Biomedical subjects

Tracey L Krupski

Publications and source records attributed to Tracey L Krupski.

11 recordsLinked to original sources

PubMed2006

The effect of postprostatectomy external beam radiotherapy on quality of life: results from the Cancer of the Prostate Strategic Urologic Research Endeavor.

BACKGROUND: Postprostatectomy salvage radiotherapy may improve prostate-specific antigen (PSA) progression-free survival, but little is known about its effect on quality of life. METHODS: From the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) data base, 1289 patients who had undergone radical prostatectomy (RP) without neoadjuvant or adjuvant hormone therapy completed validated health-related quality of life (HRQOL) questionnaires. Of these, 69 patients also received salvage radiotherapy at a median of 14 months after RP. The University of California-Los Angeles Prostate Cancer Index and the 36-item short form SF-36 questionnaire were used to compare HRQOL 12 to 18 months after external beam radiotherapy or 26 to 32 months after RP alone. Those responses also were compared with HRQOL responses from 55 men with data prior to and 12 to 18 months after primary radiotherapy. Multivariate regression identified differences between treatment groups. RESULTS: Men who underwent salvage radiotherapy were younger (P = .03) and had lower incomes (P = .01) than men who underwent RP alone; they also were younger than men who underwent primary radiotherapy (P < .01). In addition, men who received salvage radiotherapy were more likely than men who underwent RP alone to have clinically high-risk prostate cancer (P < .01). Multivariate analyses revealed that men who received salvage radiotherapy experienced more marked decrements in sexual function (P = .01) and bowel function (P = .03) than men who underwent RP alone. Salvage radiotherapy led to less impairment of sexual function (P < .01) and less sexual bother (P = .04) than primary radiotherapy. CONCLUSIONS: Although salvage radiotherapy is associated with unclear survival benefits, it adversely affects sexual and bowel function. Until randomized clinical trials demonstrate disease-specific survival benefits for salvage radiotherapy, the HRQOL detriments of additional therapy must be weighed against improved PSA progression-free survival.

Aged↗

PubMed2006

Patterns of care for men with prostate cancer after failure of primary treatment.

BACKGROUND: This study sought to determine trends in patterns of care after failure of primary prostate cancer treatment and to determine whether nonclinical factors influenced the receipt of secondary treatment. METHODS: The authors identified individuals treated for nonmetastatic prostate cancer in the years 1991-1999 from the linked databases of Medicare and the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. The outcome of interest was receipt of secondary therapy. They performed Cox proportional hazard analyses to investigate the link between demographic and clinical characteristics and the likelihood of receiving secondary treatment after either surgery or radiation. RESULTS: Of 65,716 subjects who met our inclusion criteria, 10,200 (15%) received some form of secondary therapy. For men undergoing initial surgical or radiation therapy, tumor grade, year of diagnosis, and geographic region were associated with secondary therapy. No socioeconomic factors such as education, ethnicity, or income level were associated with secondary therapy. CONCLUSIONS: Patterns of care after primary prostate cancer therapy continue to vary regionally. Standardized clinical algorithms and utilization of prostate-specific antigen testing appear to have influenced secondary therapy rates.

Aged↗

PubMed2006

Spirituality influences health related quality of life in men with prostate cancer.

Spirituality is interdependent with the biological, psychological, and interpersonal aspects of life. Although spirituality has been studied in breast cancer survivors, little work has been done in men with prostate cancer. We sought to determine whether lower spirituality in men with early stage prostate cancer is associated with worse general health-related quality of life (HRQOL), disease-specific HRQOL, or psychosocial health. Two hundred and twenty-two subjects were drawn from a state-funded program providing free prostate cancer treatment to indigent men. Validated instruments captured spirituality, general and disease-specific HRQOL, anxiety, symptom distress, and emotional well-being. We found a consistent relationship between spirituality and the outcomes assessed. Low spirituality was associated with significantly worse physical and mental health, sexual function and more urinary bother after controlling for covariates. All of the psychosocial variables studied reflected worse adjustment in the men with low spirituality. Because the likelihood of prostate cancer survivorship is high, interventions targeting spirituality could impact the physical and psychosocial health of many men.

Aged↗

PubMed2006

Update on outcomes research databases in prostate cancer 2006.

PURPOSE OF REVIEW: The purpose of this review is to summarize single-institution prostate-cancer-outcomes databases (which are most commonly derived from large academic medical centers, Veterans Affairs medical centers, and military hospitals) to summarize the design and development of three well characterized outcomes databases that combine data from multiple sites (Carcinoma of the Prostate Strategic Urological Research Endeavor, Center for Prostate Disease Research, and the Shared Equal Access Regional Cancer Hospital database) and to use the examples of obesity and prostate-specific antigen changes over time to highlight the importance of these databases in prostate-cancer outcomes. RECENT FINDINGS: Multiple databases have demonstrated that obese men are at greater risk of biochemical progression following radical prostatectomy. In addition, objective data have shown that it is more difficult to operate on obese men leading to greater risk of positive surgical margins, which may contribute to poorer outcomes. Several databases have shown that a rapidly increasing prostate-specific antigen, measured either before diagnosis or after failed primary therapy, is associated with increased risk of prostate-cancer-specific mortality. SUMMARY: Outcomes databases are extremely useful tools. They have lead to dramatic improvements of our understanding of prostate cancer. The challenge is to use this information from past patients to help us better manage our current and future patients.

