Radiation Therapy in the CEASAR cohort

There are several research inquiries falling under XRT in CEASAR. Karen Hoffman is the senior author, and Daniel Lee has been the first author on these. So far there has been

• A paper/project describing the XRT in this cohort
• A letter pointing out compliance to quality recommendations and racial disparities.
• Plans for 'Project 1': Patient reported outcomes (PROs) as a function of compliance
• Plans for 'Project 2': PROs as a function of radiation type

Cohort definition

CEASAR analytic cohort (not primary analysis cohort, which only includes EBRT, RP, and AS).

• EBRT, LDR, and EBRT + LDR/brachytherapy (EBLDR) (Exclude HDR and EBHDR)

Project "2:" Relationship between radiaiton type and PROs.

• Comparison groups/exposures: radiation type (EBRT, LDR, EBRT + LDR)
• EBRT would be the reference group.
• Complicating factor is PCa risk. Very few patient with high risk got (and should have gotten) LDR. We talked about doing 3 separate models- one for each category of risk.
• Dan's hypothesis: There will be a difference in urinary irritative symptoms/bother and bowel bother between therapies that involve brachy therapy (EBLDR and LDR) and EBRT.
• Control for time, bl function, age, and everything else. Actually, looking at the numbers, I don't think we should control for everything. The numbers will not support a generalizable model with that many terms, especially since we are dividing the data into subsets by risk.
• Handling ADT
  • include both ADT and no ADT.
  • For the high risk model, and where we can, we should control for ADT use for the sexual and hormone domain models. We could NOT do this, and note that 'adt is a component of the therapy they get.'

Project "1:" Relationship between recommendation compliance and PROs.

• Should this be separate analyses/questions for EBLDR and LDR? Or combined/averaged/aggregate analysis/results/interpretation?

Meeting notes

2017 January 4

• Can look at some of these graphically, including showing individual points.
• If the numbers are there, Karen want to break down the treatment types in as much detail they can. eg, look at with and without adt.

2017 February 7

Project "Letter"

• A few more details to add to the letter.
  • "Black patients tend to see low-quality providers."
  • We don't have a provider-level information.

Project "Three types of radiation"

• "Radiation type affects the PRO (sexual, urinary, irritative, bowel, hormonal)."
• "EBRT has a better outcome than EBHDR and EBLDR"
  • ADT and Risk need to be adjusted.
  • ADT is likely given to High Risk patients.
• Radiation type and ADT are associated with Risk strata.

Project "Compliance and PRO"

• "Compliant with IGRT is associated with PRO."
• Combine 'CompliantLdrPostProst and CompliantLdrPostRec' in Table 11 on JoAnn's report, ''Radiation therapy description and quality of care in the CEASAR cohort".

-- JoAnnAlvarez - 03 Jan 2017