Background: Although there are nearly 150,000 prostate cancer survivors in the VA, there has been little research to understand and improve survivorship care for this large population of Veterans. A substantial proportion of prostate cancer survivors in the general population have significant side effects from treatment (surgery or radiation therapy) that often persist for years including incontinence, erectile dysfunction, and metabolic syndrome, all of which can contribute to decreased quality of life. Our pilot data suggests that VA prostate cancer survivors experience similar or worse symptom burden to that of the general population of survivors. This is particularly unfortunate since many of these symptoms can be effectively self-managed. Furthermore, there is no program in the VA for assessing ongoing symptom burden in survivors and directing them to receive appropriate primary or specialty care if needed. Objectives: To address the need to improve patient-centered survivorship care management for Veterans with prostate cancer, we propose a 4 year study with two aims: 1) to conduct a randomized controlled trial to compare a personally tailored automated telephone symptom management intervention for improving symptoms and symptom self-management to usual care. We expect that those intervention group will have more confidence in symptom self-management and better symptom self-management and prostate cancer quality of life following the intervention, and that these outcomes will translate to more efficient use of services for these Veterans, and 2) to compare utilization of services among those in the intervention group to those in the control group. Methods: We will conduct a RCT of prostate cancer survivors at 3 VHA sites (Ann Arbor, Pittsburgh and St. Louis) who are 1-5 years post-treatment. Those with clinically meaningful symptom burden identified using an established measure of prostate cancer symptom burden will be invited to the study, consented and randomized to the automated telephone system or enhanced usual care (information about self-management). We will evaluate the impact of the intervention on confidence in symptom self-management as well as actual symptom burden and prostate cancer quality of life 6- and 12-months following enrollment. We will evaluate utilization of services 9-12 months post-enrollment using medical record/CPRS data sources. Finally, we will conduct a small process evaluation that will help us to better understand which elements of the intervention were effective, and will work with our primary care partners to make a recommendation for a broader deployment of an automated symptom self-management program in the VHA.
Our study will provide much needed information about how to optimize the quality of care and quality of life of Veterans who are survivors of prostate cancer. The randomized trial will evaluate an innovative information for assessing and improving symptom burden and self- management of prostate-related symptom burden in these survivors. We will further understand how symptom burden is associated with use of appropriate services in the VHA. Finally, we will work with our primary care partners to inform how to improve survivorship care for this large and growing population of Veterans.