e54 THE JOURNAL OF UROLOGY姞
4S, Supplement, Saturday, May 4, 2013
admission type (elective, urgent, emergent), and payer. We also in-
cluded the University Healthsystem Consortium’s (UHC) expected mor-
tality index, which includes measures of severity of illness and comor-
bidity. The model was then used to compute observed-to-expected
(O/E) RRT use by service.
RESULTS: There were 45,637 admissions, 806 of which re-
sulted in RRT (1.7%, or 3.31 per 1,000 inpatient days) (Table). The
urology service had 4,403 admissions during this time, with 60 RRTs
(1.4%, or 4.47 per 1,000 inpatient days). There was substantial vari-
ability among services, ranging from 0.4% to 6.2% of admissions (p ⫽
⬍0.001) and 1.39 to 8.73 per 1000 inpatient days (p ⫽⬍0.001).
However, the multivariable model demonstrated that much of the
variability was accounted for by age, admission source, admission
type, payer, days at-risk and UHC expected mortality (AUC 0.74). The
O/E RRT use ranged from 0.32 to 2.82 across services, and urology’s
O/E was 1.00.
CONCLUSIONS: RRT use varies with service volume and
acuity. The model we built offers the potential to compute expected
RRT use with high accuracy which, in conjunction with similar data on
inpatient mortality, ICU transfer, and readmission, could provide a
valuable means of tracking O/E utilization of the RRT as a measure of
appropriate use of this resource.
Source of Funding: None
133
DESCRIBING THE ‘DIGITAL DIVIDE’: INFORMATION
TECHNOLOGY USE IN PROSTATE CANCER PATIENTS WITH
LOWER SOCIOECONOMIC STATUS
Mya Levy*, Lorna Kwan, Christopher Saigal, Los Angeles, CA
INTRODUCTION AND OBJECTIVES: Men with prostate can-
cer face a complex treatment choice. A plethora of resources are
available to help them over the internet. Innovative approaches to
improving the ability of these men to make good decisions, including
desktop and smart phone applications, as well as emerging social
media tools are proliferating. However, poor access to information
technology may present barriers to accessing these applications for
men with low socioeconomic status (SES) who have prostate cancer.
Understanding this population’s current technology usage will provide
key insight into potential barriers as well as possible facilitators to these
emerging innovations. The specific aim of this study was to character-
ize current technology usage amongst a low SES, urban male popu-
lation of individuals diagnosed with prostate cancer.
METHODS: We surveyed men enrolled in California’s IMPACT
program, which provides support to underserved men with prostate
cancer. Enrollees were 300% below the Federal poverty line. A tele-
phone survey instrument was used to collect data on information
technology use. Specific items inquired about were comfort with infor-
mation technology as well as preferred or usual location of use.
Chi-square analysis was conducted to look for demographic associa-
tions with technology usage among this population.
RESULTS: 1,212 men were enrolled in IMPACT from 2006-
2012. Of those, 1,140 completed the survey instrument. 36% had
access to the internet, 26% were comfortable browsing the internet,
21% used email. In comparison, 85% of all US adults age 50-64 report
using the internet. Of subjects who accessed the internet, 81% did so
at home, 12% did so at a friend or family members’s home, and 7% did
so at the library. The percentage of men that used the internet in-
creased from 34% in 2006 to 47% in 2012. 20% of men felt comfortable
browsing in 2006, compared with 35% in 2012. 17% used email in
2006, and 35% in 2012. Individuals who preferred to speak Spanish
were less likely to use the internet (p⬍0.0001). Those who didn’t use
the internet were older, 60.8 vs. 58.8 years (p⬍0.0001).
CONCLUSIONS: Information technology usage in prostate can-
cer patients with low SES was below national averages, but did increase
over the study period. Implementation of technology-based health delivery
innovations geared toward this population is not futile, given baseline
Vol. 189, No.
information technology usage and trends over time. Further characteriza-
tion of facilitators which increase comfort with internet use and culturally
specific barriers to internet use are warranted.
Source of Funding: None
134
ELIGIBILITY OF PATIENTS WITH UROTHELIAL CANCER OF THE
BLADDER FOR NEOADJUVANT CISPLATIN-BASED
CHEMOTHERAPY
Goutham Vemana*, Gurdarshan Sandhu, St. Louis, MO;
Kenneth Nepple, Iowa City, IA; Seth Strope, St. Louis, MO
INTRODUCTION AND OBJECTIVES: Neoadjuvant cisplatin-
based chemotherapy improves overall survival in patients with muscle
invasive bladder cancer without evidence of metastatic disease. Over-
all use of this therapy appears to be low; however the proportion of
patients who should receive this therapy is unknown. We sought to
determine the overall eligibility versus the expected rate of use of
neoadjuvant chemotherapy in our population of patients undergoing
radical cystectomy.
