Community health centers (CHCs) should be important partners in research with academic health centers (AHCs). While persistent barriers to CHC-AHC partnerships have been described, our understanding of the potential solutions to these barriers is limited. This study aims to identify recommendations to support sustainable research partnerships between CHCs and AHCs to advance community-engaged health research. We conducted a qualitative study using interviews with CHC-based participants from three community health care organizations and researchers from one AHC. Twenty-five participants completed 12 individual interviews and six small group interviews. Five specific barriers to operationalizing research partnerships between CHCs and AHCs were identified, along with several recommendations to address these barriers. Recommendations are categorized into two domains-the first set calls for practical steps for researchers to adopt when conducting research, while the second set calls for deliberate, and leadership-led activities that support the creation of systemwide research partnerships between CHCs and AHCs.

INTRODUCTION:Relationships between Alzheimer's disease neuropathology, residential neighborhood, and cognitive impairment remain incompletely understood. METHODS:We examined whether residence within a disadvantaged neighborhood was associated with amyloid positron emission tomography (PET) positivity. We used data from the observational, multisite, Imaging Dementia-Evidence for Amyloid Scanning study that included cognitively impaired Medicare beneficiaries. Our secondary analysis examined multivariable-adjusted associations between neighborhood disadvantage (measured by Area Deprivation Index [ADI] deciles 1-90 vs. 91-100 representing greatest disadvantage) and amyloid PET positivity. RESULTS:Among 15,346 White, 829 Latino, 637 Black/African American, and 321 Asian individuals, 51% were female, mean age was 75.7 years, 535 (3.8%) resided in ADI 91 to 100 decile, and 61.6% were amyloid PET positive. The ADI 91-100 decile was associated with lower odds of PET positivity by visual interpretation (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.67-0.96, p ≤ .001) but not PET Centiloid value ≥ 40 versus ≤ 10 (OR 0.81, 95% CI 0.66-1.01, p = 0.060). CONCLUSION:Residence in the most disadvantaged neighborhoods may be associated with lower amyloid pathology in cognitively impaired individuals.

Consensus on optimal prostate cancer screening remains elusive. Prostate-specific antigen (PSA) testing of patients in their 40–50 s is highly predictive of aggressive disease, yet remains underutilized; Black patients face excess mortality burden, particularly at younger ages. We describe a novel age and baseline PSA-stratified protocol to mitigate harms of overdiagnosis and reduce burden of disease, particularly for Black patients, with implementation by primary care providers (PCPs) in an academic healthcare system. We developed an evidence-based, age- and baseline PSA-stratified protocol and disseminated it to PCPs via talks and written materials beginning in 2016, with implementation as a health maintenance banner in the electronic health record (EHR) in 2019. EHR data were searched for rates of PSA screening within the prior 5 years in patients aged 40–90 from 2015 to 2021. We examined associations between age and race with receipt of PSA testing over time. Multivariable hierarchical mixed effects regression was performed to identify testing predictors, with clinic and provider included as nested random effects. Across 99,994 encounters, guideline-concordant PSA screening increased from 32.7 to 45.8

African American/Black men are disproportionately impacted by prostate cancer (PCa). Patient navigation is an evidence-based approach to address barriers to care, improve access to care and health outcomes, and reduce disparities. This scoping review provides an in-depth examination of navigation programs in PCa care across the cancer continuum, with a focus on African American/Black men in the United States. We conducted a comprehensive literature search through September 1st, 2023, in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms within three main themes: PCa, patient navigation, and African American/Black men. We included studies that described or investigated navigation programs/interventions for PCa from screening through survivorship and included at least 30

