Hyperglycemia and prostate cancer recurrence in men treated for localized prostate cancer.

Background:Obesity is consistently linked with prostate cancer (PCa) recurrence and mortality, though the mechanism is unknown. Impaired glucose regulation, which is common among obese individuals, has been hypothesized as a potential mechanism for PCa tumor growth. In this study, we explore the relationship between serum glucose at time of treatment and risk of PCa recurrence following initial therapy.Methods:The study group comprised 1734 men treated with radical prostatectomy (RP) or radiation therapy (RT) for localized PCa between 2001-2010. Serum glucose levels closest to date of diagnosis were determined. PCa recurrence was determined based on PSA progression (nadir PSA+2 for RT; PSA0.2 for RP) or secondary therapy. Multivariate Cox regression was performed to determine whether glucose level was associated with biochemical recurrence after adjusting for age, race, body mass index, comorbidity, diagnosis of diabetes, Gleason Sum, PSA, treatment and treatment year.Results:Recurrence was identified in 16% of men over a mean follow-up period of 41 months (range 1-121 months). Those with elevated glucose (100 mg/dl) had a 50% increased risk of recurrence (HR 1.5, 95% CI: 1.1-2.0) compared with those with a normal glucose level (<100 mg/dl). This effect was seen in both those undergoing RP (HR 1.9, 95% CI: 1.0-3.6) and those treated with RT (HR 1.4, 95% CI: 1.0-2.0).Conclusions:Glucose levels at the time of PCa diagnosis are an independent predictor of PCa recurrence for men undergoing treatment for localized disease

Longitudinal Utilization of Invasive Pain Treatment Procedures Among Veterans with Chronic Pain Following Use of Whole Health Services and Complementary and Integrative Health Therapies

Steven B Zeliadt,1,2 Rian DeFaccio,1 Evan P Carey,3 Bella Etingen,4,5 Ethan W Rosser,1 Pradeep Suri,6 Jessica A Chen,1 Barbara G Bokhour,7,8 Scott Coggeshall1 1VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA; 2Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA; 3VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, Eastern Colorado Healthcare System, Denver, CO, USA; 4Research and Development Service, Dallas VA Medical Center, Dallas, TX, USA; 5Department of Public Health, Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA; 6Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Healthcare System, Seattle, WA, USA; 7Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; 8Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USACorrespondence: Steven B Zeliadt, VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, 1660 South Columbian Way, S-15, Seattle, WA, 98108, USA, Tel +1 206 277-4175, Fax +1 206 764-2935, Email [email protected]: To assess whether Whole Health, a system of care that emphasizes non-pharmacological approaches for chronic pain management, is associated with changes in downstream utilization of invasive pain treatment procedures.Methods: Longitudinal retrospective cohort analysis of VHA administrative data. A total of 53,412 Veterans with chronic pain were identified between April and September 2018, with 584 initiating Whole Health and 3794 initiating a complementary and integrative health (CIH) therapy independent of Whole Health (CIH-only). Whole Health included use of coaching, personal health planning, and other services including CIH referral. CIH therapies included chiropractic care, acupuncture, massage therapy, yoga, Tai Chi/Qigong, and meditation. Propensity score matching was used to estimate expected rates of invasive pain treatment procedures 0– 3, 4– 12, and 13– 18 months after initiating Whole Health or CIH-only compared to similar Veterans who had not engaged in either.Results: Overall, 14% of the population were female, 11% had received prior spine injections, 3.3% had received surgery, and 0.4% had an implantable spinal stimulator. Whole Health use was associated with 42% (− 61% to − 17%) lower utilization of invasive pain procedures at three months compared to matched patients who did not use Whole Health. This reduction was attenuated at 18 months: 22% (− 39% to − 5%). CIH-only was associated with 18% (− 29% to − 4%) lower utilization at three months compared with matched patients, but differences were minimal at 18 months: 1% (− 9% to 9%).Discussion: Whole Health care, including CIH therapies, may help patients interrupt patterns of escalating and invasive pain care.Keywords: chronic pain, complementary and integrative health, invasive spine procedures, whole health, veteran

An Automated Method for Identifying Individuals with a Lung Nodule Can Be Feasibly Implemented Across Health Systems

Introduction: The incidence of incidentally detected lung nodules is rapidly rising, but little is known about their management or associated patient outcomes. One barrier to studying lung nodule care is the inability to efficiently and reliably identify the cohort of interest (i.e. cases). Investigators at Kaiser Permanente Southern California (KPSC) recently developed an automated method to identify individuals with an incidentally discovered lung nodule, but the feasibility of implementing this method across other health systems is unknown.Methods: A random sample of Group Health (GH) members who had a computed tomography in 2012 underwent chart review to determine if a lung nodule was documented in the radiology report. A previously developed natural language processing (NLP) algorithm was implemented at our site using only knowledge of the key words, qualifiers, excluding terms, and the logic linking these parameters.Results: Among 499 subjects, 156 (31%, 95% confidence interval [CI] 27-36%) had an incidentally detected lung nodule. NLP identified 189 (38%, 95% CI 33-42%) individuals with a nodule. The accuracy of NLP at GH was similar to its accuracy at KPSC: sensitivity 90% (95% CI 85-95%) and specificity 86% (95% CI 82-89%) versus sensitivity 96% (95% CI 88-100%) and specificity 86% (95% CI 75-94%).Conclusion: Automated methods designed to identify individuals with an incidentally detected lung nodule can feasibly and independently be implemented across health systems. Use of these methods will likely facilitate the efficient conduct of multi-site studies evaluating practice patterns and associated outcomes.</jats:p