinary QOL., Conclusions: Patients who received 3DCRT, IMRT, or PBT reported distinct patterns of treatment-related QOL. Although the timing of toxicity varied between the cohorts, patients reported similar modest QOL decrements in the bowel domain and minimal QOL decrements in the urinary domains at 24 months. Prospective randomized trials are needed to further examine these differences., (Copyright © 2013 American Cancer Society.)
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- 2013
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25. Long-term quality of life outcome after proton beam monotherapy for localized prostate cancer.
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Coen JJ, Paly JJ, Niemierko A, Weyman E, Rodrigues A, Shipley WU, Zietman AL, and Talcott JA
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- Aged, Follow-Up Studies, Humans, Intestinal Diseases etiology, Male, Middle Aged, Prostate radiation effects, Prostatic Neoplasms pathology, Protons adverse effects, Radiotherapy Dosage, Seminal Vesicles radiation effects, Sexual Dysfunction, Physiological etiology, Statistics, Nonparametric, Surveys and Questionnaires, Treatment Outcome, Urination Disorders etiology, Prostatic Neoplasms radiotherapy, Proton Therapy, Quality of Life, Radiotherapy, Conformal methods
- Abstract
Objectives: High-dose external radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons., Methods: QOL questionnaires were sent at specified intervals to 95 men who received proton radiation. Of these, 87 men reported 3- and/or 12-month outcomes, whereas 73 also reported long-term outcomes (minimum 2 years). Symptom scores were calculated at baseline, 3 months, 12 months, and long-term follow-up. Generalized estimating equation models were constructed to assess longitudinal outcomes while accounting for correlation among repeated measures in an individual patient. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate, or poor function) for each symptom domain. Long-term QOL changes were assessed overall and within functional groups using the Wilcoxon signed-rank test., Results: Statistically significant changes in all four symptom scores were observed in the longitudinal analysis. For the 73 men reporting long-term outcomes, there were significant change scores for incontinence (ID), bowel (BD) and sexual dysfunction (SD), but not obstructive/irritative voiding dysfunction (OID). When stratified by baseline functional category, only men with normal function had increased scores for ID and BD. For SD, there were significant changes in men with both normal and intermediate function, but not poor function., Conclusions: Patient reported outcomes are sensitive indicators of treatment-related morbidity. These results quantitate the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category provides an individualized prediction of long-term QOL scores. High dose proton radiation was associated with small increases in bowel dysfunction and incontinence, with more pronounced changes in sexual dysfunction., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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26. Safety of early discharge for low-risk patients with febrile neutropenia: a multicenter randomized controlled trial.
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Talcott JA, Yeap BY, Clark JA, Siegel RD, Loggers ET, Lu C, and Godley PA
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- Adult, Aged, Aged, 80 and over, Ambulatory Care standards, Female, Fever blood, Fever chemically induced, Humans, Male, Middle Aged, Neoplasms blood, Neoplasms complications, Neoplasms drug therapy, Neutropenia chemically induced, Risk Factors, Young Adult, Ambulatory Care methods, Anti-Bacterial Agents administration & dosage, Antineoplastic Agents adverse effects, Fever drug therapy, Neutropenia drug therapy, Patient Discharge standards
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Purpose: Febrile neutropenia commonly complicates cancer chemotherapy. Outpatient treatment may reduce costs and improve patient comfort but risk progression of undetected medical problems., Patients and Methods: By using our validated algorithm, we identified medically stable inpatients admitted for febrile neutropenia (neutrophils < 500/μL) after chemotherapy and randomly assigned them to continued inpatient antibiotic therapy or early discharge to receive identical antibiotic treatment at home. Our primary outcome was the occurrence of any serious medical complication, defined as evidence of medical instability requiring urgent medical attention., Results: We enrolled 117 patients with 121 febrile neutropenia episodes before study termination for poor accrual. We excluded five episodes as ineligible and three because of inadequate documentation of the study outcome. Treatment groups were clinically similar, but sociodemographic imbalances occurred because of block randomization. The median presenting absolute neutrophil count was 100/μL. Hematopoietic growth factors were used in 38% of episodes. The median neutropenia duration was 4 days (range, 1 to 15 days). Five outpatients were readmitted to the hospital. Major medical complications occurred in five episodes (8%) in the hospital arm and four (9%) in the home arm (95% CI for the difference, -10% to 13%; P = .56). No study patient died. Patient-reported quality of life was similar on both arms., Conclusion: We found no evidence of adverse medical consequences from home care, despite a protocol designed to detect evidence of clinical deterioration. These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with febrile neutropenia in suitable outpatient settings with appropriate surveillance for unexpected clinical deterioration.
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- 2011
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27. Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial.
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Hendricks AM, Loggers ET, and Talcott JA
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- Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents economics, Female, Fever blood, Humans, Male, Middle Aged, Neoplasms blood, Neoplasms complications, Neutropenia blood, Socioeconomic Factors, United States, Fever drug therapy, Fever economics, Home Care Services economics, Hospitalization economics, Neutropenia drug therapy, Neutropenia economics
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Purpose: For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation., Methods: We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008., Results: Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work., Conclusion: Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.
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- 2011
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28. Patient-reported acute gastrointestinal symptoms during concurrent chemoradiation treatment for rectal cancer.