Background: Community health centers (CHCs) and those most burdened by disease are important partners in setting research agendas to address the needs of people who are medically underserved.Objectives: Identify and prioritize health equity-focused research priorities using a collaborative approach to community engagement of key informants.Methods: We used five stepwise phases from January 2021 to February 2023 to formulate and prioritize a set of health equity-focused research topics among CHC staff (leaders, clinicians), their key advisors (patients and community members), and researchers from academic medical centers in California. Phases included: (1) community advisory board formation, (2) key informant identification, (3) individual/small group interview guide development and administration, (4) initial health equity-focused topic categorization, and (5) in-person meeting with community advisors for final topic prioritization using nominal group technique.Results: Twenty individual or small group interviews were completed with 44 diverse participants, along with engagement from our community advisory board, which resulted in an initial list of 11 health equity-focused research topics. Ninety advisors including diverse community members, CHC staff/leaders, and researchers prioritized six overarching research topics. Final prioritized health-equity focused research topics include addressing mental health challenges, improving public's trust in healthcare and science, healthcare delivery models to increase access and utilization, build and sustain an anti-racist healthcare system, strategies and interventions to address health misinformation, and continuing and sustaining polices based on lessons learned from COVID-19.Conclusions: Results offer future direction for community-engaged research agendas to advance health equity among medically underserved and vulnerable patient populations.

OBJECTIVE:Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs' longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs. METHODS:25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022. We used thematic content analysis to identify key themes. RESULTS:Key themes emerged for three pandemic phases: shutdown, pivot, and recovery. During the shutdown, CHCs paused non-urgent services and in-person outreach while facing increased strain on staff capacity. Although CHCs were traditionally siloed, the pivot phase yielded efforts to build trust through information dissemination, partnerships with other health care organizations, and unprecedented innovations in care delivery. During recovery, CHCs re-prioritized preventive care but continued to face poor access to specialty care and socioeconomic resources for their patients. CONCLUSIONS:The COVID-19 pandemic magnified extant barriers within CHCs, including limitations in funding, staff capacity, and infrastructure for collaboration. CHC constituents highlight lessons learned through organization-wide adaptations and opportunities for the continuation and expansion of pandemic-related changes (e.g., investments in CHCs' workforce, care delivery infrastructure, and avenues for multidisciplinary collaboration) to better serve their communities in the post-COVID era.

