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Advisory Committee on Prostate Cancer

VIEWS: 5 PAGES: 54

									Prostate Cancer Control Plan
for Michigan (Updated 2005)

MCC Advisory Committee on
Prostate Cancer
February 15, 2006
1998 Prostate Cancer Priority
 By 2006, prostate cancer patients will have
  their knowledge and understanding of
  prostate cancer, treatment options, side
  effects, and quality-of-life issues measured
  by patient surveys, with findings used to
  develop, disseminate, and evaluate new
  patient education materials.
    2004 ACPC Charge from MCC

 Review the 1998 MCC strategic plan for prostate
  cancer control.
 Understand the progress made to date to achieve
  the current priority.
 Review the changes in science and/or clinical
  issues that have occurred since the last Prostate
  Cancer Control Plan was written.
 Develop a revised/updated Prostate Cancer
  Control plan for MI with recommendations for
  strategies to focus on over the several years.
New Plan Developed With
Special Thanks To…
 3 Work Groups

  – Primary and Secondary Prevention: Dr. Willie
    Underwood, MD – Chair

  – Treatment: Dr. Angela Fagerlin, Ph.D. - Chair

  – Survivorship: Dr. Laurel Northouse, Ph.D. –Chair

 ACPC Approval September, 2005
Progress to date: 1998 Priority
 Survey of newly-diagnosed men  many
  did not know or fully understand their
  treatment options, including the side effects
  of treatment.
 Critical review of existing patient education
  materials  accurate but not complete
  enough to support informed decision
  making.
Progress to Date
 Development by PCAC of plain language
 patient education materials (PEMs).

  – Booklet (English, Spanish, Arabic)
  – Audio tape (English)
  – Website (which includes PDF and online
    survey) www.prostatecancerdecision.org
Progress to Date
 Focus testing of PEMs  plain language made
  medical information clear, and it was found to be
  useful in making informed decisions.

 “I got more info from your site than from my MD
  & urologist combined.” (online survey
  respondent)

 Remaining Challenge: Systematic Dissemination
  to men at time of decision-making.
New Plan: Primary and
Secondary Prevention
 Priority: Increase, by 2010, awareness of
  prostate cancer risk factors as well as the
  benefits and risks of prostate cancer
  screening among primary care physicians,
  high-risk men, and the general public.
Primary and Secondary
Prevention: Current Status
 PSA a good screening test with DRE.
 Still no evidence that screening decreases
  mortality.
 African Americans still at high risk of
  disease, mortality; less likely to be aware or
  obtain testing.
 Counseling about PSA important, especially
  for high risk men (AA, Family HX).
Primary and Secondary
Prevention: What’s Needed
 Men and primary care providers need to be
  aware of screening issues.

 High risk men should be well-informed.


 Providers must understand risk factors and
  identify and counsel high risk men.
Primary and Secondary
Prevention: Progress Markers
 Repeat of 1995 Prostate Cancer KAP
 physician survey (underway early 2006).

 Repeat of 2001-02 SCBRFS to determine
 changes in counseling from providers about
 prostate cancer testing risks and benefits,
 and receipt of a PSA test among men
 (underway early 2006).
Primary and Secondary
Prevention: Objectives
1. Increase by 2010 awareness of prostate cancer
   risk factors as well as the benefits and risks of
   prostate cancer screening 30% among primary
   care physicians (Baseline: 2006 KAP survey of
   physicians), and 30% among high risk men and
   the general public (Baseline: 2006 SCBRFS).
2. By 2010, increase from 70% to 80%, the
   awareness of prostate cancer risk factors among
   African American men. (Baseline 2006
   SCBRFSS)
Primary and Secondary
Prevention: Objectives
3. By 2010, there will be a 40% increase in
   adherence to the 2005 Michigan Cancer
   Consortium prostate cancer early detection
   recommendations among primary care physicians,
   with particular emphasis on populations of higher
   than average prostate cancer risk.
Primary/Secondary Prevention
Strategies: Knowledge
 Disseminate 2006 risk assessment and early
  detection recommendations among health care
  providers.

 Encourage MAHP and MQIC to conduct risk
  assessments while counseling men about the
  efficacy of prostate cancer testing.

 Widely disseminate existing CDC prostate health
  booklets.

 Develop/conduct educational activities among
  African American men.
New Plan: Treatment
 Priority: By 2012, a higher proportion of
  men with localized/regional stage prostate
  cancer on Watchful Waiting and men with
  advanced or recurrent prostate cancer will
  receive appropriate surveillance and/or
  active treatment including increased
  enrollment in clinical trials.
Treatment: Current Status
 Still no marker to differentiate between indolent
  or aggressive disease.

 Active treatment can be curative but affect QOL.


 Optimal care during “Watchful Waiting” not clear
  to men or primary care providers.

