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Effectiveness of screening for prostate cancer
630
Abstracts / Journal of Clinical Epidemiology 55 (2002) 627–632
Methods: This was a pilot study of patients diagnosed with cancer in the previous 6 to 24 months who were recruited from three oncology practices that varied socio-demographically and in their use of complementary therapies. Participants were asked verbally if they had done anything to try to gain control over their cancer or situation. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. For each of these domains, the scores can range from 0 to 21, with 7 considered normal. Six coping styles were assessed with the Mental Adjustment to Cancer Scale. The raw score for each coping style was transformed to a scale ranging from 0 to 100, with higher scores indicating increased use of this coping style. Patients were also asked Likertresponse questions about their perceptions of the seriousness of the cancer, and the impact of the cancer and its treatment on their lives. Other clinical information was obtained at the interview or by chart review. T-tests and chi-square were used to compare the groups who did and did not feel in control. Results: Of the 44 participants, 38% were male and 84% Caucasian. The mean age was 57 years and median education was 16 years. There were 19 different cancer diagnoses, with breast (34%) and lung cancers (21%) most common; 23% had metastases and 57% were on treatment. Compared to the 11 participants who said they had not done anything to try to control their cancer or situation, the 18 who said they did try to take control were younger (50 vs 71 years old, p0.001), more likely to be married (89% vs 46%, p0.03) and less likely to live alone (6% vs 64%, p0.003). They also had lower scores for depression (2.9 vs 5.2, p0.05) and helpless/hopelessness (8.3 vs. 18.2, p0.04), and higher scores for fighting spirit-positive orientation to the illness (81.5 vs 66.3, p0.02). There were no statistically significant clinical differences. The 15 participants who were ambivalent in their response to the question of control were not included in this analysis. Conclusions: People with cancer who believe they are doing things to control their disease or situation are younger, married, living with others, and more positive in their approach to their illness. With this information, health care providers may be better able to identify patients who are likely to feel a loss of control and then address this issue along with the associated feelings of depression and helplessness. EFFECTIVENESS OF SCREENING FOR PROSTATE CANCER: A NESTED CASE-CONTROL STUDY Concato J, Wells CK, Penson D, Horwitz RI, Peduzzi P Yale University, New Haven, CT; and VA Medical Centers, Seattle WA and West Haven, CT Although screening for prostate cancer with prostate-specific antigen (PSA) or digital rectal exam (DRE) is commonly done, evidence is currently lacking to show a benefit of such testing on survival. The current study used a nested case-control design to assess the impact of screening with PSA (with or without DRE) on mortality. Among 71,661 patients receiving ambulatory care during 1989– 1990 at any of ten VA Medical Centers in New England, case subjects were men diagnosed with prostate cancer from 1991–1995 who died during 4–9 years of follow-up. Control subjects (1:1 sampling ratio) were men who are alive at the time of death of the corresponding case, matched for year of birth and VA facility. The exposure variables were screening with PSA alone, or PSA and DRE, done for screening purposes; potential screening tests must
have occurred prior to the diagnosis of prostate cancer for the cases or the corresponding date for controls. The assessment of screening was also done blind to case-control status, and tests were classified by an algorithm that took into account the clinical context of the exams. A total of 501 matched case and control subjects (1002 total patients) were included in final analyses. The frequency of screening with PSA was similar among cases (14.0%) and controls (13.0%); with an unadjusted odds ratio of 1.10 (95% C.I. 0.75 to 1.62). After adjusting for race and comorbidity, the odds ratio remained quantitatively and statistically non-significant at 1.08 (95% C.I. 0.71 to 1.64). Screening was also not associated with improved survival in analyses involving screening with PSA or DRE, among men less than 70 years of age, and using data from patients during last three years of intake when PSA testing was more commonly done. The results do not support the effectiveness of PSA or DRE in screening for prostate cancer. PREVENTION OF HIP FRACTURES THROUGH SCREENING FOR OSTEOPOROSIS: A COHORT