Objective Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs’ longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs. Methods 25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022. We used thematic content analysis to identify key themes. Results Key themes emerged for three pandemic phases: shutdown, pivot, and recovery. During the shutdown, CHCs paused non-urgent services and in-person outreach while facing increased strain on staff capacity. Although CHCs were traditionally siloed, the pivot phase yielded efforts to build trust through information dissemination, partnerships with other health care organizations, and unprecedented innovations in care delivery. During recovery, CHCs re-prioritized preventive care but continued to face poor access to specialty care and socioeconomic resources for their patients. Conclusions The COVID-19 pandemic magnified extant barriers within CHCs, including limitations in funding, staff capacity, and infrastructure for collaboration. CHC constituents highlight lessons learned through organization-wide adaptations and opportunities for the continuation and expansion of pandemic-related changes (e.g., investments in CHCs’ workforce, care delivery infrastructure, and avenues for multidisciplinary collaboration) to better serve their communities in the post-COVID era.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (PD19)1 May 2024PD19-05 SMARTER SCREENING AND TREATMENT (S3T): MITIGATING HARM VIA AGE- & BASELINE-PROSTATE SPECIFIC ANTIGEN-STRATIFIED SCREENING James Nie, Nynikka R. Palmer, Rena J. Pasick, Maria Byron, Claire M. de la Calle, Samuel L. Washington, Coleen Kivlahan, Michael B. Potter, and Matthew Cooperberg James NieJames Nie , Nynikka R. PalmerNynikka R. Palmer , Rena J. PasickRena J. Pasick , Maria ByronMaria Byron , Claire M. de la CalleClaire M. de la Calle , Samuel L. WashingtonSamuel L. Washington , Coleen KivlahanColeen Kivlahan , Michael B. PotterMichael B. Potter , and Matthew CooperbergMatthew Cooperberg View All Author Informationhttps://doi.org/10.1097/01.JU.0001009448.41537.64.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Consensus on optimal prostate cancer screening to reduce over and under treatment remains elusive. Prostate-specific antigen (PSA) testing of men in their 40s and 50s is highly predictive of aggressive disease, yet is underutilized. Black men, particularly those under 50, face excess mortality burden. We describe: i) a novel age & baseline PSA stratified protocol to mitigate harms of overdiagnosis and reduce burden of disease for Black men, in particular; ii) implementation by primary care providers (PCPs) in an academic health system. METHODS: An evidence-based age & baseline-PSA stratified protocol was developed by a multidisciplinary task force and disseminated to PCPs via continuing medical education. In July 2019, the protocol was implemented as a health maintenance banner in the electronic health record (EHR). EHR data were searched for rates of PSA screening by PCPs in men aged 40-90 by provider and clinic setting from 2015-2021. We examined associations between age and race with receipt of PSA testing over time. Multivariable hierarchical regression was performed to identify testing predictors, with clinic and provider included as nested random effects. RESULTS: Across 18,203 patients, PSA screening increased from 29.1% in 2015 to 39.6% in 2021 (p<0.001) and was noted across all age groups and despite COVID-19. Notably, PSA screening among Black men increased from 29.7% in 2015 to 52.8% in 2021, with younger Black men exhibiting the following gains: 40-44 (4.4% to 7.0%), 45-49 (38.5% to 56.1%), 50-54 (44.7% to 58.6%). In a mixed effects model, Black men were more likely to undergo PSA screening (OR 1.39, 95% CI 1.34-1.44). Screening was less likely in geriatric clinics and there was a wide range in screening (0 to 75%) across individual PCPs in all departments. CONCLUSIONS: Increased PSA screening can be obtained for younger men and Black men following multidisciplinary collaboration, PCP outreach, and an EHR-based intervention. Significant provider variation in screening rates persist, suggesting the need for continued conversation with PCPs. Download PPTDownload PPT Source of Funding: San Francisco Cancer Initiative Prostate Cancer Task Force, UCSF Helen Diller Family Comprehensive Cancer Center © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e441 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information James Nie More articles by this author Nynikka R. Palmer More articles by this author Rena J. Pasick More articles by this author Maria Byron More articles by this author Claire M. de la Calle More articles by this author Samuel L. Washington More articles by this author Coleen Kivlahan More articles by this author Michael B. Potter More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Connecting individuals to existing community resources is critical to addressing social needs and improvingpopulation health. While there is much ongoing informatics work embedding social needs screening and referrals into healthcare systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective: We used human-centered design to develop a digital platform for CBOs, focused on identification of health andsocial resources and communication with their clients. Methods: Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedbackto theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the finalproduct and summarized all major design decisions as the platform development proceeded. Results: Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutiveDevelop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, andexternal factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software tomanage their client interactions and communications, and they needed specific additional features to address the scope of theireveryday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevantcommunity resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needsemerged, such as digital training and support for staff using new platforms. The final platform, titled "Mapping to Enhancethe Vitality of Engaged Neighborhoods (MAVEN)," was completed in the Salesforce environment in 2022, and it includedfeatures and functions directly mapped to the design process. Conclusions: Engaging community organizations in user-centered design of a health and social resource platform wasessential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informedby behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will benecessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, andcustomization needed in these settings.

Prostate cancer is often an indolent disease, and delays in treatment up to 6 months do not seem to affect cancer-free survival. Inadequate pre-treatment assessment and uninformed shared decision-making can lead to decision regret and disparities in receipt of treatments. Time is on our side to allocate sufficient time and resources to consider the most appropriate and individualized treatment decision in prostate cancer care.