 Decision aids have been developed to help men
  make treatment decisions.
Treatment: Current Status

 Men with recurrent or advanced disease not
  well informed of options.

 Clinical trials undersubscribed.
Treatment: What’s Needed
 Improve the proportion of men diagnosed
 with advanced or recurrent prostate cancer
 who receive active treatment and/or are
 enrolled in clinical trials.

 Improve the proportion of men with
 localized/regional stage prostate cancer on
 watchful waiting who receive cancer
 specific follow up care.
Treatment: Progress Markers
 Tools developed that will be used to establish a
  baseline and to monitor the percentage of men
  with advanced or recurrent prostate cancer who
  receive appropriate active treatment and/or are
  enrolled in clinical trials.

 Tools developed that will be used to establish a
  baseline and to monitor the percentage of men
  with localized/regional stage prostate cancer on
  Watchful Waiting that are not receiving
  appropriate cancer specific follow up.
Treatment: Progress Markers
 Complete surveys and/or analysis of information
  from cancer registries to evaluate the percentage
  of men with advanced or recurrent prostate
  cancer who receive appropriate active treatment
  and/or are enrolled in clinical trials.

 Complete surveys and/or analysis of information
  from cancer registries to evaluate the percentage
  of men with localized/regional stage prostate
  cancer on Watchful Waiting that are not receiving
  appropriate cancer specific follow up.
Treatment Advanced or
Recurrent Disease: Objective
 By 2012, the percentage of men diagnosed with
  advanced or recurrent prostate cancer that receive
  active treatment and/or are enrolled in clinical
  trials will be measured through the use of surveys
  and/or cancer registries.

   – Based on these findings, develop means to improve the
     percentage of men diagnosed with advanced or
     recurrent prostate cancer who receive active treatment
     and/or are enrolled in clinical trials.
Treatment: Watchful Waiting
Objective
 By 2012, the proportion of men with
  localized/regional stage prostate cancer on
  Watchful Waiting who are not receiving cancer
  specific follow-up will be measured through the
  use of surveys and/or cancer registries.

   – Based on these findings, develop means to improve the
     proportion of men with localized/regional stage prostate
     cancer on Watchful Waiting who receive appropriate
     prostate cancer specific follow up care.
Treatment Watchful Waiting:
Strategies
 Conduct studies to determine the most
  appropriate interval for periodic
  examination of patients managed by the
  watchful waiting approach.

 Conduct studies to determine the
  appropriate endpoint that defines when the
  watchful waiting approach should be
  replaced with active treatment.
Treatment - Watchful Waiting:
Strategies
 Develop and disseminate information to
 patients and providers about the appropriate
 follow up when managed with watchful
 waiting.
Treatment Advanced or
Recurrent Disease: Strategies
 Support existing/develop information resources
  such as hotlines and directories for men diagnosed
  with advanced or recurrent prostate cancer.

 Develop/disseminate information to patients with
  advanced or recurrent prostate cancer and
  providers about the appropriateness of active
  treatment and/or clinical trials.
Survivorship
New Plan: Survivorship Priority
 By 2010, practice guidelines and educational
  materials will be available for professionals and
  survivors/families that address prostate cancer
  symptom management across the survivor
  continuum to decrease morbidity.
Survivorship: Priority
 By 2010, practice guidelines and educational
  materials will be available for professionals and
  survivors/families that address prostate cancer
  symptom management across the survivor
  continuum.



    Acute    Extended Permanent       Recurrent
                        IOM Report calls for
                        comprehensive post-
                        treatment care for
                        cancer survivors, 2006

                        •Address gap between
                        oncologists and primary care
                        providers

                        •Increase collaboration to
                        advance survivorship care


http://www.nap.edu/catalog/11468.html
Survivorship: Current Status
 Men with prostate cancer are the second
  largest group of cancer survivors.
 Little information is available to assist men
  and their families with survivorship issues.
 Managing symptoms that have resulted
  from the disease or the treatment for it is
  one of most troublesome issues for
  survivors.
Testimonies by Survivors to the
   President’s Cancer Panel
                “ ….loss of libido is
                  really tough … I was
                  very conscious of my
                  wife and her needs…..
                      It was probably
                  the most difficult side
                  effect that I had to live
                  with…”

                       63 yr. old survivor
Testimonies by Survivors to the
   President’s Cancer Panel
                “ After surgery I had
                  erectile dysfunction
                  and incontinence. I
                  went into extreme
                  deep depression....
                 Single, living alone,
                 did not know of a
                 support group…”
                      67 yr. old survivor
   Prostate-Specific Symptoms

