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MP86-14 PROSTATE SPECIFIC ANTIGEN AND HEALTH-RELATED QUALITY-OF-LIFE OUTCOMES IN UNINSURED MEN WITH PROSTATE CANCER
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
MP86-12 PSYCHOLOGICAL DISTRESS IN PATIENTS UNDERGOING SURGERY FOR UROLOGICAL CANCER: A PROSPECTIVE SINGLE CENTRE CROSS-SECTIONAL STUDY Antonio Luigi Pastore*, Giovanni Palleschi, Antonio Carbone, Latina, Italy; Serena Maruccia, Milano, Italy; Ana Mir Bou, Nuria Camps Bellnoch, Juan Palou, Barcelona, Spain INTRODUCTION AND OBJECTIVES: Interest in disease-specific psychological well-being of patients with cancer has increased, and it has been estimated that less than half of all cancer patients are properly identified and treated for anxiety or depression. The aim of this study was to evaluate psychological health assessment in oncological patients admitted for surgery. METHODS: We performed a cross-sectional study in consecutively enrolled patients with bladder, kidney or prostate cancer, scheduled for surgery. Demographic data, socioeconomic status, education level and diagnoses were recorded. We evaluated the level of clinically meaningful depression and anxiety assessed by two tools: the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory (STAI). In order to determine variables related to depression and anxiety among the demographic variables, logistic regression analyses were conducted, with p<0.05 considered as statistically significant. RESULTS: 207 patients completed the questionnaires and were included in the study. The most frequent procedures were performed for bladder tumours (60.4%), being transurethral resection the most common type of surgery (52.7%) followed by radical prostatectomy (24.6%). The mean STAI-state score was 19.3 (10.3), and the mean STAI-trait score was 18.4 (11.9) points. Patients showed HADs depression and anxiety scores of 3.3 (3) and 5.6 (3.3) points, respectively. Female patients showed a higher level of anxiety and STAI-trait compared to males. CONCLUSIONS: Gender, tumour type and surgical approach were significantly related to psychological distress in patients undergoing surgery for urological cancer. Females and patients with kidney tumour undergoing radical nephrectomy presented higher levels of anxiety.
e1161
Jose Maria Abascal, Maria Carme Mir, Barcelona, Spain; Xavier Bonet, Helena Vila, l’Hospitalet de Llobregat, Spain; Lluís Cecchini, Barcelona, s, l’Hospitalet de Llobregat, Spain Spain; Francesc Vigue INTRODUCTION AND OBJECTIVES: Active surveillance in localised prostate cancer is an accepted option in selected cases, but some concerns still needs to be clarified. We pretend to evaluate Health-Related Quality of Life (HRQoL), in a cross-sectional study, in patients with localized prostate cancer undergoing active surveillance (AS) compared with active treatments (radical prostatectomy, externalbeam radiotherapy, brachytherapy) and general population. METHODS: Ninety-nine patients fulfilled the inclusion criteria. This group was compared to different active treatments (n¼99 per group) from the ’Spanish Multicentric Study of Clinically Localized Prostate Cancer’ cohort using prostate-specific (Expanded Prostate Cancer Index Composite [EPIC]) and generic (36-Item Short Form Health Survey, version 2 [SF-36]) QoL instruments. SF-36 results were also compared to US reference population. RESULTS: Cross-section analysis was performed at 24 months after initial therapy or AS beginning. AS group presented statistically higher sexual scores [54.4 mean score (28.3 SD)] when compared to all other active treatments and better urinary incontinence scores [87.4 (22.8 SD)] than radical prostatectomy group [65.8 (31.6 SD)]. Patients undergoing AS were more likely to present significant urinary irritative/ obstructive symptoms compared to radical prostatectomy group. No statistically significant differences were found among other domains. Patients with localized prostate cancer, regardless of treatment applied, presented slightly higher SF-36 physical and mental dimension scores (except for radical prostatectomy) than US general population reference norm (men aged 65-74). CONCLUSIONS: AS may be a good treatment option for low or intermediate risk prostate cancer since induces the least impact in QoL. No significant differences were found on Physical and Mental Component Summaries compared to general US population. This study provides cross-sectional information about AS impact on QoL. Source of Funding: This work was supported by grants from Instituto de Salud Carlos III FEDER (FIS PI11/01191 y FIS PI13/00412) and DIUE of Generalitat de Catalunya (2014 SGR 748)