METHODS: We identified all patients at our institution from
January 2010 through December 2011 treated with radical cystectomy
for bladder cancer (n ⫽ 143). We identified factors qualifying patients
for neoadjuvant chemotherapy, including urothelial cancer, T2 or higher
stage, localized disease (pre-operative computed tomography imaging
without suspicious lymphadenopathy or other identifiable lesions), and
estimated pre-operative creatinine clearance (CrCl) using the Modifi-
cation of Diet in Renal Disease (MDRD) formula. An estimated CrCl ⱖ
45 mL/min/1.73 m2 was used as the cutoff value for adequate renal
function to receive cisplatin-based chemotherapy.
RESULTS: Of the 143 patients identified, 15% were ineligible
for neoadjuvant chemotherapy due to nodal or distant disease. Another
25% were ineligible due to tumor stage ⬍ T2 and non-urothelial
histology. Among the patients with localized, ⱖ T2 disease, 8% did not
have adequate pre-operative renal function to receive cisplatin-based
neoadjuvant therapy. Accounting for these above factors, 57% of all
radical cystectomy patients would be eligible for neoadjuvant chemo-
therapy. Of the eligible patients seen by medical oncology at our
institution, 14% refused to have neoadjuvant chemotherapy and 6%
were unable to receive treatment due to severity of symptoms (refrac-
tory hematuria, severe dysuria, etc). Accounting for these patient level
factors, only 37% of patients undergoing radical cystectomy would be
expected to receive neoadjuvant chemotherapy, with 52% of patients
potentially receiving pre-operative chemotherapy (neoadjuvant and
treatment for metastatic disease followed by salvage cystectomy).
CONCLUSIONS: There are numerous factors aside from ex-
tent of disease that limit patient eligibility for neoadjuvant chemother-
apy. These must also be considered when evaluating utilization of
neoadjuvant chemotherapy as a quality metric in urothelial cancer care.
Current national utilization of pre-operative chemotherapy in less than
15% of cystectomy patients reveals substantial underuse of this nec-
essary therapy.
Source of Funding: Washington University Institute of Clinical
and Translational Sciences grant UL1 TR000448 from the
National Center for Advancing Translational Sciences
135
VIDEO-BASED EDUCATIONAL TOOL IMPROVES PATIENT
COMPREHENSION OF COMMON PROSTATE HEALTH
TERMINOLOGY
Daniel Wang*, Musu Sesay, Caroline Tai, Daniel Lee,
Michael Goodman, Katharina Echt, Atlanta, GA; Kerry Kilbridge,
Boston, MA; Ashesh Jani, Viraj Master, Atlanta, GA
INTRODUCTION AND OBJECTIVES: Healthcare providers of-
ten counsel prostate cancer patients about treatment options using
terms that are part of the ‘core’ vocabulary of prostate cancer. How-
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
ever, studies have demonstrated a severe lack of comprehension of
these terms, especially among underserved populations. We hypothe-
sized that a video-based educational tool would significantly improve
understanding of these key terms related to prostate health among a
predominantly lower-literacy population.
METHODS: A software application was developed by various
experts, including urologists and human-computer interaction special-
ists, to serve as the video-based educational tool, emphasizing anima-
tions to promote understanding. A previously developed survey was
used to evaluate comprehension of terms related to urinary, bowel, and
sexual function. Trained interviewers provided the survey to patients
from two low-income safety-net clinics both before and after adminis-
tration of the educational tool. Pre- and post-intervention levels of
comprehension were assessed using semi-qualitative methods coded
by two independent evaluators.
RESULTS: 56 patients completed the study, with a mean
literacy level of 7th to 8th grade by literacy testing, but a self-reported
mean education level of 12th grade. Patients achieved statistically
significant improvement in comprehension for the majority of the terms
after the video intervention (see Table). Notable improvements in
understanding were exhibited for the terms ?rectal urgency’ (18% to
73%, P-value ⬍ 0.000001), ‘incontinence’ (from 14% to 50%,
P-value ⬍ 0.000035), and ‘bowel’ (14% to 46%, P-value ⬍ 0.0001).
Patients also demonstrated significant gains in understanding of the
function of the prostate (11% to 30%, P-value ⬍ 0.0074).
CONCLUSIONS: The video-based educational tool is an effective
method for combatting the severe lack of comprehension of prostate
health terminology among this population, which may be reflective of many
patients overall. The improvements in understanding achieved with this
intervention have the potential to enhance patient participation in shared
and informed decision-making. These results support combined visual and
audio multimedia as a promising tool for prostate cancer education and
thus as an area for further research and refinement.
Table - Patient comprehension of prostate health terminology as a percentage
of the total study population.
Term Pre-Intervention Post-Intervention P-value
Rectal Urgency 18% 73% 0.000001
Incontinence 14% 50% 0.000035
Bowel 14% 46% 0.0001
What does the prostate do? 11% 30% 0.0074
Source of Funding: This work was supported by a Winship
Cancer Institute of Emory University Multi-Investigator
Research Seed Grant (Co-PI’s: Drs. Master, Jani, and
Goodman).
