Mass General Brigham is a Boston-based non-profit hospital and physicians network that includes Brigham and Women's Hospital (BWH) and Massachusetts General Hospital (MGH), two of the nation's most prestigious teaching institutions. It was founded in 1994 with H. Richard Nesson, MD, former president of Brigham and Women's Hospital as CEO of Mass General Brigham and Samuel O. Thier, MD, formerly president of Massachusetts General Hospital as president. According to The Boston Globe, by 2008, Mass General Brigham became Massachusetts' "largest private employer and its biggest healthcare provider, treating more than a third of hospital patients in the Boston metropolitan area"..
OBJECTIVE To evaluate adherence to treatment guideline recommendations across the continuum of prostate cancer (PCa) care by US community urologists using several PCa-specific performance indicators (PIs). Additionally, to determine which practice-related factors, such as having a designated PCa patient champion, active patient management in a patient portal, and in-office dispensing of medications, were associated with improved PI performance. METHODS Electronic medical record data were collected retrospectively from the PPS Analytics Patient Population Health Management Platform. The cohort consisted of adult patients with a PCarelated service visit during the period July 1, 2019 to June 30, 2022. Five PIs were reviewed: dual-energy x-ray absorptiometry scanning with androgen deprivation therapy (ADT), systemic therapy in metastatic PCa, external beam radiation therapy concurrent with ADT, image monitoring, and regular testosterone testing and monitoring. RESULTS A total of 101,186 patients were identified from 95 urology practices. PI adherence rates ranged from a low of 13.6% for a dual-energy x-ray absorptiometry scan within 6 months of ADT initiation to a high of 72.3% for external beam radiation therapy concurrent with ADT in intermediate-/high-risk localized PCa. The results also demonstrated that several practice-related features were associated with better PI adherence. CONCLUSION The findings suggest there exists a wide range in PI adherence rates for urologists in the delivery of community urology care in the United States compared to clinical guideline recommendations. Future research should examine the factors associated with PI nonadherence and promote implementation of interventions that enhance guideline-concordant care. UROLOGY 196: 147-154, 2025. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
GOAL:To present data from published clinical trials of treatment of patients with prostate cancer with enzalutamide described in plain language and in a dashboard format available at: https://clinical-trials.dimensions.ai/enzalutamide-clinical-review/. RATIONALE:Treatments that are clinically active in advanced prostate cancer may benefit patients as they are treated earlier in the disease. OBJECTIVE:To show how overall survival improves as patients are treated with enzalutamide earlier in the disease.
BACKGROUND:Although germline genetic testing can inform medical management for patients with prostate cancer (PCa), data are limited regarding patient-reported outcomes (PROs) after germline genetic testing for PCa. Recall and comprehension of germline genetic testing results, uptake of post-test clinical recommendations, and psychological impact of germline genetic testing among patients with PCa were evaluated. METHODS:This is a secondary analysis of data from the PROCLAIM trial. PROs were analyzed overall and by germline genetic testing results. Differences between groups were determined by two-tailed Fisher's exact test with significance set at p < 0.05. RESULTS:Among 494 patients with informative survey responses, 60% and 71% accurately recalled and interpreted their germline genetic testing results, respectively, with the highest rates among patients with negative results and the lowest among those with variant of uncertain significance-only (VUS) results. Among 42/55 (76%) patients with positive results for whom clinicians made germline genetic testing-informed recommendations, 39 (93%) completed or planned to complete >1 clinical recommendation. Conversely, no further recommendations were made for 160/221 (72%) and 211/218 (97%) patients with VUS and negative results, respectively. However, 57% (213/371) of these patients indicated that they or their family members intended to pursue clinical management strategies that were not recommended by their clinicians. Of the patients who responded to the survey, >90% of patients reported no post-germline genetic testing increase in their level of concern for themselves or their family members. CONCLUSION:germline genetic testing for patients with PCa did not cause appreciable psychological harm to the tested patients. Furthermore, patients with positive results had a high uptake of clinician-recommended management strategies. Of note, there were inconsistencies in the understanding of VUS results, with some clinicians making recommendations not warranted by personal/family history; conversely, some patients pursued management strategies not recommended by their clinicians. This suggests that educational efforts are needed in the communication of germline genetic testing results and clinical recommendations to patients.
**Background:** Bacillus Calmette-Guérin (BCG) can reduce recurrence and delay progression among patients with high-risk non–muscle invasive bladder cancer (NMIBC), but is associated with a substantial emotional, physical, and social burden. **Objectives:** This study evaluated the adequacy of first-line intravesical BCG treatment among high-risk NMIBC patients in the United States, including the subgroup with carcinoma in situ (CIS) of the bladder. **Methods:** Adults with high-risk NMIBC treated with BCG were selected from de-identified MarketScan® Commercial, Medicare, and Medicaid Databases (1/1/2010-2/28/2021). Adequacy of BCG induction and maintenance was evaluated from the first BCG claim until the end of the patient’s observation, using a previously published claims-based algorithm (induction: ≥5 instillations within 70 days; induction and maintenance: ≥7 instillations within 274 days of first instillation) and a definition based on the landmark Southwest Oncology Group (SWOG) trial (induction: ≥5 instillations without gaps >7 days; followed by ≥2 instillations at month 3, 6, and every 6 months thereafter). Proportions of patients with adequate BCG induction and maintenance were reported overall and compared between those with and without CIS. **Results:** Of 5803 high-risk NMIBC patients treated with first-line BCG (mean age, 67.3 years; 20.6% female), 930 (16.0%) had CIS. After first-line BCG, 56.6% received another treatment. Although 86.9% had adequate BCG induction based on the claims-based algorithm (SWOG, 73.6%), only 41.5% had adequate BCG induction and maintenance (SWOG, 1.6%). Similar trends were observed for patients with and without CIS, with higher adherence to guidelines for patients with CIS (adequate induction using claims-based algorithm: 90.3% vs 86.2%; adequate induction and maintenance: 50.8% vs 39.7%, all _P_ < .001). A greater proportion of CIS patients than non-CIS patients had cystectomy (CIS, 14.4%, non-CIS, 8.5%; _P_ < .001) after first-line BCG. **Discussion:** Among patients with NMIBC treated with first-line intravesical BCG, most received adequate BCG induction but less than half had adequate BCG maintenance. BCG treatment was also inadequate for patients with CIS, with only half of patients receiving adequate BCG maintenance and a higher proportion undergoing cystectomy following first-line BCG. **Conclusions:** Results emphasize the need for additional treatment options for patients with NMIBC.
Patients diagnosed with prostate cancers are eligible for genetic testing to identify any hereditary variants that may offer physicians with significant information on treatment options. According to National Comprehensive Cancer Network (NCCN) guidelines for prostate cancer, family members of the prostate cancer patients with germline variants may qualify for genetic testing as well for risk management or surveillance means. The current industry average turnaround time for hereditary prostate genetic tests is around two weeks and this can create unnecessary anxiety in cancer patients.
