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Grant Details

Grant Number: 5R01CA134425-05 Interpret this number
Primary Investigator: Walter, Louise
Organization: Northern California Institute/Res/Edu
Project Title: Prostate-Specific Antigen Practices and Outcomes in the Elderly
Fiscal Year: 2013
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Abstract

Project Summary/Abstract Prostate-specific antigen (PSA) screening for the early detection of prostate cancer has been widely adopted in the U.S. among elderly men, including those with limited life expectancy. Such screening is grounded in pervasive beliefs that screening is always the safest course of action, despite the uncertain benefit of PSA screening. Therefore, this proposal makes innovative use of VA and Medicare claims-based data and electronic health records to determine factors associated with PSA screening and the downstream consequences following screening in elderly men across a spectrum of advancing age and comorbid illness. This includes men with favorable 10-year life expectancy for whom several guidelines recommend screening, and men with limited life expectancy for whom screening is unlikely to be beneficial. Such data are fundamental for informed PSA screening decisions among the many elderly men who are considering screening and for the development of quality measures that reward clinicians for avoiding excessive testing. This application proposes a cohort study of 826,908 men aged 65 years and older who were seen at 104 Veterans Affairs (VA) facilities during 2002 and 2003, without a history of prostate cancer, elevated PSA, or prostate cancer symptoms. VA data and Medicare claims will be used to measure the performance of PSA testing during 2003 as well as the health-system, provider, and patient-level determinants of screening and the downstream consequences following screening. Subsets of men will also be selected to obtain richer clinical detail from electronic health records about additional determinants and consequences of screening. The aims of this project are 1) to determine the health-system, provider, and patient factors associated with PSA screening in elderly men across a spectrum of advancing age and comorbid illness; 2) to quantify the real world downstream consequences (e.g., PSA testing, prostate biopsies, cancer diagnosis, treatment, and complications) during the 3 years following PSA screening in elderly men across a spectrum of advancing age and comorbid illness; and 3) to identify health-system, provider, and patient factors associated with these downstream consequences. Factors associated with PSA screening and initiating each step in the cascade of downstream consequences will be identified according to life expectancy to determine where targeted interventions are needed to discourage excessive testing in elderly men.

