Optimizing Advanced Prostate Cancer Care Among US Veterans

优化美国退伍军人的先进前列腺癌护理

• 批准号: 10634231
• 负责人: Megan Elizabeth Veresh Caram
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634231
• 关键词: Address; Adverse event; Affect; Age; Androgens; Area; Cancer Etiology; Cardiovascular Diseases; Caring; Cessation of life; Clinical Trials; Complex; Data; Development; Diabetes Mellitus; Diagnosis; Disease; Electronics; Emergency department visit; Equity; Event; Exposure to; Foundations; Frequencies; Future; Genus Mentha; Geography; Goals; Guidelines; Health; Healthcare Systems; Hospitalization; Incidence; Infrastructure; Institution; Intervention; Knowledge; Laboratories; Link; Logistic Regressions; Malignant Neoplasms; Malignant neoplasm of prostate; Mental Health; Metastatic Prostate Cancer; Methodology; Modeling; Monitor; Natural Language Processing; Neighborhoods; Neoplasm Metastasis; Newly Diagnosed; Outcome; Outpatients; Patient Outcomes Assessments; Patient Preferences; Patients; Perception; Physicians; Provider; Quality of Care; Quality of life; Records; Regression Analysis; Reporting; Research; Resources; Risk; Safety; Sampling; Shapes; Signal Transduction; Social support; Strategic Planning; Support System; Surveys; Time; United States Department of Veterans Affairs; Veterans; Vietnam; Visit; Vulnerable Populations; Work; abiraterone; advanced prostate cancer; agent orange; androgen deprivation therapy; barrier to care; black men; cancer care; care delivery; clinical practice; cohort; comorbidity; demographics; deprivation; disparity elimination; docetaxel; enzalutamide; experience; high risk; hospitalization rates; improved; individual patient; inhibitor; innovation; men; men' s group; military veteran; neighborhood association; neighborhood disadvantage; novel; novel therapeutics; patient population; personalized medicine; preference; prospective; safety assessment; side effect; socioeconomic disadvantage; standard of care; tool; treatment risk; trend

Background: Over 5 million Vietnam Veterans will be in their 70s in 2023, the age when metastatic prostate cancer is commonly diagnosed – Black men and men exposed to Agent Orange at nearly twice the rate. Fortunately, new therapies have improved survival for men with metastatic prostate cancer. However, delivering new therapies to this growing group of men is complicated and raises concerns about equity, safety, and Veteran experience. Significance: This proposal will extend knowledge about barriers to guideline-concordant care faced by Veterans with metastatic prostate cancer, the safety of treatment, and detail the Veteran’s experience with metastatic prostate cancer. This proposal directly aligns with the Department of Veterans Affairs Fiscal Years 2022-28 Strategic Plan (Goals 1 & 2), to eliminate disparities and barriers to health, to enhance Veterans’ outcomes, experiences and quality of life, and to project future trends and needs by listening to Veterans. The VA is the only institution that can perform such a timely and comprehensive study due to the unique VA- developed natural language processing tool that allows rapid case ascertainment of men with metastatic prostate cancer. Innovation & Impact: This proposal has the potential to change current clinical practice through a future multilevel intervention that mitigates barriers to treatment intensification and personalizes treatment to high -risk Veterans. The innovative natural language processing tool allows rapid case ascertainment to prospectiv ely identify new metastatic patients, which can only be done in the VA. Specific Aims: Aim 1: To investigate factors affecting equitable care for men with incident metastatic prostate cancer. Aim 2: To conduct real-time safety assessment of men treated for incident metastatic prostate cancer. Aim 3: To understand physician and patient experience after diagnosis of incident metastatic prostate cancer. Methodology: All patients will be age 18 or older with a diagnosis of incident metastatic prostate cancer. We will prospectively identify Veterans using a natural language processing tool that can identify men with new metastatic prostate cancer as soon as they are diagnosed in the VA. For Aim 1, we will use multilevel multivariable models to assess the association of neighborhood deprivation, patient demographics, and facility factors with receipt of guideline-concordant treatment intensification. Treatment intensification is defined as androgen deprivation therapy plus either docetaxel or a secondary androgen signaling inhibitor (i.e. abiraterone, enzalutamide, apalutamide) within four months of metastatic diagnosis. For Aim 2, we will compare frequency of emergency room visits, hospitalizations, and outpatient visits for conditions unrelated to cancer the year after incident diagnosis of metastatic disease to similar events in clinical trials and a historic cohort of VA patients. For Aim 3, we will survey a diverse sample of patients within four months of metastatic diagnosis to understand their experience with receiving treatment for their cancer. We will also survey a sample of physicians who treated these patients to understand their experience with barriers to delivering treatment intensification. Next Steps/Implementation: We will use the findings of this research to develop a multilevel intervention that will mitigate barriers to equitable care delivery, and help clinicians inform patients about real-world risks of treatment intensification. We will work with national partners to implement such an intervention in our next proposal.