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Chen RC, Mamon HJ, Chen YH, Gelman RS, Suh WW, Talcott JA, Clark JW, and Hong TS
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- Adolescent, Adult, Aged, Aged, 80 and over, Diarrhea etiology, Feasibility Studies, Female, Fluorouracil administration & dosage, Gastrointestinal Hemorrhage etiology, Humans, Male, Middle Aged, Combined Modality Therapy adverse effects, Fluorouracil adverse effects, Gastrointestinal Diseases etiology, Outcome Assessment, Health Care, Patient Participation, Rectal Neoplasms drug therapy, Rectal Neoplasms radiotherapy
- Abstract
Background: Although it is known that standard 5-fluorouracil-based chemoradiation therapy for rectal cancer causes significant acute gastrointestinal (GI) toxicity, research on patient-reported outcomes (PROs) is limited. The authors undertook the current study to assess the feasibility of incorporating PRO measurement into routine clinical practice and to describe the trajectory of symptom development during treatment., Methods: Seventy-seven consecutive patients who were treated between 2006 and 2008 were eligible. Patients completed the 7-item Bowel Problems Scale immediately before weekly physician visits., Results: The questionnaire completion rate was 95%. Individual GI symptoms had different trajectories of development. By Week 5, approximately 40% of all patients developed clinically meaningful pain, bowel urgency, or tenesmus that was not present during Week 1; 30% developed diarrhea, abdominal cramping, and passing mucus. However, overall symptom burden was moderate. Seventy-five percent of patients who presented with rectal bleeding at Week 1 improved by Week 3 of treatment. Within each physician-assessed grade of diarrhea, patient experience varied widely. For example, of the 50 patients who developed grade 2 diarrhea on the Radiation Therapy Oncology Group Acute Morbidity Scale, the numbers of patients reporting only occasional symptoms versus those reporting frequent or very frequent symptoms were similar., Conclusions: PROs provided information on patient symptoms during chemoradiation treatment for rectal cancer that was not captured otherwise, and it was feasible to incorporate PROs into routine clinical practice. The current results may be used by physicians to counsel their patients before treatment initiation and to provide a benchmark against which trials that use new therapies may be compared., ((c) 2010 American Cancer Society.)
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- 2010
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29. Patient-reported long-term outcomes after conventional and high-dose combined proton and photon radiation for early prostate cancer.
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Talcott JA, Rossi C, Shipley WU, Clark JA, Slater JD, Niemierko A, and Zietman AL
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- Aged, Aged, 80 and over, Cross-Sectional Studies, Data Collection, Dose-Response Relationship, Radiation, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Proton Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Prostatic Neoplasms radiotherapy, Radiation Injuries epidemiology
- Abstract
Context: Increased radiation doses improve prostate cancer control but also increase toxicity to adjacent normal tissue. Proton radiation may attenuate adverse effects., Objective: To determine long-term, patient-reported, dose-related toxicity., Design, Setting, and Patients: We performed a post hoc cross-sectional survey of surviving participants in the Proton Radiation Oncology Group (PROG) 9509--a randomized trial comparing 70.2 Gy vs 79.2 Gy of combined photon and proton radiation for 393 men with clinically localized prostate cancer (stage T1b-T2b, prostate-specific antigen <15 ng/mL, and no radiographic evidence of metastasis). The estimated 10-year biochemical progression rate for patients receiving standard dose was 32% (95% confidence interval, 26%-39%) compared with 17% (95% confidence interval, 11%-23%) for patients receiving high dose (P < .001). We surveyed 280 of the surviving 337 patients (83%) from April 2007 to September 2008., Main Outcome Measures: Prostate Cancer Symptom Indices, a validated measure of urinary incontinence, urinary obstruction and irritation, bowel problems, and sexual dysfunction, and related quality-of-life instruments., Results: At a median of 9.4 years after treatment (range, 7.4-12.1 years), participants' demographic and clinical characteristics were similar. Patient-reported outcomes were reported as mean (SD) scale score for standard dose vs high dose: urinary obstruction/irritation (23.3 [13.7] vs 24.6 [14.0]; P = .36), urinary incontinence (10.6 [17.7] vs 9.7 [15.8]; P = .99), bowel problems (7.7 [7.8] vs 7.9 [9.1]; P = .70), sexual dysfunction (68.2 [34.6] vs 65.9 [34.7]; P = .65), and most other outcomes were also similar, although patients receiving standard dose whose cancers had more often progressed expressed less confidence that their cancers were under control (mean [SD] scale score for standard dose, 76.0 [25.4] vs high dose, 86.2 [17.9]; P < .001). Many patients characterized their urinary and bowel function as normal despite reporting symptoms that, for other prostate cancer patients before and early after cancer treatment, caused substantial distress., Conclusion: Among men with clinically localized prostate cancer, treatment with higher-dose radiation compared with standard dose was not associated with an increase in patient-reported prostate cancer symptoms after a median of 9.4 years.
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- 2010
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30. Race, healthcare access and physician trust among prostate cancer patients.