Background There are more than 18 million cancer survivors in the United States. Yet, survivors of color remain under-represented in cancer survivorship research (Saltzman et al. in Contemp Clin Trials Commun 29:100986, 2022; Pang et al. in J Clin Oncol 34:3992–3999, 2016; Lythgoe et al. in Prostate Cancer Prostatic Dis 24:1208–1211, 2021). Our long-term goal is to enroll and follow a cohort of historically under-represented cancer survivors, to better understand modifiable risk factors that influence clinical and quality of life outcomes in these populations. Towards that goal, we describe herein how we applied community-based participatory research approaches to develop inclusive study materials for enrolling such a cohort. Methods We implemented community engagement strategies to inform and enhance the study website and recruitment materials for this cohort including: hiring a dedicated engagement coordinator/community health educator as a member of our team; working with the Helen Diller Family Comprehensive Cancer Center Office of Community Engagement (OCE) and Community Advisory Board members; presenting our educational, research, and study recruitment materials at community events; and establishing a community advisory group specifically for the study (4 individuals). In parallel with these efforts, 20 semi-structured user testing interviews were conducted with diverse cancer survivors to inform the look, feel, and usability of the study website. Results Engagement with community members was a powerful and important approach for this study’s development. Feedback was solicited and used to inform decisions regarding the study name (eat move sleep, EMOVES), logo, study website content and imagery, and recruitment materials. Based on community feedback, we developed additional educational materials on healthy groceries and portion size in multiple languages and created a study video. Conclusions Including an engagement coordinator as a permanent team member, partnering with the institutional community outreach and engagement resources (i.e., OCE), and allocating dedicated time and financial support for cultivating relationships with stakeholders outside the university were critical to the development of the study website and materials. Our community guided strategies will be tested as we conduct enrollment through community advisor networks and via the state cancer registry.

BACKGROUND:Active surveillance (AS) is recommended for low-risk and some intermediate-risk prostate cancer. Uptake and practice of AS vary significantly across different settings, as does the experience of surveillance-from which tests are offered, and to the levels of psychological support. OBJECTIVE:To explore the current best practice and determine the most important research priorities in AS for prostate cancer. DESIGN, SETTING, AND PARTICIPANTS:A formal consensus process was followed, with an international expert panel of purposively sampled participants across a range of health care professionals and researchers, and those with lived experience of prostate cancer. Statements regarding the practice of AS and potential research priorities spanning the patient journey from surveillance to initiating treatment were developed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Panel members scored each statement on a Likert scale. The group median score and measure of consensus were presented to participants prior to discussion and rescoring at panel meetings. Current best practice and future research priorities were identified, agreed upon, and finally ranked by panel members. RESULTS AND LIMITATIONS:There was consensus agreement that best practice includes the use of high-quality magnetic resonance imaging (MRI), which allows digital rectal examination (DRE) to be omitted, that repeat standard biopsy can be omitted when MRI and prostate-specific antigen (PSA) kinetics are stable, and that changes in PSA or DRE should prompt MRI ± biopsy rather than immediate active treatment. The highest ranked research priority was a dynamic, risk-adjusted AS approach, reducing testing for those at the least risk of progression. Improving the tests used in surveillance, ensuring equity of access and experience across different patients and settings, and improving information and communication between and within clinicians and patients were also high priorities. Limitations include the use of a limited number of panel members for practical reasons. CONCLUSIONS:The current best practice in AS includes the use of high-quality MRI to avoid DRE and as the first assessment for changes in PSA, with omission of repeat standard biopsy when PSA and MRI are stable. Development of a robust, dynamic, risk-adapted approach to surveillance is the highest research priority in AS for prostate cancer. PATIENT SUMMARY:A diverse group of experts in active surveillance, including a broad range of health care professionals and researchers and those with lived experience of prostate cancer, agreed that best practice includes the use of high-quality magnetic resonance imaging, which can allow digital rectal examination and some biopsies to be omitted. The highest research priority in active surveillance research was identified as the development of a dynamic, risk-adjusted approach.