Databases, Factual↗

PubMed2005

Geographic and socioeconomic variation in the treatment of prostate cancer.

PURPOSE: Within a framework of quality assessment, primary treatment choice constitutes an indicator of quality of care. This study examines geographic and socioeconomic variation in the primary treatment of men with prostate cancer during the era of prostate-specific antigen testing. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results public use data files, we identified men with localized/regional prostate cancer who underwent surgery, radiation therapy, or watchful waiting. We used the year 2000 US Census information to ascribe education and income levels to these men based on their county of residence and ethnicity. RESULTS: Among the 96,769 men with localized/regional prostate cancer (during 1995 to 1999) who had sufficient information for analysis, we observed significant geographic variation nationwide in surgical, radiation, and watchful waiting treatment rates (P <.0015). Patterns noted 10 years ago, such as higher surgical rates in western regions, persisted. Ethnicity, income, and grade were all independently associated with primary treatment, or lack thereof. Blacks and low-income patients had the lowest rates of surgery and radiation. Grade was the best predictor of aggressive treatment. CONCLUSION: Nonclinical factors, such as ethnicity and income, were associated with the use of watchful waiting rather than surgery or radiation in men with early-stage prostate cancer. These findings have implications for quality of care.

Aged↗

PubMed2005

Quality of prostate carcinoma care in a statewide public assistance program.

BACKGROUND: The authors evaluated the feasibility of measuring quality of care in a statewide public assistance program for men with prostate carcinoma. METHODS: The sample consisted of 84 men who were followed for > or = 6 months after receiving primary treatment for early-stage prostate carcinoma (55 received radical prostatectomy and 29 received radiotherapy) through a free public program for low-income, uninsured men. Quality was assessed by chart review with 16 indicators previously developed and validated at the RAND Corporation, as well as by telephone and mail surveys that included the University of California at Los Angeles Prostate Cancer Index short form. RESULTS: Quality of care measurement was feasible for 13 (81%) indicators from electronic chart abstraction, administrative documents, and patient questionnaires. Communication between specialist and primary physician was better for men treated with radiotherapy than with surgery (84% vs. 45%, P = 0.004). Subjects treated in private institutions were more likely than those treated in public institutions to have > or = 2 follow-up visits with the treating physician or institution within 1 year of treatment (93% vs. 63%, P = 0.003) and to have documentation of communication with the primary care physician (90% vs. 40%, P << 0.0001). Disease-specific, health-related quality of life 6 months after treatment did not appear to differ between public and private facilities. CONCLUSIONS: The authors found the application of quality of care indicators to be feasible in a statewide public assistance program, but with some differences between public and private providers. These quality of care indicators identified target areas for improvement.

Adult↗

PubMed2005

Changes in quality of life among low-income men treated for prostate cancer.

OBJECTIVES: To investigate as the primary objective changes over time in general and disease-specific health-related quality of life (HRQOL) among low-income men treated for prostate cancer in a longitudinal prospective study. METHODS: Study participants were recruited from a state-funded program providing free prostate cancer treatment to impoverished men. We included men who completed telephone interviews and self-administered questionnaires at study enrollment and 6 months of follow-up. Covariates univariately associated with HRQOL change scores were included in multivariate linear regression models. All HRQOL models were controlled for age at enrollment, race, baseline HRQOL, and treatment effects at baseline and follow-up. RESULTS: Subjects with greater baseline Gleason scores experienced more negative changes in their physical health than did men with lower Gleason scores. Men with less than a high school education experienced greater improvement in their mental well-being than did men with more than a high school education. Those experiencing treatment effects at baseline displayed greater positive changes in their urinary function than did those without treatment effects at baseline. Finally, men experiencing treatment effects at follow-up were characterized by profound reductions in sexual function compared with those free of treatment effects at follow-up. CONCLUSIONS: This work provides new insights into HRQOL over time in a low-income, multiethnic group of patients with prostate cancer.

Humans↗

PubMed2005

Health-related quality-of-life in low-income, uninsured men with prostate cancer.

The objective was to describe health-related quality-of-life (HRQOL) in low-income men with prostate cancer. Subjects were drawn from a statewide public assistance prostate cancer program. Telephone and mail surveys included the RAND 12-item Health Survey and UCLA Prostate Cancer Index Short Form and were compared with normative age-matched men without cancer from the general population reported on in the literature. Of 286 eligible men, 233 (81%) agreed to participate and completed the necessary items. The sample consisted of 51% Hispanics, 23% non-Hispanic whites, and 17% African Americans. The low-income men had worse scores in every domain of prostate-specific and general HRQOL than had the age-matched general population controls. The degree of disparity indicated substantial clinical differences in almost every domain of physical and emotional functioning between the sample group and the control group. Linear regression modeling determined that among the low-income men, Hispanic race, and income level were predictive of worse physical functioning, whereas only comorbidities predicted mental health. Low-income patients with prostate cancer appear to have quality-of-life profiles that are meaningfully worse than age-matched men from the general population without cancer reported on in the literature.