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Do YK, Carpenter WR, Spain P, Clark JA, Hamilton RJ, Galanko JA, Jackman A, Talcott JA, and Godley PA
- Subjects
- Black or African American psychology, Aged, Early Detection of Cancer statistics & numerical data, Health Status Disparities, Humans, Interviews as Topic, Male, Middle Aged, Prostatic Neoplasms ethnology, Psychometrics, Socioeconomic Factors, White People psychology, Health Services Accessibility statistics & numerical data, Physician-Patient Relations, Prostatic Neoplasms psychology, Trust
- Abstract
Objective: To study the effect of healthcare access and other characteristics on physician trust among black and white prostate cancer patients., Methods: A three-timepoint follow-up telephone survey after cancer diagnosis was conducted. This study analyzed data on 474 patients and their 1,320 interviews over three time periods., Results: Among other subpopulations, black patients who delayed seeking care had physician trust levels that were far lower than that of both Caucasians as well as that of the black patients overall. Black patients had greater variability in their levels of physician trust compared to their white counterparts., Conclusions: Both race and access are important in explaining overall lower levels and greater variability in physician trust among black prostate cancer patients. Access barriers among black patients may spill over to the clinical encounter in the form of less physician trust, potentially contributing to racial disparities in treatment received and subsequent outcomes. Policy efforts to address the racial disparities in prostate cancer should prioritize improving healthcare access among minority groups.
- Published
- 2010
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31. Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use.
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Carpenter WR, Godley PA, Clark JA, Talcott JA, Finnegan T, Mishel M, Bensen J, Rayford W, Su LJ, Fontham ET, and Mohler JL
- Subjects
- Black or African American, Aged, Health Services Accessibility, Health Status Disparities, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prostatic Neoplasms ethnology, Psychometrics, White People, Early Detection of Cancer statistics & numerical data, Physician-Patient Relations, Prostatic Neoplasms psychology, Prostatic Neoplasms therapy, Trust
- Abstract
Background: : Nonmedical factors may modify the biological risk of prostate cancer (PCa) and contribute to the differential use of early detection; curative care; and, ultimately, greater racial disparities in PCa mortality. In this study, the authors examined patients' usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in PCa screening., Methods: : Study nurses conducted in-home interviews of 1031 African-American men and Caucasian-American men aged > or =50 years in North Carolina and Louisiana within weeks of their PCa diagnosis. Medical records were abstracted, and the data were used to conduct bivariate and multivariate analyses., Results: : Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically using any PCa screening. Seeing the same physician for regular care was associated with greater trust and screening use. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior PCa screening than other men. In multivariate regression analysis, seeing the same provider remained associated with prior screening use, whereas both race and trust lost their association with prior screening., Conclusions: : The current results indicated that systems factors, including those that differ among different sources of care and those associated with the continuity of care, may provide tangible targets to address disparities in the use of PCa early detection, may attenuate racial differences in PCa screening use, and may contribute to reduced racial disparities in PCa mortality. Cancer 2009. Published 2009 by the American Cancer Society.
- Published
- 2009
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32. Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function.
- Author
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Chen RC, Clark JA, and Talcott JA
- Subjects
- Aged, Aged, 80 and over, Humans, Male, Middle Aged, Prostatic Neoplasms physiopathology, Prostatic Neoplasms therapy, Defecation, Prostatic Neoplasms psychology, Quality of Life, Sexual Behavior, Urination
- Abstract
Purpose: Although it is the most powerful predictor of early prostate cancer treatment-related complications and quality-of-life (QOL) outcomes, most studies do not stratify results by baseline function. Further, reporting functional outcomes as averaged numerical results may obscure informatively disparate courses. Using levels of treatment-related dysfunction, we address these problems and present the final QOL outcomes of our prospective cohort study of patients with early prostate cancer., Methods: We created categories for sexual, bowel, and urinary function, measured using numerical scores of the validated Prostate Cancer Symptom Indices and stratified into "normal," "intermediate" and "poor" levels of function by incorporating patient-reported symptom and distress information. We present QOL outcomes for 409 patients 36 months after radical prostatectomy, external-beam radiation therapy, and brachytherapy., Results: Different levels of baseline sexual, bowel, and urinary function produced distinctive treatment-related changes from baseline to 36 months. In general, the average scale increases in dysfunction were greatest among patients with normal baseline function, although patients with normal and intermediate baseline function had similar increases in sexual dysfunction. For patients whose baseline urinary obstruction/irritation was poor, both average scale scores and most patients' level of function improved after treatment, particularly after surgery., Conclusion: The use of functional levels to stratify treatment-related outcomes by pretreatment functional status and to display the proportions of patients with improved, stable, or worsened function after treatment provides information that more specifically conveys the expected impact of treatment to patients choosing among localized prostate cancer treatments.
- Published
- 2009
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33. Perceived family history risk and symptomatic diagnosis of prostate cancer: the North Carolina Prostate Cancer Outcomes study.