BackgroundPatient and provider race and gender concordance (patient and physician identify as the same race/ethnicity or gender) may impact patient experience and satisfaction.ObjectiveWe sought to examine how patient and physician racial and gender concordance effect patient satisfaction with outpatient clinical encounters. Furthermore, we examined factors that changed satisfaction among concordant and discordant dyads.DesignConsumer Assessment of Healthcare Provider and Systems (CAHPS) Patient Satisfaction Survey Scores were collected from outpatient clinical encounters between January 2017 and January 2019 at the University of California, San Francisco.ParticipantsPatients who were seen in the eligible time period, who voluntarily provided physician satisfaction scores. Providers with fewer than 30 reviews and encounters with missing data were excluded.Main MeasuresPrimary outcome was rate of top satisfaction score. The provider score (1-10 scale) was dichotomized as "top score (9-10)" and "low scores (<9)."Key ResultsA total of 77,543 evaluations met inclusion criteria. Most patients identified as White (73.5%) and female (55.4%) with a median age of 60 (IQR 45, 70). Compared to White patients, Asian patients were less likely to give a top score even when controlling for racial concordance (OR: 0.67; CI 0.63-0.714). Telehealth was associated with increased odds of a top score relative to in-person visits (OR 1.25; CI 1.07-1.48). The odds of a top score decreased by 11% in racially discordant dyads.ConclusionsRacial concordance, particularly among older, White, male patients, is a nonmodifiable predictor of patient satisfaction. Physicians of color are at a disadvantage, as they receive lower patient satisfaction scores, even in race concordant pairs, with Asian physicians seeing Asian patients receiving the lowest scores. Patient satisfaction data is likely an inappropriate means of determining physician incentives as such may perpetuate racial and gender disadvantages.

ObjectiveTo understand how patients and primary care practitioners (PCPs) discuss racism and their perspectives on having these conversations during primary care visits. Data Sources/Study SettingWe conducted semi-structured interviews from September 2020-March 2021 at a Federally Qualified Health Center in the San Francisco Bay Area. Study DesignWe conducted an inductive qualitative descriptive pilot study using one-on-one, semi-structured interviews with 5 members of a Patient Advisory Council and 10 internal medicine PCPs. Data Collection/Extraction MethodsInterviews were conducted via video conferencing, recorded, and transcribed. An iterative analytic process was used to thematically assess participants' experiences and perspectives and identify key themes. Principal FindingsPatients and PCPs identified benefits from engaging in conversations about racism during primary care visits and noted challenges and concerns. Patients and PCPs highlighted strategies to advance communication about racism in primary care. ConclusionsInitiating conversations about racism with patients in primary care can be meaningful, but also has risks. More research is needed for deeper exploration of patients' perspectives and development of trainings. Improving how PCPs communicate with patients about racism represents an opportunity to advance antiracism in medicine and improve health outcomes for individuals who have historically been poorly served by our health care system.

Abstract Introduction We aim to characterize the magnitude of the work burden (weeks off from work) associated with prostate cancer (PCa) treatment over a 10‐year period after PCa diagnosis and identify those at greatest risk. Materials and Methods We identified men diagnosed with PCa treated with radical prostatectomy, radiation therapy, or active surveillance/watchful waiting within CaPSURE. Patients self‐reported work burden and SF36 general health scores via surveys before and 1,3,5, and 10 years after treatment. Using multivariate repeated measures generalized estimating equation modeling we examined the association between primary treatment with risk of any work weeks lost due to care. Results In total, 6693 men were included. The majority were White (81%, 5% Black, and 14% Other) with CAPRA low‐ (60%) or intermediate‐risk (32%) disease and underwent surgery (62%) compared to 29% radiation and 9% active surveillance. Compared to other treatments, surgical patients were more likely to report greater than 7 days off work in the first year, with relatively less time off over time. Black men (RR 0.64, 95% CI 0.54–0.77) and those undergoing radiation (vs. surgery, RR 0.46, 95% CI 0.41–0.51) were less likely to report time off from work over time. Mean baseline GH score (73 [SD 18]) was similar between race and treatment groups, and stable over time. Conclusions The work burden of cancer care continued up to 10 years after treatment and varied across racial groups and primary treatment groups, highlighting the multifactorial nature of this issue and the call to leverage greater resources for those at greatest risk.

