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：超过500万的越南退伍军人将在2023年的70年代（转移性前列腺 癌症通常被诊断出来 - 黑人和男性以几乎两倍的速度暴露于橙色的橙色。 幸运的是，新疗法改善了转移性前列腺癌男性的生存率。然而， 向这群成长中的男人提供新疗法非常复杂，并引起了对公平，安全性， 和资深经验。 意义：该提案将向面临的指导方案护理提供有关障碍的知识 患有转移性前列腺癌的退伍军人，治疗的安全以及退伍军人的经验 转移性前列腺癌。该提案直接与退伍军人事务部财政年度保持一致 2022-28战略计划（目标1和2），以消除健康的差异和障碍，以增强退伍军人 成果，经验和生活质量，以及通过倾听退伍军人来预测未来的趋势和需求。 VA是唯一可以进行如此及时，全面研究的机构，因为独特的VA- 开发的自然语言处理工具，可以快速确定转移性的男性 前列腺癌。 创新与影响：该提案有可能通过未来改变当前的临床实践 多层次干预措施减轻治疗加强的障碍并将治疗个性化为高风险 退伍军人。创新的自然语言处理工具允许快速确定前景 识别新的转移性患者，只能在VA中进行。 具体目的：目标1：调查影响有事件转移性前列腺男性公平护理的因素 癌症。目的2：对因事件转移性前列腺癌治疗的男性进行实时安全评估。 目标3：诊断出事件转移性前列腺癌后了解身体和患者的经验。 方法论：所有患者均为18岁或以上，并诊断出入射转移性前列腺癌。我们 可能会使用自然语言处理工具来识别退伍军人 前列腺癌在VA中被诊断出来。对于AIM 1，我们将使用多级 多变量模型，以评估社区剥夺，患者人口统计和设施的关联 收到指南符合治疗强化的因素。治疗强化定义为 雄激素剥夺疗法加上多西他赛或继发雄激素信号抑制剂（即 阿比罗酮，enzalutamide，apalutamide）在转移性诊断后的四个月内。对于目标2，我们将 比较急诊室就诊，住院和门诊就诊的频率无关 癌症在临床试验中发生转移性疾病的事件诊断为类似事件和历史性的癌症 VA患者队列。对于AIM 3，我们将在转移的四个月内调查患者的潜水员样本 诊断以了解他们接受癌症治疗的经验。我们还将调查 对治疗这些患者的医生样本，以了解他们交付障碍的经验 治疗强化。 下一步/实施：我们将使用本研究的发现来开发多层次干预措施 将减轻公平护理交付的障碍，并帮助临床医生将现实世界的风险告知患者 治疗强化。我们将与国家合作伙伴合作，在下一个 提议。