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Depression during the treatment phase was associated with significant health resource utilization, costs and mortality among men with prostate cancer. These findings emphasize the need to effectively identify and treat depression in the setting of prostate cancer.

Abstract:Background: Patient-centered care that encompasses informed decision making can improve treatment choice, quality of care and outcomes. Patient-centered care recognizes the need for major changes in the process of care that arranges health care system around the patient.Objective: Study objective was to evaluate and discuss the interplay of components of patient-centered care by developing a conceptual model of patient-centered care.Methods: Comprehensive literature review was conducted using Medline, CINAHL, and Cochrane databases. Included were English language studies addressing issues related to patient-centered-care and patient reported outcomes.Results: Though the concept of patient-centered care emerged in the early 50s, it exploded in the health care research policy arena exponentially in the late nineties. The conceptual model described here can aid objective and subjective evaluation of patient-centered care. As we strive to improve the quality of care, patient-centered care can play a pivotal role in this process. This however requires changes in our healthcare system so as to improve overall quality of care by minimizing wasteful health resource consumption. Conclusions:With healthcare costs projected to continue their rapid increase, the current paradigm of healthcare is unsustainable. More research is needed to explore the various attributes of patient-centered care, its acceptability, and comparative effectiveness in the healthcare arena.

The wide variation of cost estimates for the same diagnosis raises serious questions of comparability, accuracy, validity and usefulness of all studies. Implementing guidelines to standardise methods and study design for cost-of-illness studies would be a worthwhile first step. The advantages and disadvantages of using money or another metric such as disability-adjusted life-years as the prime outcome measure should also be publicly discussed.

It appears that although the web-based technology is gaining popularity and leads to lower cost per response, the conventional postal method of surveying continues to deliver a better response rate among the geriatric medicine division chiefs. The web-based approach holds promise given its lower costs and acceptable response rate combined with the shorter response time.

Key Points Question Is androgen deprivation therapy exposure associated with dementia among elderly patients with prostate cancer? Findings In this cohort study of 154 089 elderly men with prostate cancer, androgen deprivation therapy exposure was associated with subsequent diagnosis of Alzheimer disease or dementia over a follow-up period of at least 10 years. Meaning Clinicians must carefully weigh the long-term risks and benefits of exposure to androgen deprivation therapy in patients with a prolonged life expectancy and stratify patients by dementia risk prior to androgen deprivation therapy initiation.

BackgroundSubstance abuse is a growing, but mostly silent, epidemic among older adults. We sought to analyze the trends in admissions for substance abuse treatment among older adults (aged 55 and older).MethodsTreatment Episode Data Set - Admissions (TEDS-A) for period between 2000 and 2012 was used. The trends in admission for primary substances, demographic attributes, characteristics of substance abused and type of admission were analyzed.ResultsWhile total number of substance abuse treatment admissions between 2000 and 2012 changed slightly, proportion attributable to older adults increased from 3.4% to 7.0%. Substantial changes in the demographic, substance use pattern, and treatment characteristics for the older adult admissions were noted. Majority of the admissions were for alcohol as the primary substance. However there was a decreasing trend in this proportion (77% to 64%). The proportion of admissions for following primary substances showed increase: cocaine/crack, marijuana/hashish, heroin, non-prescription methadone, and other opiates and synthetics. Also, admissions for older adults increased between 2000 and 2012 for African Americans (21% to 28%), females (20% to 24%), high school graduates (63% to 75%), homeless (15% to 19%), unemployed (77% to 84%), and those with psychiatric problems (17% to 32%).The proportion of admissions with prior history of substance abuse treatment increased from 39% to 46% and there was an increase in the admissions where more than one problem substance was reported. Ambulatory setting continued to be the most frequent treatment setting, and individual (including self-referral) was the most common referral source. The use of medication assisted therapy remained low over the years (7% - 9%).ConclusionsThe changing demographic and substance use pattern of older adults implies that a wide array of psychological, social, and physiological needs will arise. Integrated, multidisciplinary and tailored policies for prevention and treatment are necessary to address the growing epidemic of substance abuse in older adults.

Objective. To determine the minimal important difference (MID) in generic and prostate-specific health-related quality of life (HRQoL) using distribution-and anchorbased methods. Study Design and Setting. Prospective cohort study of 602 newly diagnosed prostate cancer patients recruited from an urban academic hospital and a Veterans Administration hospital. Participants completed generic (SF-36) and prostate-specific HRQoL surveys at baseline and at 3, 6, 12, and 24 months posttreatment. Anchor-based and distribution-based methods were used to develop MID estimates. We compared the proportion of participants returning to baseline based on MID estimates from the two methods. Results. MID estimates derived from combining distribution-and anchor-based methods for the SF-36 subscales are physical function = 7, role physical = 14, role emotional = 12, vitality = 9, mental health = 6, social function = 9, bodily pain = 9, and general health = 8; and for the prostate-specific scales are urinary function = 8, bowel function = 7, sexual function = 8, urinary bother = 9, bowel bother = 8, and sexual bother = 11. Proportions of participants returning to baseline values corresponding to MID estimates from the two methods were comparable. Conclusions. This is the first study to assess the MID for generic and prostate-specific HRQoL using anchor-based and distribution-based methods. Although variation exists in the MID estimates derived from these two methods, the recovery patterns corresponding to these estimates were comparable. Key Words. Prostate cancer, health-related quality of life, minimal important difference, anchor based, distribution basedIn the era of comparative effectiveness, health status measures are assuming importance in the arena of patient-reported outcomes. Health-related quality of life (HRQoL) is an important component of patient-reported outcomes