Objective To analyze the factors associated with non-attendance at a urology telehealth clinic in a large urban safety-net hospital after institutional-mandated transition to telehealth due to COVID-19. Methods We identified all encounters scheduled for telehealth after March 17, 2020 and in the subsequent 8 weeks. Logistic regression was used to identify factors associated with attendance. Results In total there were 322 telehealth encounters, 228 (70.8%) of which were attended and 94 (29.2%) that were not attended. Racial/ethnic minorities accounted for 175 (77.0%) of attended and 73 (76.7%) of non-attended encounters. On multivariable regression, single/divorced/widowed (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.26-4.43), current substance use disorder (OR 5.33, 95% CI 2.04-13.98), and being scheduled for a new patient appointment (OR 1.81, 95% CI 1.04-3.13) were associated with higher odds of not attending a telehealth encounter. Race/ethnicity, primary language, and country of birth were not associated with odds of attendance. Conclusion Our findings identify several social factors (social support, substance use) associated with non-attendance at outpatient telehealth urology encounters at an urban safety-net hospital during the early stages of the COVID-19 pandemic. These barriers may have a greater impact specifically within a safety-net healthcare system and will inform equitable provision of urology telehealth programs in the future Funding Goldberg-Benioff Endowed Professorship in Cancer Biology. The sponsors had no involvement with this study.

BACKGROUND:The excess incidence and mortality due to prostate cancer that impacts African American men constitutes the largest of all cancer disparities. Patient navigation is a patient-centered healthcare system intervention to eliminate barriers to timely, high-quality care across the cancer continuum and improves health outcomes among vulnerable patients. However, little is known regarding the extent to which navigation programs include cultural humility to address prostate cancer disparities among African American men. We present a scoping review protocol of an in-depth examination of navigation programs in prostate cancer care-including navigation activities/procedures, training, and management-with a special focus on cultural context and humility for African American men to achieve health equity. METHODS:We will conduct comprehensive searches of the literature in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms (Mesh and Emtree) within the three main themes: prostate cancer, patient navigation, and African American men. We will also conduct a search of the gray literature, hand-searching, and reviewing references of included papers and conference abstracts. In a two-phase approach, two authors will independently screen titles and abstracts, and full-text based on inclusion/exclusion criteria. All study designs will be included that present detailed data about the elements of navigation programs, including intervention content, navigator training, and/or management. Data will be extracted from included studies, and review findings will be synthesized and summarized. DISCUSSION:A scoping review focused on cultural humility in patient navigation within the context of eliminating disparities in PCa care among African American men does not yet exist. This review will synthesize existing evidence of patient navigation programs for African American prostate cancer patients and the inclusion of cultural humility. Results will inform the development and implementation of future programs to meet the unique needs of vulnerable prostate cancer patients in safety net settings. SYSTEMATIC REVIEW REGISTRATION:PROSPERO 2021 CRD42021221412.

Introduction: Cancer precision medicine as part of standard of care (SOC) or clinical trials (CT) requires access to high cost advanced diagnostics and therapeutics.The difference in out-of-pocket (OOP) costs associated with cancer treatment as part of SOC versus CTs remains limited.This study sought to evaluate the varying financial burden and toxicity among cancer patients receiving treatment at an academic medical center as part of a CT versus SOC.Methods: Patients presenting to medical oncology clinic at an academic medical center for a new or follow-up visit, who were English-speaking and able to provide informed consent, were approached for a one-time survey from July 2018 to August 2020.Study participants provided demographic, clinical, financial, and patient reported outcomes data.Results: A total of 67 participants completed the survey.In the study, CT participants were significantly younger than SOC participants (CT, mean 57 years, SD=13.5;SOC, mean 67, SD=10.7;p=0.002).The mean time since diagnosis was significantly longer among SOC participants at 7.9 years (SD=7.3)compared to CT participants at 2.7 years (SD=3.9)(p=.001).Most participants were non-Hispanic white (SOC, 78%; CT 71%).A significantly higher proportion of CT participants reported OOP cost exceeding $1,000 in the prior 30 days compared to SOC participants (SOC, 8.3%; CT, 16.1%, p<0.001).Significantly more SOC participants felt very comfortable discussing cost with their cancer doctor compared to CT participants (SOC, 69%; CT, 35%; p=0.02).Discussion: This study observed significantly higher OOP cost and financial toxicity among participants receiving treatment within a CT compared to SOC.Future research will need to fully evaluate the financial burdens associated with CT participation.

