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Additional file 1.

IVR call schedule. (DOCX 172Â kb)

EPIC. (DOC 120Â kb)

Citation Network Analysis Methods. (DOCX 14Â kb)

SPIRIT Checklist. (DOCX 23Â kb)

Prostate cancer treatment is a significant source of morbidity and healthcare spending. Evolving clinical data have supported expanding surveillance as a means to "right-size" treatment. Integrated delivery systems afford the possibility of hastening this objective.Retrospective cohort study of Medicare beneficiaries.We used a 20% sample of national Medicare claims to assess the impact of healthcare integration on rates of treatment and potential overtreatment in men newly diagnosed with prostate cancer between 2007 and 2011. Rates were measured according to the extent of integration within a market (ie, none, low, intermediate, and high). Generalized estimating equations were used to assess the relationship between integration and utilization, adjusting for confounders.Rates of treatment declined across all markets (P.01 for overall time trend), but the rate of decline was similar for the 4 market types (P = .27). In the most integrated markets, the rate decreased by 28.8%, or from 55.5 per 10,000 population in 2007 to 39.5 per 10,000 in 2011. After adjusting for confounders, men residing in the most integrated markets were 2.1% less likely to be treated with curative intent compared with those living in areas without integrated delivery systems (P = .04). However, rates of potential overtreatment were similar across all markets regardless of the level of integration (P = .21).Healthcare integration was associated with small declines in prostate cancer treatment in newly diagnosed men, but not with potential overtreatment. Integrated care alone may be insufficient to curtail potential overtreatment of prostate cancer.

ObjectiveTo establish a score threshold that constitutes a clinically relevant change for each domain of the Expanded Prostate Cancer Index Composite (EPIC) Short Form (EPIC-26). Although its use in clinical practice and clinical trials has increased worldwide, the clinical interpretation of this 26-item disease-specific patient-reported quality of life questionnaire for men with localized prostate cancer would be facilitated by characterization of score thresholds for clinically relevant change (the minimally important differences [MIDs]).MethodsWe used distribution- and anchor-based approaches to establish the MID range for each EPIC-26 domain (urinary, sexual, bowel, and vitality/hormonal) based on a prospective multi-institutional cohort of 1201 men treated for prostate cancer between 2003 and 2006 and followed up for 3years after treatment. For the anchor-based approach, we compared within-subject and between-subject score changes for each domain to an external "anchor" measure of overall cancer treatment satisfaction.ResultsWe found the bowel and vitality/hormonal domains to have the lowest MID range (a 4-6 point change should be considered clinically relevant), whereas the sexual domain had the greatest MID values (10-12). Urinary incontinence appeared to have a greater MID range (6-9) than the urinary irritation/obstruction domain (5-7).ConclusionUsing 2 independent approaches, we established the MIDs for each EPIC-26 domain. A definition of these MID values is essential for the researcher or clinician to understand when changes in symptom burden among prostate cancer survivors are clinically relevant.

Context:\ud Long-term survival following a diagnosis of cancer is improving in developed nations. However, living longer does not necessarily equate to living well.\ud \ud Objective:\ud To search systematically and synthesise narratively the evidence from randomised controlled trials (RCTs) of supportive interventions designed to improve prostate cancer (PCa)-specific quality of life (QoL).\ud \ud Evidence acquisition:\ud A systematic search of Medline and Embase was carried out from inception to July 2014 to identify interventions targeting PCa QoL outcomes. We did not include nonrandomised studies or trials of mixed cancer groups. In addition to database searches, citations from included papers were hand-searched for any potentially eligible trials.\ud \ud Evidence synthesis:\ud A total of 2654 PCa survivors from 20 eligible RCTs were identified from our database searches and reference checks. Disease-specific QoL was assessed most frequently by the Functional Assessment of Cancer Therapy-Prostate questionnaire. Included studies involved men across all stages of disease. Supportive interventions that featured individually tailored approaches and supportive interaction with dedicated staff produced the most convincing evidence of a benefit for PCa-specific QoL. Much of these data come from lifestyle interventions. Our review found little supportive evidence for simple literature provision (either in booklets or via online platforms) or cognitive behavioural approaches.\ud \ud Conclusions:\ud Physical and psychological health problems can have a serious negative impact on QoL in PCa survivors. Individually tailored supportive interventions such as exercise prescription/referral should be considered by multidisciplinary clinical teams where available. Cost-effectiveness data and an understanding of how to sustain benefits over the long term are important areas for future research.\ud \ud Patient summary:\ud This review of supportive interventions for improving quality of life in prostate cancer survivors found that supervised and individually tailored patient-centred interventions such as lifestyle programmes are of benefit.