MP86-14 PROSTATE SPECIFIC ANTIGEN AND HEALTH-RELATED QUALITY-OF-LIFE OUTCOMES IN UNINSURED MEN WITH PROSTATE CANCER Avi Baskin*, Joseph Shirk, Lorna Kwan, Karim Chamie, Los Angeles, CA
Source of Funding: None
MP86-13 HEALTH RELATED QUALITY OF LIFE OF PATIENTS UNDERGOING ACTIVE SURVEILLANCE e COMPARISON WITH PROSTATE CANCER ACTIVE TREATMENTS rez, l’Hospitalet Lluis Fumado*, Barcelona, Spain; Jose Francisco Sua de Llobregat, Spain; Olatz Garín, Andrea Sureda, Montse Ferrer, Barcelona, Spain; Manel Castells, l’Hospitalet de Llobregat, Spain;
INTRODUCTION AND OBJECTIVES: Prostate Specific Antigen (PSA) continues to be a useful marker of risk strata and disease progression for patients with prostate cancer. While there have been multiple investigations into the relationship between PSA and mortality, there is a dearth in the literature describing the association between PSA and health-related quality-of-life (HRQOL) outcomes. In this study, we hypothesize that PSA is inversely related with HRQOL in patients with prostate cancer. METHODS: Our cohort consisted of a prospective analysis of men from a state-funded program that provides free prostate cancer care to underinsured and uninsured low-income California residents with prostate cancer. Highest pre-treatment PSA was our primary exposure variable of interest. We created 4 strata: <10, 10-19.9, 2049.9 and 50 PSA. The primary outcome variables were HRQOL at program enrollment using the RAND SF-12 to measure physical and mental health, and the UCLA Prostate Cancer Index Short Form to measure urinary, sexual and bowel habits in two domains: bother and function. Controlling for demographic and clinical variables, we conducted separate multivariable linear regression analysis for each quality of life domain.
THE JOURNAL OF UROLOGYâ
e1162
RESULTS: 627 men were eligible for the study. Age, ethnicity, primary language, education and Charlson comorbidity did not differ across PSA strata. Compared to the referent group PSA <10, those with PSA 50 were more likely to receive androgen deprivation therapy as their primary form of treatment (p <0.01). Patients with PSAs 10-19.9 were more likely to have sexual bother (b¼11.1, p<0.03) compared to the referent group. (See Table) There were no other differences in other HRQOL domains across PSA strata. CONCLUSIONS: In this population, we found no statistically significant difference in HRQOL outcomes by PSA level. The finding that patients with very elevated PSA levels having outcomes that were no worse than patients with less aggressive disease is important clinically because most quality of life detriments tend to be from treatment of localized disease. Further, these findings will inform physicians on patient symptomatology despite PSA level.
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
We also directly observed women during their stay and recorded the frequency and types of interpersonal behaviors and interactions. RESULTS: Twenty-six women participated in the interviews. Themes of social isolation, depression, shame, and stress were present in women’s testimonials of their experiences prior to fistula camp arrival (see Table). When discussing experiences during and after fistula camp stay, themes of social support and hopefulness emerged. Behaviors and interactions indicating social integration with bond formation and social support within the fistula ward were observed. CONCLUSIONS: Exposure to other women who had obstetric fistula was of therapeutic benefit to women with these same conditions. We found that the impact of shared experience amongst the women played a critical role in their understanding, perception, and outlook towards their condition and their hope for recovery. A group-based model of postoperative care that integrates physical and psychosocial healing may be highly effective for this population.