You have accessJournal of UrologyCME1 May 2022MP28-10 10-YEAR OUTCOMES IN WORK LOSS, PHYSICAL FUNCTION, AND MENTAL HEALTH OF 6,693 MEN UNDERGOING PRIMARY TREATMENT FOR PROSTATE CANCER Samuel Washington, Peter Lonergan, Janet Cowan, Shoujun Zhao, Scott Greenberg, Jenny Broering, Nynikka Palmer, Robert Parker, Alexander Bell, Matthew Cooperberg, and Peter Carroll Samuel WashingtonSamuel Washington More articles by this author , Peter LonerganPeter Lonergan More articles by this author , Janet CowanJanet Cowan More articles by this author , Shoujun ZhaoShoujun Zhao More articles by this author , Scott GreenbergScott Greenberg More articles by this author , Jenny BroeringJenny Broering More articles by this author , Nynikka PalmerNynikka Palmer More articles by this author , Robert ParkerRobert Parker More articles by this author , Alexander BellAlexander Bell More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002571.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with prostate cancer (PCa) often consider their work (time off) and health when choosing between management options. Using the CaPSURE database, we examine associations between PCa treatment and work loss, physical function, and mental health within ten years of initial management. METHODS: We identified men with PCa managed with radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy (BT), or active surveillance/watchful waiting (AS/WW), in a longitudinal study of 43 primarily community-based US urology practices. Data on work type [full-time, part-time, or retired/unemployed/disabled)], physical labor (PL, y/n), weeks of work missed, number of clinic visits annually, physical function (PF) and mental health (MH) were collected prior to treatment and 1,3,5 and 10 years after treatment. We examined associations between treatment and work weeks missed, PF, and MH using repeated measures GEE and generalized linear mixed modeling adjusted for clinical, health behaviors, and demographics. Estimates were reported as relative risk (RR) and 95% confidence intervals or slope and standard error (SE). A p<0.05 was significant. RESULTS: We identified 6,673 men, with mean age at diagnosis of 64.4 years (SD 8.3). Most were insured (54% private, 43% Medicare), white (90%, 7% Black, 1% Latino) with low- (60%) or intermediate-risk (32%) disease by CAPRA score. Most had paid work (44%) or were retired (45%) and underwent RP (62%, 14% BT, 14% EBRT, 10% AS/WW). Men missed median 5.3 weeks in first year (IQR 1.6-12.2) with up to 2.1 weeks missed at all other time points. Full-time work (RR 1.5, 95% 1.34-1.64), part time work (RR 1.19, CI 1.03-1.38), and PL (RR 1.17, 95% CI 1.05-1.30) conferred greater risk of long-term work loss. Full time (slope +17.7, SE 0.7) and part time work (slope +8.9, SE 0.9) maintained long-term PF. Treatment was not associated with long term work loss or changes in PF. MH was maintained with full time (slope +1.7, SE 0.5) and part time work (slope +2.3, SE 0.6). AS/WW (slope +1.5, SE 0.7) maintained MH while declining with BT (slope -0.8, SE 0.6) and EBRT (slope -0.9, SE 0.6). CONCLUSIONS: Most men undergoing PCa treatment for PCa continued to miss work due to cancer care for years after treatment. Employment maintained MH and PF over time. Compared to RP, AS/WW maintained long-term MH scores while BT and RT noted declines over time. When counseling men, long-term impact of PCa treatment on work and health should be carefully discussed thoroughly. Source of Funding: UCSF Goldberg-Benioff Program in Translational Cancer Biology © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e464 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Washington More articles by this author Peter Lonergan More articles by this author Janet Cowan More articles by this author Shoujun Zhao More articles by this author Scott Greenberg More articles by this author Jenny Broering More articles by this author Nynikka Palmer More articles by this author Robert Parker More articles by this author Alexander Bell More articles by this author Matthew Cooperberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF DownloadLoading ...