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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3031 — Quality of Post-Treatment Surveillance Received by Veterans Following Initial Surgery or Radiotherapy for Prostate Cancer

Zeliadt SB, and Porter MP, VA Puget Sound; Makarov DV, VA New York Harbor; Hu E, VA Puget Sound; Gore JL, University of Washington; Lin DW, and Wright JW, VA Puget Sound;

Objectives:
The Institute of Medicine report “Cancer Patient to Cancer Survivor: Lost in Transition” highlighted significant gaps in ongoing care following initial treatment for many cancer survivors. No prior VA study has examined patterns of post-treatment surveillance for men with prostate cancer.

Methods:
VA oncology registry and VISN20 regional data warehouse records were used to identify a cohort of Veterans in the Pacific Northwest Network (VISN20) diagnosed with prostate cancer between 2001 and 2009 who underwent primary treatment with surgery or radiotherapy. All post-treatment PSA lab tests and outpatient care visits were identified through 12/2010. Patients were censored at the time of recurrence or death. Recurrence was defined as any evidence of biochemical progression or initiation of secondary hormonal therapy or salvage radiotherapy.

Results:
We identified 1,802 Veterans with localized prostate cancer who underwent treatment within 6 months of diagnosis and had at least one year of complete follow-up after treatment. Overall, 97.2% (96.5-98.0) received appropriate surveillance including at least one post-treatment PSA test in the year following treatment. Of 1,217 men with 3 years of complete follow-up, 87.0% (85.1-88.9) received appropriate surveillance with PSA tests at least annually. Dual use and utilization of services from non-VA providers appeared to be low among this cohort. When we censored 51 men who had no further evidence of VA use after treatment, the proportion receiving complete follow-up at 3 years increased slightly to 88.2% (86.4 – 90.0). We explored potential factors associated with lower rates of follow-up including disease risk characteristics, type of treatment, age, co-morbidity, BMI, alcohol use, geographic location, and race. In contrast to prior studies, none of these were associated with differences in follow-up care utilization. Recurrence rates were similar to published studies; at 5 years, 18% (16.0 – 21.4) of survivors had evidence of cancer recurrence.

Implications:
Rates of appropriate surveillance after initial cancer treatment are higher in this VA cohort compared to patients in community practice.

Impacts:
Performance measures of follow-up care for prostate cancer can be assessed using VA electronic databases. While most men received appropriate monitoring, there is an opportunity for additional improvement, likely requiring a multidisciplinary, coordinated effort between primary care and urology.


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