When we talk about cancer, words that conjure up a battlefield or brawl are often used. “I’m going to fight this.” “Let’s eradicate it.” “I want it destroyed.” So, if a doctor said your best course of action would be to “wait it out” or that eradicating the cancer could lead to side effects that would drastically decrease your quality of life, how would you respond? That’s the scenario men with a prostate cancer diagnosis experience every day. Because prostate cancer spreads very slowly, a case deemed low-risk might be best treated through active surveillance – forgoing surgery or radiation in favor of regular monitoring of the cancer to determine when – and if – a patient needs more invasive treatment. Two grants from the Blue Cross Blue Shield of Michigan Foundation are helping University of Michigan researchers look at how care is delivered to patients with prostate cancer, focusing on understanding and improving the decision-making process when it comes to treatment.
Understanding low-risk patients who choose invasive treatment
Dr. Archana Radhakrishnan is an assistant professor at U of M and practices as a primary care physician. A $50,000 grant will help Radhakrishnan delve into the complex factors men face as they decide to move forward on a course of treatment. Unlike other diagnoses, prostate cancer puts a greater decision-making onus on the patient. Do you get rid of the cancer and face a potential lifetime of side effects that can range from incontinence to erectile dysfunction or do you opt for active surveillance? Cancer can be a frightening diagnosis, but according to the Michigan Urological Surgery Improvement Collaborative (MUSIC), “low-risk prostate cancer is often unlikely to cause significant problems” in a patient’s lifetime. In fact, guidelines for low-risk prostate cancer have evolved from recommending surgery or radiation as the primary strategy to an active surveillance approach, yet one-third of men in this category who initially choose active surveillance do decide to pursue more invasive options in the end. Radhakrishnan wants to know why. Through her research project she plans to conduct interviews with urologists, patients and patients’ spouses and partners to assess the factors that go into a patient’s treatment decision. She’ll also use Blue Cross Blue Shield of Michigan claims data to potentially find patterns between provider visits and urologist visits that would be tied to men staying on active surveillance. Radhakrishnan knows anxiety and worry can drive men to choose more invasive treatment. She also suspects partners and spouses influence the decision-making process, as do health care providers. By interviewing everyone involved, she hopes to identify factors that tip the scale toward or away from active surveillance. She’ll also be looking at how a team-based approach to care with primary care physicians and urologists could help men feel more comfortable with a decision to remain on active surveillance, which could improve quality of life by lessening the risk for side effects. Her hope at the end of the project would be to know what drives men’s decisions and to be able to identify factors to help them stay on active surveillance for as long as that’s appropriate. “At the end of the day, we want them to have the best quality of life possible,” she said.
Helping higher-risk patients make an informed treatment choice
A $10,000 grant will help Dr. Nnenaya Agochukwu, research fellow at U of M Department of Urology, develop a prototype risk calculator to help men really understand what they can expect when it comes to sexual function recovery following a radical prostatectomy. This type of surgery removes the entire prostate gland and the cancer along with it. It’s most appropriate for men with intermediate-risk disease and a life expectancy of at least 10 years. Although it removes the cancer, it also has the most significant effect on sexual function – an important component of health-related quality of life, Agochukwu said. By developing a tool that health care providers could use with patients to help them understand the likelihood of facing side effects related to sexual function, Agochukwu hopes men will be able to make more informed decisions. “Studies show that some patients may be even willing to sacrifice survival to remain potent,” she said. Agochukwu, the MUSIC team and collaborators in the departments of Urology and Industrial and Operations Engineering are using patient-reported outcomes sourced from MUSIC and looking at variables such as baseline sexual function, age, race, co-morbidities, body mass index and surgery type to develop the risk calculator. Men will be able to see a realistic picture of their sexual outcomes following radical prostatectomy, based on their unique circumstances. She expects to have the prototype developed by late fall and will offer it up to health care providers to test with patients. Their feedback will likely refine the tool, which she believes has the potential to transform how men decide on a course of treatment. “I think that helping men make this decision, including this preference- and evidence-based way would greatly enhance the decision-making process,” Agochukwu said. If you found this post helpful, you might also want to read:
- Michigan Urologists Leading on Prostate Cancer Care
- Collaboration Creates Guidelines to Avoid Unnecessary Testing on Prostate Cancer Patients
- Why Black Men Need to Talk About Prostate Cancer Sooner
Photo credit: Chinnapong