In part because of concern regarding overtreatment in men with prostate cancer, watchful waiting with active surveillance (WWAS) has been increasingly used in men diagnosed with low-risk prostate cancer. The present study investigates the difference in costs between men with low-risk prostate cancer treated with up-front radical prostatectomy (RP) versus WWAS.
A cost model was constructed using data from centers that have published their results in men who were followed up with WWAS compared with the actual costs of up-front RP calculated from a high volume center. Two WWAS arms of 15-year duration were created in which the follow-up protocol and conversion rate to active treatment were varied.
The cost of up-front RP including costs of surgery, complications, and follow up for 15 years was $15 235 per person. Costs of WWAS were estimated using annual conversion rates from WWAS to RP of both 5% and 7%. Costs per person in the WWAS arms ranged from $6558 to $11 992 in the scenarios created which represent a 43%-78.7% reduction in costs when compared with men undergoing up-front RP.
Watchful waiting with active surveillance is being increasingly used in hopes of decreasing the potential overtreatment of prostate cancer in men with low-risk disease. The present study suggests that WWAS is likely to markedly decrease costs when compared with active treatment with RP.
"Historically, fewer than 10% of patients with prostate cancer (PCa) have been followed with watchful waiting or active surveillance, rather than being treated with definitive therapy (typically prostatectomy, external beam radiation, or brachytherapy)  . There is growing consensus that this number is inappropriately low as evidence indicates that some patients with PCa have been overtreated, resulting in unnecessary decrements in the quality of patients' lives and increased financial cost    . "
[Show abstract][Hide abstract] ABSTRACT: Objective:
With growing evidence that some men with prostate cancer (PCa) may be overtreated, clinicians need greater knowledge of the factors that influence uptake of treatment recommendations in general, and specifically, uptake of active surveillance in patients for whom this is an appropriate treatment option. The objective of this study was to test the role of the quality of the physician-patient relationship in the choice to be followed by active surveillance, rather than receive definitive therapy (e.g., surgery and radiation). We hypothesized that patients would have been more influenced by their physicians' treatment recommendations to the degree that they held more positive perceptions of their relationship with their physicians, independent of treatment recommended.
Methods and materials:
Patients with PCa (n = 120) being followed with active surveillance at a comprehensive cancer center completed self-report assessments of their treatment decision-making process. Generalized estimating equations were used to model the association between participants' perceptions of their relationships with their physicians and influence of these physicians' recommendations on their treatment decision.
After controlling for the type of treatment recommended, Gleason score, and education, 3 predictors, trust in the physician, perceived closeness with the physician, and the degree to which the physician shared control over treatment decision making, were associated with greater influence of physician's treatment recommendation. Receiving a recommendation for active surveillance, compared with definitive therapy, was also associated with higher perceived trust, closeness, shared control over treatment decision making, lower likelihood of having been treated poorly by a physician, and greater influence of physician's treatment recommendation.
There is increasing concern that patients with relatively less aggressive PCa, older age, or serious comorbidities are being unnecessarily treated with surgery or radiation, putting them at risk for side effects, and contributing to high health care costs. When active surveillance is an appropriate course of treatment, the quality of patients' relationships with their physicians may be a determinant of following a recommendation for active surveillance. Results may have implications for treatment uptake in general, indicating that the quality of the physician-patient relationship, including trust, closeness, shared decision making--all elements of patient-centered care--may be important motivators of treatment adoption and adherence.
[Show abstract][Hide abstract] ABSTRACT: A fast ALC amplifier for burst-to-burst amplitude equalization in Satellite Communication TDMA is described. Some considerations are also provided concerning the definition of the optimum loop bandwidth in actual systems.
[Show abstract][Hide abstract] ABSTRACT: Any discussion of the future of medicine should include a discussion of prostate cancer surgery, which is presently one of the most rapidly evolving and technologically advanced areas of medicine. Prostate cancer is the most common cancer in men for which the surgical treatment is radical prostatectomy (RP). RP affords a high chance of cure for localized prostate cancer and has a demonstrated survival benefit. RP has been around for more than a century and has undergone a dramatic evolution culminating in modern techniques that allow for excellent oncologic control and quality of life. A variety of surgical approaches exist for RP including open, laparoscopic, and laparoscopic with robotic assistance. Outcomes, cost, learning curves and usage trends for these approaches are discussed. Conservative options that may precede surgery are also discussed.
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