Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes.

OBJECTIVE: To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy. METHODS: All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed. RESULTS: A total of 1133 fusion biopsies performed by 5 providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5%-46.9%, adjusted P-value = .575). Clinically significant cancer detection rates ranged from 11.1% to 16.7% in PI-RADS 3 (unadjusted P = .838), from 24.6% to 43.4% in PI-RADS 4 (adjusted P = .003), and from 69.4% to 78.8% in PI-RADS 5 (adjusted P = .766) lesions. CONCLUSION: There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.

The Role of Social Support in Telehealth Utilization Among Older Adults in the United States During the COVID-19 Pandemic.

Background: Older adults may experience a significant digital divide and need support with using technology to transition to telehealth. This study examines the role of social support for telehealth utilization among older adults during the COVID-19 pandemic. Materials and Methods: We used data from the COVID-19 Sample Person Interview to the National Health and Aging Trends Study. Using logistic regression, we measured the association between telehealth utilization and social support. Results: Nearly one in five respondents used telehealth during the COVID-19 pandemic (weighted %: 20.6 [585/3188]). Currently living with family or friends and receipt of technical support were associated with telehealth utilization. Among residents of an assisted living facility, those who received communications technology support from the facility were more likely to use telehealth. Conclusion: Health care providers and policies should aim to reduce barriers to telehealth among older adults, with efforts such as digital literacy support and training.

Repealing the Affordable Care Act and Implications for Cancer Care.

Calls to repeal the Affordable Care Act (ACA) have become increasingly frequent. Most attempts to repeal the ACA have targeted specific policies rather than the ACA as a whole. This article describes the specific policies under debate and the ramifications of repealing each of them. Specific attention is given to insurance coverage, individual premiums, and budgetary impact. Based on the literature regarding the ACA's impact to date, the impact of ACA repeal on Surgical oncology care is predicted.