Variation in the use of active surveillance for low-risk prostate cancer.
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
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.
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.