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Publications

Screening mammography in older women: a review.
Authors: Walter LC, Schonberg MA
Source: JAMA, 2014 Apr 2;311(13), p. 1336-47.
PMID: 24691609
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A framework for crafting clinical practice guidelines that are relevant to the care and management of people with multimorbidity.
Authors: Uhlig K, Leff B, Kent D, Dy S, Brunnhuber K, Burgers JS, Greenfield S, Guyatt G, High K, Leipzig R, Mulrow C, Schmader K, Schunemann H, Walter LC, Woodcock J, Boyd CM
Source: J Gen Intern Med, 2014 Apr;29(4), p. 670-9.
EPub date: 2014 Jan 18.
PMID: 24442332
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Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold.
Authors: Espaldon R, Kirby KA, Fung KZ, Hoffman RM, Powell AA, Freedland SJ, Walter LC
Source: Urology, 2014 Mar;83(3), p. 599-605.
EPub date: 2014 Jan 16.
PMID: 24439009
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Incorporating lag time to benefit into prevention decisions for older adults.
Authors: Lee SJ, Leipzig RM, Walter LC
Source: JAMA, 2013 Dec 25;310(24), p. 2609-10.
PMID: 24322396
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Disability during the last two years of life.
Authors: Smith AK, Walter LC, Miao Y, Boscardin WJ, Covinsky KE
Source: JAMA Intern Med, 2013 Sep 9;173(16), p. 1506-13.
PMID: 23836120
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Five-year downstream outcomes following prostate-specific antigen screening in older men.
Authors: Walter LC, Fung KZ, Kirby KA, Shi Y, Espaldon R, O'Brien S, Freedland SJ, Powell AA, Hoffman RM
Source: JAMA Intern Med, 2013 May 27;173(10), p. 866-73.
PMID: 23588999
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Talking about stopping cancer screening-not so easy.
Authors: Schonberg MA, Walter LC
Source: JAMA Intern Med, 2013 Apr 8;173(7), p. 532-3.
PMID: 23479053
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Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults.
Authors: Thai JN, Walter LC, Eng C, Smith AK
Source: J Am Geriatr Soc, 2013 Feb;61(2), p. 264-9.
EPub date: 2013 Jan 15.
PMID: 23320808
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American Cancer Society lung cancer screening guidelines.
Authors: Wender R, Fontham ET, Barrera E Jr, Colditz GA, Church TR, Ettinger DS, Etzioni R, Flowers CR, Gazelle GS, Kelsey DK, LaMonte SJ, Michaelson JS, Oeffinger KC, Shih YC, Sullivan DC, Travis W, Walter L, Wolf AM, Brawley OW, Smith RA
Source: CA Cancer J Clin, 2013 Mar-Apr;63(2), p. 107-17.
EPub date: 2013 Jan 11.
PMID: 23315954
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Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark.
Authors: Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O'Brien S, Walter LC
Source: BMJ, 2013 Jan 8;346, p. e8441.
EPub date: 2013 Jan 8.
PMID: 23299842
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Individualizing cancer screening in older adults: a narrative review and framework for future research.
Authors: Eckstrom E, Feeny DH, Walter LC, Perdue LA, Whitlock EP
Source: J Gen Intern Med, 2013 Feb;28(2), p. 292-8.
EPub date: 2012 Sep 28.
PMID: 23054920
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Addressing the aging crisis in U.S. criminal justice health care.
Authors: Williams BA, Goodwin JS, Baillargeon J, Ahalt C, Walter LC
Source: J Am Geriatr Soc, 2012 Jun;60(6), p. 1150-6.
EPub date: 2012 May 29.
PMID: 22642489
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Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans.
Authors: Wang S, Wong ML, Hamilton N, Davoren JB, Jahan TM, Walter LC
Source: J Clin Oncol, 2012 May 1;30(13), p. 1447-55.
EPub date: 2012 Mar 26.
PMID: 22454424
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80 is the new 60: implications of irrational exuberance regarding longevity on prostate cancer treatment decisions.
Authors: Freedland SJ, Walter LC
Source: J Gen Intern Med, 2012 May;27(5), p. 485-6.
PMID: 22328015
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Senior adult oncology.
Authors: Hurria A, Browner IS, Cohen HJ, Denlinger CS, deShazo M, Extermann M, Ganti AK, Holland JC, Holmes HM, Karlekar MB, Keating NL, McKoy J, Medeiros BC, Mrozek E, O'Connor T, Petersdorf SH, Rugo HS, Silliman RA, Tew WP, Walter LC, Weir AB 3rd, Wildes T
Source: J Natl Compr Canc Netw, 2012 Feb;10(2), p. 162-209.
PMID: 22308515
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Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations.
Authors: Dinh TA, Alperin P, Walter LC, Smith R
Source: J Gen Intern Med, 2012 Jun;27(6), p. 730-8.
EPub date: 2012 Jan 12.
PMID: 22237663
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Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.
Authors: So C, Kirby KA, Mehta K, Hoffman RM, Powell AA, Freedland SJ, Sirovich B, Yano EM, Walter LC
Source: J Gen Intern Med, 2012 Jun;27(6), p. 653-60.
EPub date: 2011 Dec 17.
PMID: 22180196
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What is the right cancer screening rate for older adults.
Authors: Walter LC
Source: Arch Intern Med, 2011 Dec 12;171(22), p. 2037-9.
PMID: 22158574
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Quality indicators for older adults: preventing unintended harms.
Authors: Lee SJ, Walter LC
Source: JAMA, 2011 Oct 5;306(13), p. 1481-2.
PMID: 21972311
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Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis.
Authors: Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M
Source: Gastrointest Endosc, 2011 Oct;74(4), p. 885-96.
PMID: 21951478
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A clinical index to stratify hospitalized older adults according to risk for new-onset disability.
Authors: Mehta KM, Pierluissi E, Boscardin WJ, Kirby KA, Walter LC, Chren MM, Palmer RM, Counsell SR, Landefeld CS
Source: J Am Geriatr Soc, 2011 Jul;59(7), p. 1206-16.
EPub date: 2011 Jun 7.
PMID: 21649616
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Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens.
Authors: Kistler CE, Kirby KA, Lee D, Casadei MA, Walter LC
Source: Arch Intern Med, 2011 Aug 8;171(15), p. 1344-51.
EPub date: 2011 May 9.
PMID: 21555655
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Colorectal cancer screening and surveillance in the elderly patient.
Authors: Day LW, Walter LC, Velayos F
Source: Am J Gastroenterol, 2011 Jul;106(7), p. 1197-206;quiz 1207.
EPub date: 2011 Apr 26.
PMID: 21519362
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Lack of follow-up after fecal occult blood testing in older adults: inappropriate screening or failure to follow up?
Authors: Carlson CM, Kirby KA, Casadei MA, Partin MR, Kistler CE, Walter LC
Source: Arch Intern Med, 2011 Feb 14;171(3), p. 249-56.
EPub date: 2010 Oct 11.
PMID: 20937917
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Patient perceptions of mistakes in ambulatory care.
Authors: Kistler CE, Walter LC, Mitchell CM, Sloane PD
Source: Arch Intern Med, 2010 Sep 13;170(16), p. 1480-7.
PMID: 20837835
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Recognizing dementia as a terminal illness in nursing home residents: Comment on "Survival and comfort after treatment of pneumonia in advanced dementia".
Authors: Chang A, Walter LC
Source: Arch Intern Med, 2010 Jul 12;170(13), p. 1107-9.
PMID: 20625014
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