Long-term follow-up care among prostate cancer patients is important as biochemical recurrence can occur many years after diagnosis, with 20%–30% of men experiencing biochemical recurrence within 10 years of treatment. This study examined predictors of follow-up care among 1,158 radical prostatectomy patients, treated at the Washington University in St. Louis, within 6 months, 1 year, and 2 years post surgery. Predictors examined included age at surgery, race (Black vs. White), rural/urban status, education, marital status, and prostate cancer aggressiveness. Multivariable logistic regression was used to assess the association between the predictors and follow-up visits with a urologist in 6 months, the 1st year, and the 2nd year post surgery. In a secondary analysis, any follow-up visit with a prostate-specific antigen (PSA) test was included, regardless of provider type. Men that were Black (6 months OR: 0.60; 95% CI [0.36, 0.99], 1 year OR: 0.34; 95% CI [0.20, 0.59], 2 year OR: 0.41; 95% CI [0.25, 0.68]), resided in a rural residence (1 year OR: 0.61; 95% CI [0.44, 0.85], 2 year OR: 0.41; 95% CI [0.25, 0.68]), or were unmarried (2 year OR: 0.69; 95% CI [0.49, 0.97]) had a reduced odds of follow-up visits with a urologist. In models where any follow-up visit with a PSA test was examined, race remained a significant predictor of follow-up. The results indicate that Black men, men residing in a rural residence, and unmarried men may not receive adequate long-term follow-up care following radical prostatectomy. These men represent a high-risk group that could benefit from increased support post treatment.
This study aims to evaluate follow-up activities completed by participants attending community prostate cancer (PCa) screening events. On-site surveys were collected from participants of 17 free PCa screening events from 2007 to 2011 in the St. Louis, MO metropolitan area. Follow-up action surveys were mailed to all on-site participants to assess medical (i.e., made an appointment with a doctor, got additional testing for PCa, made an appointment to be screened) and nonmedical activities (i.e., sought social support, health information-seeking, health behavior modifications) completed after the PCa screening event. Further, t tests and chi-square tests characterized participant information from the on-site survey and within each follow-up activity category for the mailed surveys. Among 1,088 on-site community PCa screening participants, the mean age was 50 years old, 94% were Black, and 30% responded to the mailed follow-up action survey. For the recorded follow-up activities, 65% of participants reported medically reported activities, of which “made an appointment to get a yearly physical” was the most common action (29%). Health behavior modifications were the most common nonmedically related activities (44%). Health information-seeking behaviors were the least reported follow-up action (22%). Men with higher incomes, married, with health insurance, and a primary care physician, most often participated in post-PSA screening activities, namely medically-related and social support activities. Understanding the most common activities completed by participants of a community PCa screening suggests the effectiveness of community events to re-engage underserved populations in the health-care system and provides insight on acceptable health promotion opportunities.
Background: Advances in screening and treatment of prostate cancer have dramatically increased the number of survivors in the US population. Prostate cancer is the most common cancer in men, and given its long natural history and with onset beginning around ages 50-60 years old, it will continue to rise and affect our aging population. Long-term survivorship care requires follow-up and ongoing discussions about care planning and health behaviors to mitigate the long-term risks of cancer. However, there is little research on the early phases of post-treatment and limited preparation for patients about what they should be doing to optimize their health in this time frame, including the importance of bi-annual and annual follow-up appointments. Therefore, it is important to understand patient characteristics associated with post-treatment follow-up appointments for prostate cancer patients. In this study, we aim to identify characteristics associated with 6-month, 1-year and 2-year follow-up visits after prostatectomy. Methods: A prostate cancer clinical cohort of 1,694 prostate cancer prostatectomy patients was analyzed. The 3 outcome variables: 6-month follow-up, 1-year follow-up, and 2-year follow-up were created by assessing time between date of surgery and dates of office visit within a two month window. Individual characteristics assessed were race, age, rural/urban status of patient, high-risk status of patient's prostate cancer and education. Descriptive statistics using chi-square test for categorical variables and t-tests for continuous variables were conducted. Logistic regression analyses assessed the association of each outcome variable and the individual characteristics above. Results: 6-month follow-up: Patients who live in rural areas were less likely to have a 6-month follow-up compared to patients who live in urban areas (OR=0.667 95%CI:0.539,0.825). 1-year follow-up: Patients diagnosed with high-risk disease were more likely to attend their 1-year follow-up appointment compared to low-risk patients (OR=1.376 95%CI:1.107,1.712); Patients who live in rural areas were less likely to attend 1-year follow-up (OR=0.838 95%CI:0.664,1.05); and African-American patients were less likely to attend 1-year follow-up compared to White patients (OR=0.509 95%CI:0.346,0.749). 2-year follow-up: High risk patients were more likely to attend 2-year follow-up (OR=1.413 95%CI:1.10,1.813). Conclusion: African-American patients and patients who live in rural areas are less likely to return to follow-up visits after prostatectomy. High-risk patients who have more advanced disease, are more likely to return to follow-up visits. Survivorship care plans should focus on strategies to increase follow-up retention for rural and African-American patients. Note: This abstract was not presented at the conference. Citation Format: Bettina F. Drake, Veronica Hicks, Danielle Rancilio. Predictors of Follow-up Visits Post-Prostatectomy. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A71.
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