Veterans’ access to quality prostate cancer care may lag behind general population


"One notable finding was that veterans may not have access to the same quality of prostate cancer care as the US general population," says Olubiyi Aworunse, MD, MPH, PhD.

In this video, Mital Patel, MD, and Olubiyi Aworunse, MD, MPH, PhD, discuss the background and notable findings from the JU Open Plus study “Practice Patterns and Patient Experience of Care Among US Veterans with Prostate Cancer: A 10-Year Scoping Review.”


Please describe the background for this study.

Patel: This study focuses on a critical, unique, and important population. The Veterans Health System is the largest integrated health care system in the US, and we know prostate cancer is the most prevalent cancer and the second leading cause of cancer-related death in the US with the projection of 1 in 8 men being diagnosed in their lifetime. When we look at the veteran population, the incidence rate increases to 1 in 5 diagnosed each year, unfortunately. We conducted a scoping review of literature published in the past 10 years and found roughly 150 publications that focused on prostate cancer practice patterns and patient experience among US veterans. The literature review was conducted according to PRISMA standards.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

Awonrunse: Regards to notable findings, out of the 150 studies, most were retrospective evaluations of VA databases, and they covered a lot of topics...One notable finding was that veterans may not have access to the same quality of prostate cancer care as the US general population, with significant variations in practice patterns and patient experiences. Centers where patients get treatment also influences adherence to NCCN guidelines and quality of care. In addition, the use of non definitive treatment has been increasing over the years in the Veterans Health System, with most of the patients with low-risk prostate cancer being managed with active surveillance or watchful waiting. However, there's increasing evidence that clinical outcomes with localized cancer are more favorable with definitive treatment. Other findings included that chemotherapy cycles were longer, combination therapy was used less, and treatment of febrile neutropenia was used less in the veterans population compared with the general population. The major research gap that we found was an absence of studies examining techniques available for mitigation of adverse events of radiation therapy, and placement of radioprotective spacers increase space between the prostate and rectum...In terms of disparities, literature showed mixed results with respect to access to prostate cancer treatment...Also Black men may present with more aggressive prostate cancer, but they have better clinical outcomes with treatment, including less biochemical recurrence, metastases, and mortality outcomes upon treatment compared with White men.

Patel: Certainly, there were some surprising findings that we did come across. First, it was interesting to learn that there was a wide variation in treatment patterns when it came to adhering to NCCN guidelines for treating prostate cancer in the VA population. Despite subsets of veterans presenting at a more aggressive stage for prostate cancer, better outcomes for definitive treatment were observed. There is a potential to educate and adjust practice patterns in 2 ways, we thought, based off of the findings. One was to identify cancer at an earlier stage and implement watchful waiting and to facilitate adoption of definitive treatment when it is appropriate. Lastly, with the potential for better outcomes with definitive treatments, such as radiation therapy, it was surprising to see the lack of literature on the use of rectal spacing in the veteran population. Since rectal spacing has the potential to ease concerns about side effects of radiation therapy for prostate cancer, it is essential that physicians treating veterans understand the evidence that can support early radiation treatment with rectal spacing.

This transcription was edited for clarity.

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