SS 10 - Patient Reported Outcomes/QoL/Survivorship 1: Fixing What's Broken and Reaching for the Sky
Presenter(s)
R. C. Chen1, S. Pugh2, P. A. Ganz3, G. D. A. Padula4, B. F. Koontz5, L. Cannick III6, P. J. Vetter7, O. Thomas8, H. A. Yoon9, I. Abdalla10, H. B. Mackley11, C. H. Chapman12, M. D. Cheney13, J. M. Kilburn14, E. McTyre15, S. Gupta-Burt16, R. Paulus17, and M. E. Cooley18; 1Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, 2The American College of Radiology, Philadelphia, PA, 3University of California Los Angeles, Los Angeles, CA, 4Bon Secours Mercy Health, Youngstown, OH, 5AdventHealth Cancer Institute, Orlando, FL, 6Blue Ridge Radiation Oncology, Anderson, SC, 7Aspirus Regional Cancer Center, Wausau, WI, 8Beebe Healthcare, Rehoboth Beach, DE, 9Cancer Care Specialists of Illinois, Decatur, IL, 10CoxHealth, Springfield, MO, 11Department of Radiation Oncology, Geisinger Cancer Institute, Danville, PA, 12University of California, San Francisco, San Francisco, CA, 13Harvard Radiation Oncology Program, Boston, MA, 14Gibbs Cancer Center, Spartanburg Medical Center, Spartanburg, SC, 15Prisma Health Radiation Oncology, Greenville, SC, 16Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, KS, 17The American College of Radiology, Philidelphia, PA, 18Dana-Farber Cancer Institute, Boston, MA
Purpose/Objective(s): Prostate cancer patients treated with curative intent with radiation therapy (RT) and androgen deprivation therapy (ADT) need coordinated care after treatment completion between the radiation oncologist and primary care provider (PCP) to monitor the potential cardiovascular (CV) effects caused by ADT. We hypothesized that intensifying survivorship care planning would improve adherence to American Heart Association (AHA) guideline-recommended cardiovascular monitoring, which includes follow-up with PCP for fasting glucose and cholesterol testing.
Materials/Methods: Cluster randomization of community practices was used. The control arm included a SCP with treatment summary, and outlines recommended follow-up, reviewed with the patient during the last week of RT and sent to the PCP. The experimental arm intensifies survivorship care planning by adding 1) a treatment plan which outlines the planned course of treatment, reviewed with patient and sent to PCP at the beginning of RT; 2) scheduled visit for patient to review SCP with PCP; 3) SCP updates at one- and two-years. 490 evaluable patients from 35 practices were needed to detect an absolute difference of 15% in adherence to AHA guidelines at 2 years using an adjusted chi-square test. Multivariable hierarchical longitudinal models assessed the impact of intensified SCP on primary and secondary outcomes through 24 months while adjusting for covariates.
Results: Thirty-five practices were randomized; 548 patients were analyzable. Median age was 70, 14.7% Black, 25.8% with baseline diabetes and 66.5% on hypertension medication. Only 68.7% had adequate health literacy at baseline, assessed by the Brief Health Literacy Screen. AHA guideline adherence at 2 years was not different in the two arms (62.3% for control and 61.3% experimental, p=.97). Secondary outcomes, including calculated AHA CV risk score and patient-reported outcomes related to coordination of care and satisfaction with cancer care were not different between the two arms (See Table 1).
Conclusion: Adherence to guideline-recommended CV care for prostate cancer survivors who receive RT and ADT with curative intent remains suboptimal, even with a multi-pronged survivorship care planning approach. Continued efforts to improve the care and outcomes of cancer survivors are needed.
Abstract 158 - Table 1 | | 24-month outcomes | Treatment effect p-value (longitudinal model) |
| Control | Experimental |
| AHA guideline adherence (%) | 62.3% | 61.3% | .97 |
| AHA cardiovascular disease risk score (mean) | .257 | .256 | .56 |
| Coordination of care with oncology provider (mean) | 5.32 | 5.54 | .16 |
| Coordination of care with PCP (mean) | 5.29 | 5.46 | N/A |
| Satisfaction with cancer care with oncology provider (mean) | 83.50 | 83.48 | .22 |
| Satisfaction with cancer care with PCP (mean) | 82.0 | 82.7 | N/A |