Source of Funding: none
MP86-15 EFFECTS OF GROUP REHABILITATION UPON WOMEN UNDERGOING SURGERY FOR OBSTETRIC FISTULA Pooja Parameshwar*, Los Angeles, CA; Musa Kayondo, Mbarara, Uganda; A. Lenore Ackerman, Jennifer Anger, Christopher Tarnay, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Obstetric fistula due to prolonged obstructed labor is a significant public health concern in the developing world. Fistula patients experience chronically elevated levels of social isolation, stigmatization, and depression. In this qualitative study, we aimed to evaluate the experience of group rehabilitation during postoperative recovery in the setting of a “fistula camp” upon women seeking surgical care for fistula and related birth injuries. As this population is marginalized and ostracized, we predicted that group rehabilitation might be particularly germane. METHODS: Study participants were women who received surgical care for obstetric fistula and high-grade perineal lacerations at the Mbarara Regional Referral Hospital in Uganda during 2 fistula camps in 2015 and 2016. Using semi-structured interviews, we sought to characterize the lived experiences of these women and their feelings surrounding their medical and surgical care in the setting of a groupbased rehabilitative fistula camp. Interviews were conducted via translators who spoke the native dialects. Data was transcribed and analyzed using grounded theory methods, as described by Charmaz.
Source of Funding: None
MP86-16 A MULTI-CENTER ANALYSIS OF PROSTATE CANCER (PCA) TREATMENT AMONG VETERANS FOLLOWING INTRODUCTION OF THE 17-GENE GENOMIC PROSTATE SCORE (GPS) ASSAY Julie Lynch, Boston, MA; Megan Rothney, Redwood City, CA; Raoul Salup, Cesar Ercole, Tampa, FL; Sharad Mathur, David Duchene, Kansas City, MO; Joseph Basler, Javier Hernandez, Michael Liss, San Antonio, TX; Michael Porter, Jonathan L. Wright, Seattle, WA; Michael Risk, Minneapolis, MN; Mark Garzotto, Portland, OR; Olga Efimova, Salt Lake City, UT; Michael Kemeter, Bela Denes, Phillip Febbo, Redwood City, CA; Atreya Dash*, Seattle, WA INTRODUCTION AND OBJECTIVES: Active Surveillance (AS), a recommended management approach for low risk PCa, has been widely implemented within VA Medical Centers (VAMCs). However, Veteran characteristics such as age, race, and Agent Orange (AO) exposure may limit use of AS in some patients. The GPS test uses tumor biology to predict likelihood of favorable pathology. GPS may
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
MP86-12 PSYCHOLOGICAL DISTRESS IN PATIENTS UNDERGOING SURGERY FOR UROLOGICAL CANCER: A PROSPECTIVE SINGLE CENTRE CROSS-SECTIONAL STUDY Antonio Luigi Pastore*, Giovanni Palleschi, Antonio Carbone, Latina, Italy; Serena Maruccia, Milano, Italy; Ana Mir Bou, Nuria Camps Bellnoch, Juan Palou, Barcelona, Spain INTRODUCTION AND OBJECTIVES: Interest in disease-specific psychological well-being of patients with cancer has increased, and it has been estimated that less than half of all cancer patients are properly identified and treated for anxiety or depression. The aim of this study was to evaluate psychological health assessment in oncological patients admitted for surgery. METHODS: We performed a cross-sectional study in consecutively enrolled patients with bladder, kidney or prostate cancer, scheduled for surgery. Demographic data, socioeconomic status, education level and diagnoses were recorded. We evaluated the level of clinically meaningful depression and anxiety assessed by two tools: the Hospital Anxiety and Depression Scale and the State-Trait Anxiety Inventory (STAI). In order to determine variables related to depression and anxiety among the demographic variables, logistic regression analyses were conducted, with p<0.05 considered as statistically significant. RESULTS: 207 patients completed the questionnaires and were included in the study. The most frequent procedures were performed for bladder tumours (60.4%), being transurethral resection the most common type of surgery (52.7%) followed by radical prostatectomy (24.6%). The mean STAI-state score was 19.3 (10.3), and the mean STAI-trait score was 18.4 (11.9) points. Patients showed HADs depression and anxiety scores of 3.3 (3) and 5.6 (3.3) points, respectively. Female patients showed a higher level of anxiety and STAI-trait compared to males. CONCLUSIONS: Gender, tumour type and surgical approach were significantly related to psychological distress in patients undergoing surgery for urological cancer. Females and patients with kidney tumour undergoing radical nephrectomy presented higher levels of anxiety.