- Author
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Spain P, Carpenter WR, Talcott JA, Clark JA, Do YK, Hamilton RJ, Galanko JA, Jackman A, and Godley PA
- Subjects
- Adult, Black or African American, Aged, Genetic Predisposition to Disease, Health Services Accessibility, Humans, Male, Mass Screening statistics & numerical data, Middle Aged, Perception, Physician-Patient Relations, Risk, Socioeconomic Factors, White People, Health Knowledge, Attitudes, Practice, Prostatic Neoplasms diagnosis, Prostatic Neoplasms ethnology, Prostatic Neoplasms psychology
- Abstract
Background: Prostate cancer (PrCA) is the most common cancer and the second leading cause of cancer death among US men. African American (AA) men remain at significantly greater risk of PrCA diagnosis and mortality than other men. Many factors contribute to the experienced disparities., Methods: Guided by the Health Belief Model, the authors surveyed a population of AA and Caucasian men newly diagnosed with PrCA to describe racial differences in perceived risk of PrCA and to examine whether 1) perceived high risk predicts greater personal responsibility for prostate care; and 2) greater personal responsibility for prostate care predicts earlier, presymptomatic diagnosis. Multivariate general linear modeling was performed., Results: The authors found that men with a PrCA family history appreciated their increased risk, but AA men with a family history were less likely to appreciate their increased risk. Nevertheless, neither reporting a PrCA family history nor perceived increased risk significantly predicted screening and preventive behaviors. Furthermore, higher physician trust predicted increased likelihood to have regular prostate exams and screening, indicating that the racial differences in seeking prostate care may be mediated through physician trust. Expressed personal responsibility for screening and more frequent preventive behaviors were associated with more frequent screening diagnoses, fewer symptomatic diagnoses, and less frequent advanced cancers., Conclusions: Together, these results indicate that appreciating greater risk for PrCA is not sufficient to ensure that men will intend, or be able, to act. Increased trust in physicians may be a useful, central marker that efforts to reduce disparities in access to medical care are succeeding., ((c) 2008 American Cancer Society.)
- Published
- 2008
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34. Treatment 'mismatch' in early prostate cancer: do treatment choices take patient quality of life into account?
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Chen RC, Clark JA, Manola J, and Talcott JA
- Subjects
- Aged, Choice Behavior, Contraindications, Humans, Male, Middle Aged, Prostatic Neoplasms psychology, Rectal Diseases complications, Sexual Dysfunction, Physiological complications, Treatment Outcome, Urination Disorders complications, Brachytherapy, Prostatectomy, Prostatic Neoplasms radiotherapy, Prostatic Neoplasms surgery, Quality of Life
- Abstract
Background: Pretreatment urinary, bowel, and sexual dysfunction may increase the toxicity of prostate cancer treatments or preclude potential benefits. Using patient-reported baseline dysfunction from a prospective cohort study, we determined the proportion of patients receiving relatively contraindicated ('mismatched') treatments., Methods: Baseline obstructive uropathy and bowel dysfunction relatively contraindicate brachytherapy (BT) and external beam radiation therapy (EBRT), respectively, because they increase patients' vulnerability to treatment-related toxicity. Baseline sexual dysfunction renders moot the intended benefit of nerve-sparing radical prostatectomy (NSRP), which is to preserve sexual function. We categorized patients' clinical circumstances by increasing complexity and counted the mismatches in each, expecting weaker or multiple contraindications to increase mismatched treatments., Results: Of 438 eligible patients, 389 (89%) reported preexisting dysfunction, and more than one-third received mismatched treatments. Mismatches did not significantly increase with clinical complexity, and watchful waiting was very infrequent, even when all treatment options were contraindicated. Patient age and comorbidity, but not preexisting dysfunction, were associated with treatment choice. As expected, mismatched BT and EBRT led to worsened urinary and bowel symptoms, respectively, and NSRP did not improve outcomes after baseline sexual dysfunction., Conclusions: Pretreatment dysfunction does not appear to reliably influence treatment choices, and patients receiving mismatched treatments had worse outcomes. Further study is needed to determine why mismatched treatments were chosen, including the role of incomplete patient-physician communication of baseline dysfunction, and whether using a validated questionnaire before treatment decision-making would bypass this difficulty. Treatment mismatch may be a useful outcome indicator of the quality of patient-centered decisions., (2007 American Cancer Society)
- Published
- 2008
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35. Androgen deprivation-mediated cytoreduction before interstitial brachytherapy for prostate cancer does not abrogate the elevated risk of urinary morbidity associated with larger initial prostate volume.
- Author
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Petit JH, Gluck C, Kiger WS 3rd, Laury Henry D, Karasiewicz C, Talcott JA, Berg S, Holupka EJ, and Kaplan ID
- Subjects
- Aged, Humans, Male, Neoadjuvant Therapy, Prostatic Neoplasms pathology, Risk, Urinary Catheterization, Androgen Antagonists therapeutic use, Brachytherapy adverse effects, Brachytherapy methods, Dysuria etiology, Prostate pathology, Prostatic Neoplasms drug therapy, Prostatic Neoplasms radiotherapy
- Abstract
Purpose: We examined whether prostate volume reduction after a short course of androgen deprivation (AD) lowered the risks of acute and chronic urinary morbidity related to radioactive seed implantation for low-risk prostate cancer., Methods and Materials: Eighty-one patients received AD for cytoreduction before interstitial brachytherapy alone. Urinary morbidity was carefully assessed for all patients during a median followup of 53 (range, 23-78) months after treatment. Outcomes were then compared with those of a control group of 81 patients who were matched 1:1 based on identical prostate volume measured at the time of radioactive seed implant, but who had not received AD., Results: Despite effective cytoreduction (median, 30% prostate volume reduction) with AD, prolonged catheterization was required significantly more often for patients who had received AD when compared with the control group of patients who were implanted at identical prostate volumes but who had not received AD (27% vs. 9%, p = 0.02). This finding remained statistically significant on multivariate analysis (p = 0.04). Surgical intervention (9% vs. 4%, p = 0.09) and subsequent urinary incontinence (4% vs. 1%, p = 0.16) were also more frequent among patients who had received AD when compared with implant volume-matched controls., Conclusions: Patients who achieved smaller prostate volumes through the use of AD maintained a significantly elevated risk (threefold) for urinary complications, commensurate with their initially large prostate volume, when compared with a control group of patients who were implanted at identical prostate volumes but who had not received AD. Therefore, patients presenting with larger prostate glands that would warrant a short course of AD before implant should be counseled accordingly when discussing options for local therapy.
