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