Pd13-11 the Effect of Dual Eligibility on the Quality of Active Surveillance in Patients With Newly Diagnosed Prostate Cancer

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance I (PD13)1 May 2024PD13-11 THE EFFECT OF DUAL ELIGIBILITY ON THE QUALITY OF ACTIVE SURVEILLANCE IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER Kassem Faraj, Rodney Dunn, Vahakn Shahinian, Brent Hollenbeck, and Lindsey Herrel Kassem FarajKassem Faraj , Rodney DunnRodney Dunn , Vahakn ShahinianVahakn Shahinian , Brent HollenbeckBrent Hollenbeck , and Lindsey HerrelLindsey Herrel View All Author Informationhttps://doi.org/10.1097/01.JU.0001009552.62973.71.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dual eligible beneficiaries are particularly vulnerable patients who qualify for Medicare (age) and Medicaid (low income). Fully dual eligible beneficiaries have access to support services that may facilitate care coordination, while others (i.e., partially dual eligible) do not have access to these services. The extent to which these services affect prostate cancer active surveillance quality is unclear. METHODS: We performed a cohort study of Medicare beneficiaries diagnosed with prostate cancer managed by active surveillance from 2015-2019. Ideal surveillance entailed having both 1-2 PSA tests and a confirmatory test (i.e., mpMRI, genomics, or biopsy) at 1 year. Testing below or above these thresholds was categorized as "underuse" or "overuse" of testing. Quality was compared between fully dual eligible ("F"), partially dual eligible ("P"), and non-dual eligible ("N") men. RESULTS: Of 138,785 men with newly diagnosed prostate cancer, 4,611 (3.3%) were fully dual eligible and 2,031 (1.5%) were partially dual eligible. Thirty two percent (F), 31% (P), and 31% (N) of men underwent active surveillance. As shown in Figure 1, ideal surveillance was lower in dual eligible beneficiaries (F-11%, P-9%, N-15%, p<0.001). This corresponded to more underuse (F-70%, P-74%, N-63%) in dual eligible men and more overuse in non-dual eligible men (F-19%, P-16%, N-22%). The most common reasons for underuse (Figure 2) were the 1) lack of PSA and confirmatory testing (41%) and 2) adequate PSA testing but no confirmatory test (38%). CONCLUSIONS: A minority of men on active surveillance receive recommended follow-up testing. Dual eligible men experienced less frequent ideal surveillance, potentially reflecting disparities in care. Partially dual eligible men had the worst rates of ideal surveillance and the highest rates of underuse, which may reflect the lack of support services. Policymakers aiming to improve surveillance quality should ensure that vulnerable groups have the resources needed to comply with the recommended testing. Download PPTDownload PPT Source of Funding: This study is supported by funding from the National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the Prostate Cancer Foundation-Pfizer Health Equity Grant No K08CA237638 (Herrel) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e266 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kassem Faraj More articles by this author Rodney Dunn More articles by this author Vahakn Shahinian More articles by this author Brent Hollenbeck More articles by this author Lindsey Herrel More articles by this author Expand All Advertisement PDF downloadLoading ...