- Published
- 2007
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36. Hidden barriers between knowledge and behavior: the North Carolina prostate cancer screening and treatment experience.
- Author
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Talcott JA, Spain P, Clark JA, Carpenter WR, Do YK, Hamilton RJ, Galanko JA, Jackman A, and Godley PA
- Subjects
- Adult, Black or African American, Aged, Communication Barriers, Humans, Male, Middle Aged, North Carolina, Prostatic Neoplasms epidemiology, Registries, Socioeconomic Factors, White People, Attitude to Health ethnology, Health Knowledge, Attitudes, Practice, Health Services Accessibility statistics & numerical data, Mass Screening statistics & numerical data, Prostatic Neoplasms prevention & control
- Abstract
Background: Prostate cancer (PC) mortality is much greater for African American than for Caucasian men. To identify patient factors that might account for some of this disparity, men within 6 months of diagnosis were surveyed about health attitudes and behavior., Methods: Using Rapid Identification in the North Carolina Cancer Registry, 207 African American and 348 Caucasian recently diagnosed PC patients were identified and surveyed., Results: African American men were younger and less often currently married, and had lesser education, job status, and income than Caucasian men (all P < .001). African American men were at no greater distance to medical care, but had less access: poorer medical insurance coverage, more use of public clinics and emergency wards, less continuity with a primary physician, and more often omitted physician visits they felt they needed. They also expressed less trust in physicians. African American men acknowledged their greater risk of PC, accepted greater responsibility for their health, and reported more personal failures that delayed diagnosis. African American men more often requested the tests that diagnosed their cancers, which resulted more often from routinely ordered screening tests for Caucasian men. African American men expressed less interest in nontraditional treatments., Conclusions: Despite lesser education, African American men in North Carolina are aware of their increased risk of cancer, the importance of treatment, and their responsibility for their health. Obstacles to timely diagnosis and appropriate care, including greater physician distrust, appear more likely to arise from reduced access and continuity of medical care arising from their worse socioeconomic position.
- Published
- 2007
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37. Bringing prostate cancer quality of life research back to the bedside: translating numbers into a format that patients can understand.
- Author
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Talcott JA, Clark JA, Manola J, and Mitchell SP
- Subjects
- Aged, Erectile Dysfunction etiology, Humans, Intestinal Diseases etiology, Male, Middle Aged, Postoperative Complications, Radiotherapy adverse effects, Stress, Psychological etiology, Treatment Outcome, Urinary Incontinence etiology, Erectile Dysfunction psychology, Health Status Indicators, Intestinal Diseases psychology, Prostatic Neoplasms therapy, Quality of Life psychology, Urinary Incontinence psychology
- Abstract
Purpose: Although measuring quality of life of patients with prostate cancer serves important research goals, its primary clinical purpose is informing patients. Sophisticated quality of life measures produce purely numerical results that patients have difficulty understanding. We present an approach that preserves the methodological strengths of validated multi-item measures but provides more accessible information for clinical use., Materials and Methods: Using validated indexes measuring urinary, bowel and sexual function we surveyed patients with clinically localized prostate cancer before treatment and at intervals thereafter. Based on patient responses to parallel distress measures we defined 3 levels of function, including normal-no abnormal symptom, intermediate-any abnormal symptom but none severely abnormal and poor-any severely abnormal symptom. We then translated patient survey results into these levels. To assess measurement properties we compared average symptom distress scores in patients at each symptom level., Results: Levels of function and patient distress scores correlated strongly. Large and approximately equal differences in distress scores separated patients at successive levels in all symptom indexes (effect size greater than 1.2, p < 0.0001). Using these categories we created tables showing 24-month outcomes in 417 previously reported patients by pretreatment symptom level and treatment, providing a tool for patients to determine posttreatment outcomes in similar patients., Conclusions: Using symptom indexes to define levels of function produces a quality of life metric that is valid, defines quantitative intervals, is transparent and may be more useful to patients. This approach provides methodologically sound outcome information to patients attempting to choose a prostate cancer treatment.
- Published
- 2006
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38. Confidence and uncertainty long after initial treatment for early prostate cancer: survivors' views of cancer control and the treatment decisions they made.