e1161
Jose Maria Abascal, Maria Carme Mir, Barcelona, Spain; Xavier Bonet, Helena Vila, l’Hospitalet de Llobregat, Spain; Lluís Cecchini, Barcelona, s, l’Hospitalet de Llobregat, Spain Spain; Francesc Vigue INTRODUCTION AND OBJECTIVES: Active surveillance in localised prostate cancer is an accepted option in selected cases, but some concerns still needs to be clarified. We pretend to evaluate Health-Related Quality of Life (HRQoL), in a cross-sectional study, in patients with localized prostate cancer undergoing active surveillance (AS) compared with active treatments (radical prostatectomy, externalbeam radiotherapy, brachytherapy) and general population. METHODS: Ninety-nine patients fulfilled the inclusion criteria. This group was compared to different active treatments (n¼99 per group) from the ’Spanish Multicentric Study of Clinically Localized Prostate Cancer’ cohort using prostate-specific (Expanded Prostate Cancer Index Composite [EPIC]) and generic (36-Item Short Form Health Survey, version 2 [SF-36]) QoL instruments. SF-36 results were also compared to US reference population. RESULTS: Cross-section analysis was performed at 24 months after initial therapy or AS beginning. AS group presented statistically higher sexual scores [54.4 mean score (28.3 SD)] when compared to all other active treatments and better urinary incontinence scores [87.4 (22.8 SD)] than radical prostatectomy group [65.8 (31.6 SD)]. Patients undergoing AS were more likely to present significant urinary irritative/ obstructive symptoms compared to radical prostatectomy group. No statistically significant differences were found among other domains. Patients with localized prostate cancer, regardless of treatment applied, presented slightly higher SF-36 physical and mental dimension scores (except for radical prostatectomy) than US general population reference norm (men aged 65-74). CONCLUSIONS: AS may be a good treatment option for low or intermediate risk prostate cancer since induces the least impact in QoL. No significant differences were found on Physical and Mental Component Summaries compared to general US population. This study provides cross-sectional information about AS impact on QoL. Source of Funding: This work was supported by grants from Instituto de Salud Carlos III FEDER (FIS PI11/01191 y FIS PI13/00412) and DIUE of Generalitat de Catalunya (2014 SGR 748)
MP86-14 PROSTATE SPECIFIC ANTIGEN AND HEALTH-RELATED QUALITY-OF-LIFE OUTCOMES IN UNINSURED MEN WITH PROSTATE CANCER Avi Baskin*, Joseph Shirk, Lorna Kwan, Karim Chamie, Los Angeles, CA
Source of Funding: None
MP86-13 HEALTH RELATED QUALITY OF LIFE OF PATIENTS UNDERGOING ACTIVE SURVEILLANCE e COMPARISON WITH PROSTATE CANCER ACTIVE TREATMENTS rez, l’Hospitalet Lluis Fumado*, Barcelona, Spain; Jose Francisco Sua de Llobregat, Spain; Olatz Garín, Andrea Sureda, Montse Ferrer, Barcelona, Spain; Manel Castells, l’Hospitalet de Llobregat, Spain;
INTRODUCTION AND OBJECTIVES: Prostate Specific Antigen (PSA) continues to be a useful marker of risk strata and disease progression for patients with prostate cancer. While there have been multiple investigations into the relationship between PSA and mortality, there is a dearth in the literature describing the association between PSA and health-related quality-of-life (HRQOL) outcomes. In this study, we hypothesize that PSA is inversely related with HRQOL in patients with prostate cancer. METHODS: Our cohort consisted of a prospective analysis of men from a state-funded program that provides free prostate cancer care to underinsured and uninsured low-income California residents with prostate cancer. Highest pre-treatment PSA was our primary exposure variable of interest. We created 4 strata: <10, 10-19.9, 2049.9 and 50 PSA. The primary outcome variables were HRQOL at program enrollment using the RAND SF-12 to measure physical and mental health, and the UCLA Prostate Cancer Index Short Form to measure urinary, sexual and bowel habits in two domains: bother and function. Controlling for demographic and clinical variables, we conducted separate multivariable linear regression analysis for each quality of life domain.
