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Grant Details

Grant Number: 1R01CA134425-01A2 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: 2009


Abstract

DESCRIPTION (provided by applicant): 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 application 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. PUBLIC HEALTH RELEVANCE: This study will have unique public health importance because it will be the largest "real world" study of how PSA screening is being targeted among elderly men according to life expectancy and the downstream consequences associated with these screening decisions. The findings of this study are critical to improving PSA screening decisions in elderly men as well as to improving national screening guidelines, decision aids, and quality measures in this area.



Publications

Clinician Factors Associated With Prostate-specific Antigen Screening In Older Veterans With Limited Life Expectancy
Authors: Tang V.L. , Shi Y. , Fung K. , Tan J. , Espaldon R. , Sudore R. , Wong M.L. , Walter L.C. .
Source: Jama Internal Medicine, 2016-05-01 00:00:00.0; 176(5), p. 654-61.
PMID: 27042937
Related Citations

Treatment patterns for older veterans with localized prostate cancer.
Authors: Hoffman R.M. , Shi Y. , Freedland S.J. , Keating N.L. , Walter L.C. .
Source: Cancer Epidemiology, 2015 Oct; 39(5), p. 769-77.
PMID: 26228494
Related Citations

A Randomized Controlled Effectiveness Trial for PSA Screening Decision Support Interventions in Two Primary Care Settings.
Authors: Lewis C.L. , Adams J. , Tai-Seale M. , Huang Q. , Knowles S.B. , Nielsen M.E. , Pignone M.P. , Walter L.C. , Frosch D.L. .
Source: Journal Of General Internal Medicine, 2015 Jun; 30(6), p. 810-6.
PMID: 25666221
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Statin medications are associated with a lower probability of having an abnormal screening prostate-specific antigen result.
Authors: Shi Y. , Fung K.Z. , Freedland S.J. , Hoffman R.M. , Tang V.L. , Walter L.C. .
Source: Urology, 2014 Nov; 84(5), p. 1058-65.
PMID: 25443902
Related Citations

Screening mammography in older women: a review.
Authors: Walter L.C. , Schonberg M.A. .
Source: Jama, 2014-04-02 00:00:00.0; 311(13), p. 1336-47.
PMID: 24691609
Related Citations

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 J.S. , Greenfield S. , Guyatt G. , High K. , Leipzig R. , et al. .
Source: Journal Of General Internal Medicine, 2014 Apr; 29(4), p. 670-9.
PMID: 24442332
Related Citations

Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold.
Authors: Espaldon R. , Kirby K.A. , Fung K.Z. , Hoffman R.M. , Powell A.A. , Freedland S.J. , Walter L.C. .
Source: Urology, 2014 Mar; 83(3), p. 599-605.
PMID: 24439009
Related Citations

Incorporating lag time to benefit into prevention decisions for older adults.
Authors: Lee S.J. , Leipzig R.M. , Walter L.C. .
Source: Jama, 2013-12-25 00:00:00.0; 310(24), p. 2609-10.
PMID: 24322396
Related Citations

Disability during the last two years of life.
Authors: Smith A.K. , Walter L.C. , Miao Y. , Boscardin W.J. , Covinsky K.E. .
Source: Jama Internal Medicine, 2013-09-09 00:00:00.0; 173(16), p. 1506-13.
PMID: 23836120
Related Citations

Five-year downstream outcomes following prostate-specific antigen screening in older men.
Authors: Walter L.C. , Fung K.Z. , Kirby K.A. , Shi Y. , Espaldon R. , O'Brien S. , Freedland S.J. , Powell A.A. , Hoffman R.M. .
Source: Jama Internal Medicine, 2013-05-27 00:00:00.0; 173(10), p. 866-73.
PMID: 23588999
Related Citations

Talking about stopping cancer screening-not so easy.
Authors: Schonberg M.A. , Walter L.C. .
Source: Jama Internal Medicine, 2013-04-08 00:00:00.0; 173(7), p. 532-3.
PMID: 23479053
Related Citations

American Cancer Society lung cancer screening guidelines.
Authors: Wender R. , Fontham E.T. , Barrera E. , Colditz G.A. , Church T.R. , Ettinger D.S. , Etzioni R. , Flowers C.R. , Gazelle G.S. , Kelsey D.K. , et al. .
Source: Ca: A Cancer Journal For Clinicians, 2013 Mar-Apr; 63(2), p. 107-17.
PMID: 23315954
Related Citations

Individualizing cancer screening in older adults: a narrative review and framework for future research.
Authors: Eckstrom E. , Feeny D.H. , Walter L.C. , Perdue L.A. , Whitlock E.P. .
Source: Journal Of General Internal Medicine, 2013 Feb; 28(2), p. 292-8.
PMID: 23054920
Related Citations