背景：到 2023 年，超过 500 万越南退伍军人将年届 70 多岁，这是前列腺转移的年龄 癌症的诊断率很高——黑人男性和接触橙剂的男性的比率几乎是男性的两倍。 幸运的是，新疗法提高了患有转移性前列腺癌的男性的生存率。然而， 为这一不断增长的男性群体提供新疗法非常复杂，并引发了对公平、安全、 和退伍军人的经验。 意义：该提案将扩展人们对指南一致护理面临的障碍的了解。 患有转移性前列腺癌的退伍军人、治疗的安全性以及退伍军人的详细经历 转移性前列腺癌。该提案与退伍军人事务部财政年度直接一致 2022-28 战略计划（目标 1 和 2），消除健康方面的差距和障碍，提高退伍军人的健康水平 成果、经验和生活质量，并通过倾听退伍军人的意见来预测未来的趋势和需求。这 由于 VA 独特的优势，VA 是唯一能够进行如此及时、全面研究的机构。 开发了自然语言处理工具，可以快速确定患有转移性男性的病例 前列腺癌。 创新和影响：该提案有可能通过未来改变当前的临床实践 多层次干预，减少强化治疗的障碍并使高风险个体化治疗 退伍军人。创新的自然语言处理工具可以快速确定病例并预测未来的情况 识别新的转移患者，这只能在 VA 中完成。 具体目标： 目标 1：调查影响男性前列腺转移患者公平护理的因素 癌症。目标 2：对接受转移性前列腺癌治疗的男性进行实时安全性评估。 目标 3：了解转移性前列腺癌诊断后医生和患者的体验。 方法：所有被诊断患有转移性前列腺癌的患者均年满 18 岁。我们 将使用自然语言处理工具前瞻性地识别退伍军人，该工具可以识别具有新特征的男性 一旦在 VA 诊断出转移性前列腺癌。对于目标 1，我们将使用多级 用于评估邻里剥夺、患者人口统计数据和设施之间的关联的多变量模型 接受符合指南的强化治疗的因素。治疗强化定义为 雄激素剥夺疗法加多西紫杉醇或次要雄激素信号抑制剂（即， 阿比特龙、恩杂鲁胺、阿帕鲁胺）在转移诊断后四个月内。对于目标 2，我们将 比较与以下情况无关的情况下急诊室就诊、住院和门诊就诊的频率 癌症事件发生后一年诊断出临床试验中类似事件的转移性疾病，这是历史性的 VA 患者队列。对于目标 3，我们将在转移后四个月内调查不同的患者样本 诊断以了解他们接受癌症治疗的经历。我们还将调查一个 治疗这些患者的医生样本，以了解他们在分娩障碍方面的经历 治疗强化。 后续步骤/实施：我们将利用这项研究的结果来制定多层次的干预措施 将减少公平医疗服务的障碍，并帮助临床医生告知患者现实世界的风险 治疗强化。我们将与国家合作伙伴合作，在下一次实施此类干预措施 提议。