Prostate Cancer Control Plan for Michigan ... 1998 MC

1
Prostate Cancer Control Plan for Michigan
(Updated 2005)

• MCC Advisory Committee on Prostate Cancer
• February 15, 2006

2
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.

3
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.

4
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

5
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.

6
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

7
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.

8
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.

9
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).

10
Primary and Secondary Prevention Whats 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.

11
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).

12
Primary and Secondary Prevention Objectives

• 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).
• By 2010, increase from 70 to 80, the awareness
  of prostate cancer risk factors among African
  American men. (Baseline 2006 SCBRFSS)

13
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.

14
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.

15
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.

16
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.

17
Treatment Current Status

• Men with recurrent or advanced disease not well
  informed of options.
• Clinical trials undersubscribed.

18
Treatment Whats 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.

19
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.

20
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.

21
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.

22
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.

23
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.

24
Treatment - Watchful Waiting Strategies

• Develop and disseminate information to patients
  and providers about the appropriate follow up
  when managed with watchful waiting.

25
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.

26
Survivorship
27
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.

28
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.

29

• 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
30
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.

31
Testimonies by Survivors to the Presidents
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

32
Testimonies by Survivors to thePresidents
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

33
Prostate-Specific Symptoms

• Urinary Incontinence
• Bowel Problems
• Erectile Dysfunction
• Hormone Imbalance

34
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.

35
Survivorship Whats 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.

36
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.

37
Survivorship Objective One

• By 2010, develop and distribute practice
  guidelines for prostate cancer symptom management
  to Michigan primary care providers and pertinent
  specialists.

38
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.

39
Survivorship Strategies Practice Guidelines

• Identify the content for symptom management at
  the different phases of prostate cancer
  survivorship.
• Develop practice guidelines that are age-
  specific and culturally appropriate.

40
Survivorship Strategies Practice Guidelines

• Develop strategies to facilitate implementation
  of the guidelines during the critical transition
  from specialty care to follow-up care by primary
  care providers.
• Develop a process to distribute the guidelines to
  health care providers and to survivors /
  families in Michigan.

41
Survivorship Strategies Practice Guidelines

• Develop a method to evaluate the effect
• of the practice guidelines on the health
  related quality of life of survivors and families
  in Michigan.

42
Survivorship Strategies Educational Materials

• Identify needs of survivors through literature
  review and focus groups.
• Identify existing educational materials relevant
  to prostate cancer survivors and families that
  will address their information needs.

43
Survivorship Strategies Educational Materials

• Identify gaps in existing prostate cancer
  educational materials.
• 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.

44
Survivorship Strategies Educational Materials

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

45
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)

46
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.

47
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.

48
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

49
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

50
2005 MCC Prostate Cancer Early Detection
Recommendations

• All candidates for early detection should be
  fully informed of potential risks and benefits
  before being tested.

51
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.

52
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

53
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.

54
ACPC Recommendation

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