- Author
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Clark JA and Talcott JA
- Subjects
- Aged, Aged, 80 and over, Biomarkers, Tumor blood, Choice Behavior, Erectile Dysfunction, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Neoplasm Staging, Prospective Studies, Prostate-Specific Antigen blood, Prostatic Neoplasms immunology, Prostatic Neoplasms pathology, Quality of Life, Risk Factors, Surveys and Questionnaires, Uncertainty, Decision Making, Prostatic Neoplasms therapy
- Abstract
Purpose: The many years most men diagnosed with early prostate cancer live after diagnosis allow evolving assessments of their cancer control and their treatment choices, but little is known of these outcomes or the factors that influence them., Patients and Methods: We surveyed an established, prospective cohort that had initiated treatment for early prostate cancer 4 to 8 years previously. We assessed perceived cancer control, quality of treatment decisions, and other domains of quality of life, along with treatment-related urinary, bowel, and sexual dysfunction., Results: Most men reported high confidence in cancer control and their treatment decisions, but many reported misgivings about one or both. The diagnostic, treatment, and quality-of-life factors associated with these two outcomes were distinct. Perceived cancer control was lower among those with adverse medical factors: higher pretreatment Gleason scores, subsequent rises in prostate-specific antigen (PSA), and secondary androgen ablation therapy. Confidence in treatment decisions was unrelated to these factors and was higher in men who opted for radical prostatectomy or brachytherapy, reported close attention to current PSA, had high masculine self-esteem and little distress from sexual dysfunction, and were married., Conclusion: Although perceptions of cancer control and the quality of their treatment decisions are linked, men can distinguish between these two outcomes. They incorporate objective indicators of high risk and adverse outcomes when assessing their cancer control; confidence in treatment decisions represents a more complex psychosocial adjustment to the persistent uncertainty that originates with their diagnosis.
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- 2006
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39. Racial differences in clinical progression among Medicare recipients after treatment for localized prostate cancer (United States).
- Author
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Cohen JH, Schoenbach VJ, Kaufman JS, Talcott JA, Schenck AP, Peacock S, Symons M, Amamoo MA, Carpenter WR, and Godley PA
- Subjects
- Black or African American statistics & numerical data, Aged, Aged, 80 and over, Asian People statistics & numerical data, Disease-Free Survival, Hispanic or Latino statistics & numerical data, Humans, Male, Medicare, Proportional Hazards Models, Prostatic Neoplasms mortality, Prostatic Neoplasms therapy, SEER Program, Survival Rate, Treatment Outcome, United States epidemiology, White People statistics & numerical data, Prostatic Neoplasms ethnology
- Abstract
Objective: Prostate cancer recurrence impacts patient quality of life and risk of prostate-cancer specific death following definitive treatment. We investigate differences in disease-free survival among white, black, Hispanic, and Asian patients in a large, population-based database., Methods: Merged Surveillance, Epidemiology, and End Results Program (SEER) and Medicare files provided data on 23,353 white patients, 2,814 black patients, 480 Hispanic patients, and 566 Asian patients diagnosed at age 65-84 years with clinically localized prostate cancer between 1986 and 1996 in five SEER sites. Patients were followed through 1998. Racial differences in disease-free survival were assessed using Kaplan-Meier survival curves and Cox regression models., Results: The 75th percentile disease-free survival time for black patients was 13 months less than that for white patients (95% confidence interval [CI]: 6.2-19.8 months), 29.7 months less than that for Hispanic patients (95% CI: 4.4-55.0 months), and 39.1 months less than that for Asian patients (95% CI: 12.1-66.1 months). In multivariate analysis, black race predicted shorter disease-free survival among surgery patients, but not among radiation patients., Conclusions: Black patients experienced shorter disease-free survival compared to white, Hispanic, and Asian patients, and the disease-free survival of white, Hispanic, and Asian patients were not statistically different. Earlier recurrence of prostate cancer may help explain black patients' increased risk of mortality from prostate cancer.
- Published
- 2006
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40. Are prostate cancer outcomes affected by a delay between diagnosis and radical prostatectomy?
- Author
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Talcott JA
- Published
- 2006
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41. Rebalancing ratios and improving impressions: later thoughts from the prostate cancer prevention trial investigators.
- Author
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Talcott JA
- Subjects
- Humans, Male, Treatment Outcome, Adenocarcinoma prevention & control, Enzyme Inhibitors therapeutic use, Finasteride therapeutic use, Prostatic Neoplasms prevention & control
- Published
- 2005
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42. How could getting screened for prostate cancer hurt you?
- Author
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Talcott JA
- Subjects
- Humans, Male, Prostatic Neoplasms psychology, Prostatic Neoplasms therapy, Prostatic Neoplasms diagnosis
- Published
- 2005
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43. Employment after therapy for localized prostate cancer: widening the perspective.
- Author
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Talcott JA
- Subjects
- Humans, Male, Prostatic Neoplasms diagnosis, Prostatic Neoplasms pathology, Unemployment, Employment, Prostatic Neoplasms therapy
- Published
- 2005
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44. Suspected spinal cord compression in cancer patients: a multidisciplinary risk assessment.
- Author
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Lu C, Gonzalez RG, Jolesz FA, Wen PY, and Talcott JA
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Multivariate Analysis, Neurologic Examination, Observer Variation, Retrospective Studies, Risk Assessment, Spinal Cord pathology, Magnetic Resonance Imaging, Neoplasms complications, Spinal Cord Compression etiology, Spinal Cord Compression pathology
- Abstract
Investigators involved in this study sought to identify independent clinical predictors of spinal cord compression (SCC) in cancer patients by analyzing a comprehensive set of potential risk factors based on the results of spine magnetic resonance imaging (MRI). In all, the investigators analyzed 136 episodes of suspected SCC among 134 cancer patients evaluated with spine MRI. Each subject was interviewed within 7 days of the spine MRI to collect accurate self-reported symptom data. Neurologic examination data were detailed by the physician examining the subject prior to the spine MRI; uniform demographic and clinical information regarding the subject's cancer history was abstracted from the medical record. Multivariable logistic regression analysis was used to identify independent predictors of SCC. Clinically significant SCC was defined as thecal sac compression (TSC), which occurred in 50 episodes (37%). Four independent predictors of TSC were identified and included information from the neurologic examination (abnormal neurologic examination), subject-reported symptoms (middle or upper back pain), and the oncologic history (known vertebral metastases and metastatic disease at initial diagnosis). These four predictors stratified patients experiencing episodes into subgroups with varying risks of TSC, ranging from 8% (no risk factors) to 81% (three or four risk factors). These results confirmed earlier retrospective studies indicating that the evaluation of cancer patients with suspected SCC should be based upon clinical information that includes cancer-related history, symptom data,and the presence of pertinent neurologic signs. These predictors may help clinicians to assess risk in this patient population.