Every patient is an individual: clinicians balance individual factors when discussing prognosis with diverse frail elderly adults.
Authors: Thai J.N. , Walter L.C. , Eng C. , Smith A.K. .
Source: Journal Of The American Geriatrics Society, 2013 Feb; 61(2), p. 264-9.
PMID: 23320808
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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 S.J. , Boscardin W.J. , Stijacic-Cenzer I. , Conell-Price J. , O'Brien S. , Walter L.C. .
Source: Bmj (clinical Research Ed.), 2013-01-08 00:00:00.0; 346, p. e8441.
EPub date: 2013-01-08 00:00:00.0.
PMID: 23299842
Related Citations

Medical center characteristics associated with PSA screening in elderly veterans with limited life expectancy.
Authors: So C. , Kirby K.A. , Mehta K. , Hoffman R.M. , Powell A.A. , Freedland S.J. , Sirovich B. , Yano E.M. , Walter L.C. .
Source: Journal Of General Internal Medicine, 2012 Jun; 27(6), p. 653-60.
PMID: 22180196
Related Citations

Impact of comorbidity on colorectal cancer screening cost-effectiveness study in diabetic populations.
Authors: Dinh T.A. , Alperin P. , Walter L.C. , Smith R. .
Source: Journal Of General Internal Medicine, 2012 Jun; 27(6), p. 730-8.
PMID: 22237663
Related Citations

Addressing the aging crisis in U.S. criminal justice health care.
Authors: Williams B.A. , Goodwin J.S. , Baillargeon J. , Ahalt C. , Walter L.C. .
Source: Journal Of The American Geriatrics Society, 2012 Jun; 60(6), p. 1150-6.
PMID: 22642489
Related Citations

80 is the new 60: implications of irrational exuberance regarding longevity on prostate cancer treatment decisions.
Authors: Freedland S.J. , Walter L.C. .
Source: Journal Of General Internal Medicine, 2012 May; 27(5), p. 485-6.
PMID: 22328015
Related Citations

Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans.
Authors: Wang S. , Wong M.L. , Hamilton N. , Davoren J.B. , Jahan T.M. , Walter L.C. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2012-05-01 00:00:00.0; 30(13), p. 1447-55.
EPub date: 2012-05-01 00:00:00.0.
PMID: 22454424
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Senior adult oncology.
Authors: Hurria A. , Browner I.S. , Cohen H.J. , Denlinger C.S. , deShazo M. , Extermann M. , Ganti A.K. , Holland J.C. , Holmes H.M. , Karlekar M.B. , et al. .
Source: Journal Of The National Comprehensive Cancer Network : Jnccn, 2012 Feb; 10(2), p. 162-209.
PMID: 22308515
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What is the right cancer screening rate for older adults.
Authors: Walter L.C. .
Source: Archives Of Internal Medicine, 2011-12-12 00:00:00.0; 171(22), p. 2037-9.
PMID: 22158574
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Health services research is translational: lessons learned from VHA-funded research on cancer screening in older adults.
Authors: Walter L.C. .
Source: Translational Behavioral Medicine, 2011 Dec; 1(4), p. 548-50.
PMID: 24073078
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Quality indicators for older adults: preventing unintended harms.
Authors: Lee S.J. , Walter L.C. .
Source: Jama, 2011-10-05 00:00:00.0; 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 L.W. , Kwon A. , Inadomi J.M. , Walter L.C. , Somsouk M. .
Source: Gastrointestinal Endoscopy, 2011 Oct; 74(4), p. 885-96.
PMID: 21951478
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Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens.
Authors: Kistler C.E. , Kirby K.A. , Lee D. , Casadei M.A. , Walter L.C. .
Source: Archives Of Internal Medicine, 2011-08-08 00:00:00.0; 171(15), p. 1344-51.
EPub date: 2011-08-08 00:00:00.0.
PMID: 21555655
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Colorectal cancer screening and surveillance in the elderly patient.
Authors: Day L.W. , Walter L.C. , Velayos F. .
Source: The American Journal Of Gastroenterology, 2011 Jul; 106(7), p. 1197-206;quiz 1207.
PMID: 21519362
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A clinical index to stratify hospitalized older adults according to risk for new-onset disability.
Authors: Mehta K.M. , Pierluissi E. , Boscardin W.J. , Kirby K.A. , Walter L.C. , Chren M.M. , Palmer R.M. , Counsell S.R. , Landefeld C.S. .
Source: Journal Of The American Geriatrics Society, 2011 Jul; 59(7), p. 1206-16.
PMID: 21649616
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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 C.M. , Kirby K.A. , Casadei M.A. , Partin M.R. , Kistler C.E. , Walter L.C. .
Source: Archives Of Internal Medicine, 2011-02-14 00:00:00.0; 171(3), p. 249-56.
EPub date: 2011-02-14 00:00:00.0.
PMID: 20937917
Related Citations

Patient perceptions of mistakes in ambulatory care.
Authors: Kistler C.E. , Walter L.C. , Mitchell C.M. , Sloane P.D. .
Source: Archives Of Internal Medicine, 2010-09-13 00:00:00.0; 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 L.C. .
Source: Archives Of Internal Medicine, 2010-07-12 00:00:00.0; 170(13), p. 1107-9.
PMID: 20625014
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