136
INFLUDENCE OF RACE AND COMORBIDITY ON THERAPY FOR
PROSTATE CANCER: EVOLUTION OVER 15 YEARS
Alicia Morgans*, Daniel Barocas, Matthew Resnick, Kang-Hsien Fan,
Tatsuki Koyoma, Nashville, TN; Karen Hoffman, Houston, TX;
Sherrie Kaplan, Irvine, CA; Antoinette Stroop, Salt Lake City, UT;
Sheldon Greenfield, Irvine, CA; Ann Hamilton, Los Angeles, CA;
Vivien Chen, Xiao-Cheng Wu, New Orleans, LA; Richard Hoffman,
Albuquerque, NM; David Penson, Nashville, TN
INTRODUCTION AND OBJECTIVES: Multiple management
options exist for early stage prostate cancer. We assessed the influ-
ence of comorbid illness and sociodemographic factors on selection of
definitive vs. non-definitive therapy for localized prostate cancer using
patient-reported data from two prospective cohorts of prostate cancer
survivors (Prostate Cancer Outcomes Study (PCOS) and Comparative
Effectiveness Analysis of Surgery and Radiation for prostate cancer
(CEASAR)). We then analyzed the effect of these characteristics over
time by comparing the two cohorts.
METHODS: We analyzed men ⬍75 years old with localized
prostate cancer diagnosed from 1994-1995 and followed through 2009-
2010 (PCOS), and diagnosed from 2011-2012 and followed through
THE JOURNAL OF UROLOGY姞 e55
the present (CEASAR). We used a multivariable logistic regression
model incorporating sampling weights to assess the influence of age,
race, marital status, income level, insurance status, geographic region
and comorbid illness (cardiac disease, diabetes, pulmonary disease,
stroke, and overall health) on receipt of definitive treatment (prostatec-
tomy or radiation) versus non-definitive treatment (hormonal therapy,
active surveillance or no treatment).
RESULTS: Baseline characteristics among 2334 PCOS and
1368 CEASAR participants were similar, but CEASAR included fewer
non-Caucasians and had higher median income and education. Prev-
alence of comorbid disease was similar between cohorts. Overall, 17%
of PCOS and 28% of CEASAR participants reported non-definitive
treatment (P⬍0.001). In PCOS, African American race (vs. Caucasian
OR 0.39, 95% CI 0.23-0.65), poor overall health (vs. excellent OR 0.32,
95% CI 0.11-0.89), cardiac disease (OR 0.51, 95% CI 0.31-0.82),
unmarried status (OR 0.52, 95% CI 0.34-0.82), and older age (OR 0.32
per 10 year increment, 95% CI 0.23-0.46) were associated with report
of non-definitive treatment. In CEASAR, fair health (vs. excellent OR
0.54, 95% CI 0.31-0.93) and older age (OR 0.50 per 10 year increment,
95% CI 0.41-0.62) were the only characteristics significantly associated
with non-definitive treatment.
CONCLUSIONS: African American race and unmarried status
are associated with report of non-definitive treatment in PCOS, but not
in our contemporary cohort. Although poor or fair health influenced
report of definitive treatment in PCOS and CEASAR, respectively, only
cardiac disease in PCOS affected report of definitive treatment. These
differences may reflect changing perceptions of the risk/benefit ratio of
aggressive therapy, reduced racial disparity, and changing patient or
physician therapy preferences.
Source of Funding: R01HS019356 (Penson) 09/01/10-08/31/13
AHRQ Comparative Effectiveness of Treatments for Localized
Prostate Cancer
General & Epidemiological Trends &
Socioeconomics: Practice Patterns, Cost
Effectiveness (II)
Moderated Poster Session 6
Sunday, May 5, 2013 8:00 AM-10:00 AM
137
UTILIZATION OF PREOPERATIVE CHEMOTHERAPY AND
ASSOCIATED OUTCOMES AFTER RADICAL CYSTECTOMY:
AN ANALYSIS OF THE AMERICAN COLLEGE OF SURGEONS
NATIONAL QUALITY IMPROVEMENT PROGRAM
David Johnson, Will Kirby, Jed Ferguson, Jonathan Matthews,
Matthew Nielsen, Raj Pruthi, Angela Smith*, Eric Wallen,
Michael Woods, Chapel Hill, NC
INTRODUCTION AND OBJECTIVES: Preoperative chemo-
therapy in combination with radical cystectomy is associated with a
significant survival advantage for those with muscle-invasive bladder
cancer. The objective of this study was to evaluate the utilization of
preoperative chemotherapy with radical cystectomy as well as its ability
to predict post-operative complications using the American College of
Surgeons National Surgical Quality Improvement Program (ACS-
NSQIP) database.
METHODS: We performed a retrospective review of the NSQIP
2010 Participant Use Data File. ACS-NSQIP collects data on 135
variables, including peri-operative data, 30-day post-operative compli-
cations and mortality on all major surgical procedures at participating
institutions from 2005-2010. During this time period, 626 patients
underwent radical cystectomy with 286 patients (46%) experiencing a
complication. The complication rates for those with and without preop-