- Published
- 2005
45. Patient-reported acute gastrointestinal toxicity in men receiving 3-dimensional conformal radiation therapy for prostate cancer with or without neoadjuvant androgen suppression therapy.
- Author
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Tsai HK, Manola J, Abner A, Talcott JA, D'Amico AV, and Beard C
- Subjects
- Aged, Aged, 80 and over, Combined Modality Therapy, Diarrhea etiology, Dose-Response Relationship, Drug, Drug Administration Schedule, Gastrointestinal Hemorrhage etiology, Humans, Male, Middle Aged, Neoadjuvant Therapy, Pain etiology, Quality of Life, Androgen Antagonists adverse effects, Androgen Antagonists therapeutic use, Prostatic Neoplasms drug therapy, Prostatic Neoplasms radiotherapy, Radiation Injuries etiology, Radiation Injuries prevention & control, Radiotherapy, Conformal adverse effects
- Abstract
Objective: To investigate the impact of 2 months of neoadjuvant and 2 months of concurrent hormonal therapy on the acute gastrointestinal (GI) toxicities associated with 3-dimensional conformal radiation therapy (3D-CRT) for prostate adenocarcinoma., Methods: The study cohort consisted of 80 men who underwent 3D-CRT with (n=40) or without (n=40) neoadjuvant and concurrent hormonal therapy. Computerized tomography-based planning occurred after neoadjuvant hormonal therapy. All patients completed a previously validated, quality-of-life self-assessment tool on 7 GI symptoms, including diarrhea, urgency, pain, rectal bleeding, cramping, mucus, and tenesmus, at baseline and weekly during radiation therapy., Results: Patients who received hormonal therapy were more likely to have T2b, T2c, T3a, or T3b (P<0.001) or Gleason score 7, 8, or 9 (P=0.02) disease compared to those that did not. The dose delivered to the planning target volume was 70 Gy for both groups. Median radiation treatment volume was numerically smaller for the hormone group but not to a statistically significant degree (949 vs. 1043 cc, P=0.30). Patients who received hormonal therapy had less rectal pain (P<0.01) and tenesmus (P=0.02) but more rectal mucus (P=0.03) compared to those who did not., Conclusions: Prostate gland volume reduction after androgen suppression therapy may reduce patient-reported acute GI toxicities associated with 3D-CRT for prostate cancer.
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- 2005
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46. Data pooling and analysis to build a preliminary item bank: an example using bowel function in prostate cancer.
- Author
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Eton DT, Lai JS, Cella D, Reeve BB, Talcott JA, Clark JA, McPherson CP, Litwin MS, and Moinpour CM
- Subjects
- Adult, Aged, Data Collection methods, Humans, Male, Middle Aged, Psychometrics, Statistics, Nonparametric, Intestine, Large physiopathology, Prostatic Neoplasms physiopathology, Quality of Life, Surveys and Questionnaires
- Abstract
Assessing bowel function (BF) in prostate cancer can help determine therapeutic trade-offs. We determined the components of BF commonly assessed in prostate cancer studies as an initial step in creating an item bank for clinical and research application. We analyzed six archived data sets representing 4,246 men with prostate cancer. Thirty-one items from validated instruments were available for analysis. Items were classified into domains (diarrhea, rectal urgency, pain, bleeding, bother/distress, and other) then subjected to conventional psychometric and item response theory (IRT) analyses. Items fit the IRT model if the ratio between observed and expected item variance was between 0.60 and 1.40. Four of 31 items had inadequate fit in at least one analysis. Poorly fitting items included bleeding (2), rectal urgency (1), and bother/distress (1). A fifth item assessing hemorrhoids was poorly correlated with other items. Our analyses supported four related components of BF: diarrhea, rectal urgency, pain, and bother/distress.
- Published
- 2005
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47. Quality of life in prostate cancer.
- Author
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Talcott JA and Clark JA
- Subjects
- Forecasting, Health Status, Health Status Indicators, Humans, Male, Prostatic Neoplasms therapy, Surveys and Questionnaires, Prostatic Neoplasms psychology, Quality of Life
- Abstract
Little more than a decade ago, measurements of health-related quality of life (HRQOL) of prostate cancer patients began to enter the medical literature. Initially controversial and of little apparent relevance to clinical care, HRQOL has grown in importance in prostate cancer to the point that providing it in treatment discussions is now considered a core element of clinical care. The United States (US) Food and Drug Administration has used it to make approval decisions for prostate cancer drugs, and Europeans have endorsed its central role in prostate cancer as well [Altwein J, Ekman P, Barry M, et al. How is quality of life in prostate cancer patients influenced by modern treatment? The Wallenberg symposium. Urology 1997, 49(Suppl 4A), 66-76.]. We propose to characterise the treatment dilemmas facing patients with prostate cancer, the clinical relevance of HRQOL research, its central conceptual elements, the characteristics of some available instruments to measure it, the use of HRQOL in clinical studies, and some of the remaining challenges we have identified during our 13 years in the field.