STUDY Korn LM, Powe NR, Levine MA, Harris TB, Robbins J, Fitzpatrick A, Fried LP Johns Hopkins University (LK, NP, ML, LF) and National Institute on Aging (TH), Bethesda, MD; University of California (JR), Sacramento, CA; University of Washington (AF), Seattle, WA Background and purpose: Guidelines disagree on who should be screened for osteoporosis, in part due to lack of direct evidence for the effectiveness of screening. The objective of this study was to determine if population-based screening for osteoporosis in older adults is associated with fewer incident hip fractures compared to usual primary care. Methods: We conducted a non-concurrent cohort study of 3107 adults over age 65 who lived in four U.S. communities enrolled in the Cardiovascular Health Study. Participants were randomly selected from Medicare eligibility lists. We included those who came to their study visits in 1994–95 and excluded those with a history of osteoporosis, hip fracture or bisphosphonate use. In that year, participants in 2 of the 4 communities were offered bone density scans, and the results of these tests were given to the participants and their primary care providers. In the other 2 communities, participants received usual primary care. The two groups (those screened by the study and those receiving usual care) were followed for up to 6 years for the outcome of incident hip fracture, which was abstracted from medical records. Variables considered as potential confounders included demographic variables, medical problems, medications, and physical exam findings. Survival analysis and Cox proportional hazards models were used to compare time to first hip fracture in the screened and usual care groups. Results: Of 1422 eligible participants offered scans, 97% completed them. There were 33 incident hip fractures in the screened group (n1422 people) and 69 incident hip fractures in the usual care group (n1685 people; p0.01). At the end of 6 years, the cumulative incidence of hip fractures in the screened group was 3.0%, compared to 5.0% in the usual care group (p0.01). The unadjusted relative hazard of having a first hip fracture was significantly lower in the screened group (HR 0.59, 95% CI 0.39–0.89). Screening was still associated with a significantly lower hazard of hip fracture after adjustment for gender, age, race-ethnicity, education, self-reported health status, body weight, exercise, walking
Abstracts / Journal of Clinical Epidemiology 55 (2002) 627–632
Methods: This was a pilot study of patients diagnosed with cancer in the previous 6 to 24 months who were recruited from three oncology practices that varied socio-demographically and in their use of complementary therapies. Participants were asked verbally if they had done anything to try to gain control over their cancer or situation. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. For each of these domains, the scores can range from 0 to 21, with 7 considered normal. Six coping styles were assessed with the Mental Adjustment to Cancer Scale. The raw score for each coping style was transformed to a scale ranging from 0 to 100, with higher scores indicating increased use of this coping style. Patients were also asked Likertresponse questions about their perceptions of the seriousness of the cancer, and the impact of the cancer and its treatment on their lives. Other clinical information was obtained at the interview or by chart review. T-tests and chi-square were used to compare the groups who did and did not feel in control. Results: Of the 44 participants, 38% were male and 84% Caucasian. The mean age was 57 years and median education was 16 years. There were 19 different cancer diagnoses, with breast (34%) and lung cancers (21%) most common; 23% had metastases and 57% were on treatment. Compared to the 11 participants who said they had not done anything to try to control their cancer or situation, the 18 who said they did try to take control were younger (50 vs 71 years old, p0.001), more likely to be married (89% vs 46%, p0.03) and less likely to live alone (6% vs 64%, p0.003). They also had lower scores for depression (2.9 vs 5.2, p0.05) and helpless/hopelessness (8.3 vs. 18.2, p0.04), and higher scores for fighting spirit-positive orientation to the illness (81.5 vs 66.3, p0.02). There were no statistically significant clinical differences. The 15 participants who were ambivalent in their response to the question of control were not included in this analysis. Conclusions: People with cancer who believe they are doing things to control their disease or situation are younger, married, living with others, and more positive in their approach to their illness. With this information, health care providers may be