THE JOURNAL OF UROLOGYâ
e1162
RESULTS: 627 men were eligible for the study. Age, ethnicity, primary language, education and Charlson comorbidity did not differ across PSA strata. Compared to the referent group PSA <10, those with PSA 50 were more likely to receive androgen deprivation therapy as their primary form of treatment (p <0.01). Patients with PSAs 10-19.9 were more likely to have sexual bother (b¼11.1, p<0.03) compared to the referent group. (See Table) There were no other differences in other HRQOL domains across PSA strata. CONCLUSIONS: In this population, we found no statistically significant difference in HRQOL outcomes by PSA level. The finding that patients with very elevated PSA levels having outcomes that were no worse than patients with less aggressive disease is important clinically because most quality of life detriments tend to be from treatment of localized disease. Further, these findings will inform physicians on patient symptomatology despite PSA level.
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
We also directly observed women during their stay and recorded the frequency and types of interpersonal behaviors and interactions. RESULTS: Twenty-six women participated in the interviews. Themes of social isolation, depression, shame, and stress were present in women’s testimonials of their experiences prior to fistula camp arrival (see Table). When discussing experiences during and after fistula camp stay, themes of social support and hopefulness emerged. Behaviors and interactions indicating social integration with bond formation and social support within the fistula ward were observed. CONCLUSIONS: Exposure to other women who had obstetric fistula was of therapeutic benefit to women with these same conditions. We found that the impact of shared experience amongst the women played a critical role in their understanding, perception, and outlook towards their condition and their hope for recovery. A group-based model of postoperative care that integrates physical and psychosocial healing may be highly effective for this population.
Source of Funding: none
MP86-15 EFFECTS OF GROUP REHABILITATION UPON WOMEN UNDERGOING SURGERY FOR OBSTETRIC FISTULA Pooja Parameshwar*, Los Angeles, CA; Musa Kayondo, Mbarara, Uganda; A. Lenore Ackerman, Jennifer Anger, Christopher Tarnay, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Obstetric fistula due to prolonged obstructed labor is a significant public health concern in the developing world. Fistula patients experience chronically elevated levels of social isolation, stigmatization, and depression. In this qualitative study, we aimed to evaluate the experience of group rehabilitation during postoperative recovery in the setting of a “fistula camp” upon women seeking surgical care for fistula and related birth injuries. As this population is marginalized and ostracized, we predicted that group rehabilitation might be particularly germane. METHODS: Study participants were women who received surgical care for obstetric fistula and high-grade perineal lacerations at the Mbarara Regional Referral Hospital in Uganda during 2 fistula camps in 2015 and 2016. Using semi-structured interviews, we sought to characterize the lived experiences of these women and their feelings surrounding their medical and surgical care in the setting of a groupbased rehabilitative fistula camp. Interviews were conducted via translators who spoke the native dialects. Data was transcribed and analyzed using grounded theory methods, as described by Charmaz.
Source of Funding: None
MP86-16 A MULTI-CENTER ANALYSIS OF PROSTATE CANCER (PCA) TREATMENT AMONG VETERANS FOLLOWING INTRODUCTION OF THE 17-GENE GENOMIC PROSTATE SCORE (GPS) ASSAY Julie Lynch, Boston, MA; Megan Rothney, Redwood City, CA; Raoul Salup, Cesar Ercole, Tampa, FL; Sharad Mathur, David Duchene, Kansas City, MO; Joseph Basler, Javier Hernandez, Michael Liss, San Antonio, TX; Michael Porter, Jonathan L. Wright, Seattle, WA; Michael Risk, Minneapolis, MN; Mark Garzotto, Portland, OR; Olga Efimova, Salt Lake City, UT; Michael Kemeter, Bela Denes, Phillip Febbo, Redwood City, CA; Atreya Dash*, Seattle, WA INTRODUCTION AND OBJECTIVES: Active Surveillance (AS), a recommended management approach for low risk PCa, has been widely implemented within VA Medical Centers (VAMCs). However, Veteran characteristics such as age, race, and Agent Orange (AO) exposure may limit use of AS in some patients. The GPS test uses tumor biology to predict likelihood of favorable pathology. GPS may