- Published
- 2005
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48. American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer.
- Author
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Loblaw DA, Mendelson DS, Talcott JA, Virgo KS, Somerfield MR, Ben-Josef E, Middleton R, Porterfield H, Sharp SA, Smith TJ, Taplin ME, Vogelzang NJ, Wade JL Jr, Bennett CL, and Scher HI
- Subjects
- Combined Modality Therapy, Disease Progression, Humans, Male, Neoplasm Metastasis, Prostatic Neoplasms pathology, Prostatic Neoplasms physiopathology, Receptors, Androgen, Antineoplastic Agents, Hormonal therapeutic use, Neoplasm Recurrence, Local drug therapy, Palliative Care, Prostatic Neoplasms drug therapy
- Abstract
Purpose: To develop a clinical practice guideline for the management of men with metastatic, recurrent, or progressive carcinoma of the prostate. The focus of this document is on the use, combinations, and timing of various forms of androgen deprivation therapy (ADT) for the palliation of men with androgen-sensitive disease., Methods: An expert panel and writing committee were formed. The questions to be addressed by the guideline were determined, and a systematic review of the literature was performed, which included a search of online databases, bibliographic review, and consultation with content experts. A priori criteria were used to select studies for analysis and study authors were contacted when necessary., Results: There were 10 randomized controlled trials, six systematic reviews, and one Markov model available to inform the guidelines., Conclusion: A full discussion between practitioner and patient should occur to determine which therapy is best for the patient. Bilateral orchiectomy or luteinizing hormone releasing hormone agonists are the recommended initial treatments. Nonsteroidal antiandrogen therapy may be discussed as an alternative, but steroidal antiandrogens should not be offered as monotherapy. Patients willing to accept the increased toxicity of combined androgen blockage for a small benefit in survival should be offered nonsteroidal antiandrogen in addition to castrate therapy. Until data from studies using modern medical diagnostic/biochemical tests and standardized follow-up schedules become available, no specific recommendations can be issued regarding the question of early versus deferred ADT. A discussion about the pros and cons of early versus deferred ADT should occur.
- Published
- 2004
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49. Prostate cancer (metastatic).
- Author
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Michaelson MD, Smith MR, and Talcott JA
- Subjects
- Androgen Antagonists therapeutic use, Androgens, Humans, Male, Neoplasm Metastasis, Neoplasms, Hormone-Dependent drug therapy, Neoplasms, Hormone-Dependent radiotherapy, Prostatic Neoplasms diagnostic imaging, Prostatic Neoplasms radiotherapy, Radionuclide Imaging, Prostatic Neoplasms drug therapy
- Published
- 2003
50. Time course and predictors of symptoms after primary prostate cancer therapy.
- Author
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Talcott JA, Manola J, Clark JA, Kaplan I, Beard CJ, Mitchell SP, Chen RC, O'Leary MP, Kantoff PW, and D'Amico AV
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Erectile Dysfunction epidemiology, Erectile Dysfunction etiology, Fecal Incontinence epidemiology, Fecal Incontinence etiology, Humans, Male, Massachusetts epidemiology, Middle Aged, Postoperative Complications etiology, Prospective Studies, Prostatic Neoplasms pathology, Prostatic Neoplasms psychology, Radiotherapy adverse effects, Surveys and Questionnaires, Time Factors, Urethral Obstruction epidemiology, Urethral Obstruction etiology, Urinary Bladder radiation effects, Urinary Incontinence epidemiology, Urinary Incontinence etiology, Postoperative Complications epidemiology, Prostatectomy adverse effects, Prostatic Neoplasms radiotherapy, Prostatic Neoplasms surgery, Quality of Life
- Abstract
Purpose: Understanding the distinctive patterns of treatment-related dysfunction after alternative initial treatments for early prostate cancer (PC) may improve patients' choice of treatment and later help them adjust to its consequences. We characterized the time course of treatment complications while adjusting for potentially confounding pretreatment factors hindering other observational studies., Patients and Methods: In a prospective cohort study of 417 men we assessed urinary, bowel, and sexual function from before primary treatment to 24 months after. To control for potential confounding, we measured sociodemographic and PC prognostic factors, medical comorbidity, and pretreatment function commonly affected by PC and its treatment., Results: Patients who underwent external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT) differed significantly in sociodemographic factors, cancer prognostic factors, and pretreatment symptom status, especially sexual function. Urinary incontinence increased sharply after RP, while bowel problems and urinary irritation/obstruction rose after EBRT and BT. Sexual dysfunction increased in all patients, particularly after radical prostatectomy, and nerve-sparing surgical technique had little apparent benefit. There was no change in urinary function and little change in overall bowel function after 12 months, but the time course of sexual dysfunction varied by treatment and, for bowel function, by symptom. Multiple regression modeling confirmed that treatment influences all 24-month outcomes, but residual confounding persisted., Conclusion: Pretreatment function and the primary treatment modality for early stage PC strongly predict the affected organ systems and time course of dysfunction. With this information, patients and their physicians may refine their choice of treatment and better anticipate its consequences.
- Published
- 2003
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