better able to identify patients who are likely to feel a loss of control and then address this issue along with the associated feelings of depression and helplessness. EFFECTIVENESS OF SCREENING FOR PROSTATE CANCER: A NESTED CASE-CONTROL STUDY Concato J, Wells CK, Penson D, Horwitz RI, Peduzzi P Yale University, New Haven, CT; and VA Medical Centers, Seattle WA and West Haven, CT Although screening for prostate cancer with prostate-specific antigen (PSA) or digital rectal exam (DRE) is commonly done, evidence is currently lacking to show a benefit of such testing on survival. The current study used a nested case-control design to assess the impact of screening with PSA (with or without DRE) on mortality. Among 71,661 patients receiving ambulatory care during 1989– 1990 at any of ten VA Medical Centers in New England, case subjects were men diagnosed with prostate cancer from 1991–1995 who died during 4–9 years of follow-up. Control subjects (1:1 sampling ratio) were men who are alive at the time of death of the corresponding case, matched for year of birth and VA facility. The exposure variables were screening with PSA alone, or PSA and DRE, done for screening purposes; potential screening tests must
have occurred prior to the diagnosis of prostate cancer for the cases or the corresponding date for controls. The assessment of screening was also done blind to case-control status, and tests were classified by an algorithm that took into account the clinical context of the exams. A total of 501 matched case and control subjects (1002 total patients) were included in final analyses. The frequency of screening with PSA was similar among cases (14.0%) and controls (13.0%); with an unadjusted odds ratio of 1.10 (95% C.I. 0.75 to 1.62). After adjusting for race and comorbidity, the odds ratio remained quantitatively and statistically non-significant at 1.08 (95% C.I. 0.71 to 1.64). Screening was also not associated with improved survival in analyses involving screening with PSA or DRE, among men less than 70 years of age, and using data from patients during last three years of intake when PSA testing was more commonly done. The results do not support the effectiveness of PSA or DRE in screening for prostate cancer. PREVENTION OF HIP FRACTURES THROUGH SCREENING FOR OSTEOPOROSIS: A COHORT STUDY Korn LM, Powe NR, Levine MA, Harris TB, Robbins J, Fitzpatrick A, Fried LP Johns Hopkins University (LK, NP, ML, LF) and National Institute on Aging (TH), Bethesda, MD; University of California (JR), Sacramento, CA; University of Washington (AF), Seattle, WA Background and purpose: Guidelines disagree on who should be screened for osteoporosis, in part due to lack of direct evidence for the effectiveness of screening. The objective of this study was to determine if population-based screening for osteoporosis in older adults is associated with fewer incident hip fractures compared to usual primary care. Methods: We conducted a non-concurrent cohort study of 3107 adults over age 65 who lived in four U.S. communities enrolled in the Cardiovascular Health Study. Participants were randomly selected from Medicare eligibility lists. We included those who came to their study visits in 1994–95 and excluded those with a history of osteoporosis, hip fracture or bisphosphonate use. In that year, participants in 2 of the 4 communities were offered bone density scans, and the results of these tests were given to the participants and their primary care providers. In the other 2 communities, participants received usual primary care. The two groups (those screened by the study and those receiving usual care) were followed for up to 6 years for the outcome of incident hip fracture, which was abstracted from medical records. Variables considered as potential confounders included demographic variables, medical problems, medications, and physical exam findings. Survival analysis and Cox proportional hazards models were used to compare time to first hip fracture in the screened and usual care groups. Results: Of 1422 eligible participants offered scans, 97% completed them. There were 33 incident hip fractures in the screened group (n1422 people) and 69 incident hip fractures in the usual care group (n1685 people; p0.01). At the end of 6 years, the cumulative incidence of hip fractures in the screened group was 3.0%, compared to 5.0% in the usual care group (p0.01). The unadjusted relative hazard of having a first hip fracture was significantly lower in the screened group (HR 0.59, 95% CI 0.39–0.89). Screening was still associated with a significantly lower hazard of hip fracture after adjustment for gender, age, race-ethnicity, education, self-reported health status, body weight, exercise, walking