 Urinary Incontinence
 Bowel Problems
 Erectile Dysfunction
 Hormone Imbalance
Survivorship: Current Status
 Symptoms can extend for a number of years
  following treatment and are associated with
  lower QOL and more emotional distress
  among men and their partners.
 Men typically followed for only 6 months
  by their cancer specialist.
 Primary care providers often unaware of or
  lack time to address cancer survivor issues.
Survivorship: What’s Needed?
 Prostate-specific practice guidelines to
  assist providers to deliver ongoing care to
  survivors and their family members,
  including health related quality of life
  (HRQOL) concerns.
 Access to the latest educational materials
  on prostate cancer symptom management
  for survivors, families and providers.
Survivorship: Progress Markers
 Practice guidelines for prostate cancer
  symptom management have been developed
  for providers.
 Educational materials for prostate cancer
  symptom management have been developed
  for providers and survivors/families.
Survivorship: Objective One

 By 2010, develop and distribute practice
 guidelines for prostate cancer symptom
 management to Michigan primary care
 providers and pertinent specialists.
Survivorship: Objective Two

 By 2010, provide educational materials
 for prostate cancer symptom
 management to prostate cancer survivors
 and their families that are culturally
 sensitive and at an appropriate reading
 level.
Survivorship Strategies:
Practice Guidelines
1. Identify the content for symptom
   management at the different phases of
   prostate cancer survivorship.
2. Develop practice guidelines that are
   age- specific and culturally appropriate.
Survivorship Strategies:
Practice Guidelines
3. Develop strategies to facilitate
   implementation of the guidelines during
   the critical transition from specialty care
   to follow-up care by primary care
   providers.
4. Develop a process to distribute the
   guidelines to health care providers and to
   survivors / families in Michigan.
Survivorship Strategies:
Practice Guidelines

5. Develop a method to evaluate the effect
   of the practice guidelines on the health
   related quality of life of survivors and
   families in Michigan.
Survivorship Strategies:
Educational Materials
1. Identify needs of survivors through
   literature review and focus groups.
2. Identify existing educational materials
   relevant to prostate cancer survivors
   and families that will address their
   information needs.
Survivorship Strategies:
Educational Materials
3. Identify gaps in existing prostate cancer
   educational materials.
4. Adopt, adapt, develop patient education
   material for prostate cancer survivors
   and their family members.
5. Develop a process to distribute
   symptom management educational
   materials to providers and
   survivors/families in Michigan.
Survivorship Strategies:
Educational Materials

6. Develop a method to evaluate how the
   utilization of educational materials affects
   the health related quality of life of
   survivors and families in Michigan.
Take away message

    “The most rational approach
     to treating prostate cancer
     includes not only adding
     years to life ….but also
     adding life to years”.
                   Litwin et al. (1995)
ACPC Recommendations
 The ACPC recommends that the MCC:
  – Accept the Prostate Cancer Control Plan for
    Michigan (Updated 2005).
  – Adopt the survivorship goal and its objectives
    as the next prostate cancer priority to be
    addressed collaboratively by the MCC member
    organizations.
2005 MCC Prostate Cancer Early
Detection Recommendations

 Men who may be candidates for early
 detection:
  – Men age 50 with life expectancy of at least 10
    years.
  – Higher risk men starting at age 45.
2005 MCC Prostate Cancer Early
Detection Recommendations

 Higher Risk Men
  – African Americans
  – Men with family history first degree relative(s)
  – Men with strong family history – early age at
    diagnosis, multiple family members
  – Men with BRCA1 or 2 mutation
2005 MCC Prostate Cancer Early
Detection Recommendations
 Men who are NOT candidates for early
 detection:
  – Men younger than age 50 of average risk
  – Men of any age with less than 10 years of life
    expectancy
  – Men with suspected or known prostate cancer
 Men with symptoms should receive
 diagnostic evaluation
2005 MCC Prostate Cancer Early
Detection Recommendations

 All candidates for early detection should be
  fully informed of potential risks and
  benefits before being tested.
2005 MCC Prostate Cancer Early
Detection Recommendations
 Counseling should address key points:
  – Prostate cancer is an important problem.
  – Benefits have not been proven but early
    detection MAY save lives.
  – Early detection and treatment MAY prevent
    future cancer-related illness.
  – Treatment of prostate cancer does have risks
    that should be carefully evaluated before
    making a decision to be treated.
2005 MCC Prostate Cancer Early
Detection Recommendations
 Key counseling points (continued)
  – Both DRE & PSA can have false positives and false
    negatives.
  – An abnormal test may require further evaluation.
  – Risk of developing prostate cancer increases with age.
  – African American men and men with a family history
    are at highest risk of getting & dying from prostate
    cancer.
 Refer men to CDC booklets
2005 MCC Prostate Cancer Early
Detection Recommendations

 After men receive information, health care
  providers should:

  – Address any patient concerns.
  – Facilitate a shared decision-making process.
  – IF the man chooses to be tested, both a DRE
    and PSA should be done.
ACPC Recommendation

 The ACPC recommends the MCC Endorse
 the revised Prostate Cancer Early Detection
 Recommendations.

								
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