Variation in the use of active surveillance for low-risk prostate cancer.
Document Type
Article
Publication Date
1-2018
Institution/Department
Urology, CORE
Journal Title
Cancer
MeSH Headings
Adenocarcinoma, Adult, Aged, Cancer Care Facilities, Disease Management, Humans, Kallikreins, Male, Middle Aged, Multivariate Analysis, Neoplasm Staging, Odds Ratio, Practice Patterns, Physicians', Prostate-Specific Antigen, Prostatic Neoplasms, Retrospective Studies, Watchful Waiting
Abstract
BACKGROUND: This study assessed the use of active surveillance in men with low-risk prostate cancer and evaluated institutional factors associated with the receipt of active surveillance.
METHODS: A retrospective, hospital-based cohort of 115,208 men with low-risk prostate cancer diagnosed between 2010 and 2014 was used. Multivariate and mixed effects models were used to examine variation and factors associated with active surveillance.
RESULTS: During the study period, the use of active surveillance increased from 6.8% in 2010 to 19.9% in 2014 (estimated annual percentage change, +28.8%; 95% confidence interval [CI], + 19.6% to + 38.7%; P = .002). The adjusted probability of active-surveillance receipt by institution was highly variable. Compared with patients treated at comprehensive community cancer centers, patients treated at community cancer programs (odds ratio [OR], 2.00; 95% CI, 1.50-2.67; P < .001) and academic institutions (OR, 2.47; 95%, CI, 1.81-3.37; P < .001) had higher odds of receiving active surveillance. Compared with patients treated at very low-volume facilities, patients treated at very high-volume facilities had higher odds of receiving active surveillance (OR, 3.57; 95% CI, 1.94-6.55; P < .001). Patient and hospital characteristics accounted for 60.2% of the overall variation, whereas the treating institution accounted for 91.5% of the unexplained variability.
CONCLUSIONS: Within this hospital-based cohort, the use of active surveillance for low-risk prostate cancer increased significantly over time. Significant variation was found in the use of active surveillance. Most of the variation was attributable to facility-related factors such as the facility type, facility volume, and institution. Policies to achieve consistent and higher rates of active surveillance, when appropriate, should be a priority of professional societies and patient advocacy groups. Cancer 2018;124:55-64. © 2017 American Cancer Society.
ISSN
1097-0142
First Page
55
Last Page
64
Recommended Citation
Löppenberg, Björn; Friedlander, David F; Krasnova, Anna; Tam, Andrew; Leow, Jeffrey J; Nguyen, Paul L; Barry, Hawa; Lipsitz, Stuart R; Menon, Mani; Abdollah, Firas; Sammon, Jesse D.; Sun, Maxine; Choueiri, Toni K; Kibel, Adam S; and Trinh, Quoc-Dien, "Variation in the use of active surveillance for low-risk prostate cancer." (2018). Maine Medical Center. 173.
https://knowledgeconnection.mainehealth.org/mmc/173