Adaptation, Psychological↗

PubMed2005

Ethnic variation in health-related quality of life among low-income men with prostate cancer.

OBJECTIVE: To describe and compare health-related quality of life (HRQOL) among Hispanic, African-American, and Caucasian men with localized prostate cancer. DESIGN: Observational study of low-income, ethnically diverse men with non-metastatic prostate cancer. SETTING: Statewide public assistance program in California. PARTICIPANTS: 208 men (51 Caucasian, 115 Hispanic, and 42 African-American men) with non-metastatic disease. INTERVENTIONS: Radical retropubic prostatectomy, radiation therapy, and hormonal therapy. MAIN OUTCOME MEASURES: Validated instruments measured general and disease-specific HRQOL, anxiety and fear of recurrence, spirituality, symptom distress, and self-efficacy. RESULTS: Hispanic men with prostate cancer were less educated, more often in significant relationships, and had more variable incomes compared with men of other ethnic/racial backgrounds. In univariate analyses, Caucasian men reported better physical function but less spirituality, while Hispanic men reported worse sexual function. Multivariate analysis revealed that Hispanic men had significantly worse physical function, bowel function, and bowel bother. African-American men experienced greater anxiety over recurrence. African-American and Hispanic men were more spiritual than Caucasian men. CONCLUSIONS: Greater attention to demographic variations in HRQOL may allow physicians to improve outcomes across ethnicities in low-income men with prostate cancer by offering more specialized counseling and providing referral to social support systems.

Adaptation, Psychological↗

PubMed2004

Natural history of bone complications in men with prostate carcinoma initiating androgen deprivation therapy.

BACKGROUND: As evidence accumulates in favor of androgen deprivation therapy (ADT) in patients with recurrent or metastatic prostate carcinoma, concern has increased regarding bone loss associated with therapeutic hypogonadism. The current study described the natural history of bone complications in men with prostate carcinoma who have initiated ADT. METHODS: Using 1992-2001 claims data from a 5% national random sample of Medicare beneficiaries, the authors identified men with prostate carcinoma who initiated ADT between 1992 and 1994. They analyzed inpatient, outpatient, and physician claims for bone complications over 7 subsequent years. They stratified the quartile of patients who survived longest into 2 cohorts: those who had received ADT for longer than and those who had received ADT for shorter than the median of 697 days. They evaluated the cumulative proportions of patients in each cohort with claims for pathologic fractures, osteoporosis/osteopenia, and nonpathologic fractures. RESULTS: In the 1992-1994 sample, 4494 men with prostate carcinoma initiated ADT. Of these, 1126 survived > 2028 days (5.5 years). During the first 3 years of evaluation, the proportion of bone events was similar for men with shorter durations of ADT and men with longer durations of ADT. However, by 7 years, more men in the longer ADT cohort (45%) had sustained at least 1 pathologic or nonpathologic fracture compared with men in the shorter ADT cohort (40%). CONCLUSIONS: In the current study, men with prostate carcinoma were found to be at risk for adverse bone effects from both the disease and the treatment. These longitudinal data revealed that fractures are common in this patient population and appear to be linked to the duration of ADT.

Adenocarcinoma↗

PubMed2003

Variation in continence and potency by definition.

PURPOSE: The reporting of quality of life outcomes after prostate cancer treatment has improved with the use of validated instruments and third party data collection, and yet widely disparate continence and potency rates persist among providers. We assessed how well various definitions of these outcomes correspond with each other in the same patients. MATERIALS AND METHODS: A longitudinal cohort of 269 men undergoing radical prostatectomy for early stage prostate cancer completed quality of life questionnaires, including the University of California-Los Angeles Prostate Cancer Index. Six definitions of urinary continence and 6 definitions of potency represented by individual or aggregated items in the survey were analyzed. Using 2,506 questionnaires patients meeting the criteria for continence or potency by each definition were compared. RESULTS: Correspondence among continence definitions varied widely. Of the men who reported using no pads only 42% leaked urine not at all. Other definitions had higher rates of concordance with 98% of patients who reported total control also claiming no pads. Correspondence among potency definitions was even more disparate. Only 5% of men with erections firm enough for intercourse reported having morning erection very often, while 61% rated their ability to function sexually as good or very good. CONCLUSIONS: Variations in outcomes from items intended to measure the same domain reflect the idiosyncrasy of patient definitions of urinary and erectile function. Disease targeted, health related quality of life outcomes vary greatly depending on the specific definition used.

Erectile Dysfunction↗