Nataniel H Lester-Coll1, Henry S Park2, Charles E Rutter2, Christopher D Corso2, Brandon R Mancini2, Debra N Yeboa2, Simon P Kim3, Cary P Gross4, James B Yu5. 1. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT. Electronic address: nataniel.lester-coll@yale.edu. 2. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT. 3. Urology Institute, Case Western Reserve University School of Medicine, University Hospital Case Medical Center, Cleveland, OH. 4. Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 5. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, CT; Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT.
Abstract
OBJECTIVE: To identify factors associated with expectant management (EM) in a large cohort of men with low-risk prostate cancer based on cancer center type (community vs academic). EM, consisting of active surveillance or observation for men with low-risk prostate cancer, is an increasingly recognized management option, given the morbidity and lack of a survival benefit associated with definitive treatment. However, the influence of cancer center type on treatment selection is uncertain. MATERIALS AND METHODS: We performed a retrospective analysis of the National Cancer Data Base from 2010 to 2013. Men with low-risk prostate cancer were divided by management strategy into groups consisting of EM or definitive treatment. The association between management strategy and facility type (community vs academic) was characterized using 2-level hierarchical mixed effects logistic regression models. RESULTS: There were 52,417 (57%) men evaluated at community centers and 39,139 men (43%) evaluated at academic centers. Patients evaluated at academic centers were significantly more likely to receive EM than those at community centers (17% vs 8%, P < .001). After adjusting for pertinent covariates, evaluation at an academic vs community facility was independently associated with increased odds of EM utilization (adjusted odds ratio 2.70, 95% confidence interval 2.00-3.66). Fifty-one percent of the total variance was explained by interfacility variation. CONCLUSION: The likelihood of receiving EM for low-risk prostate cancer was significantly lower in men evaluated at community centers. Further investigation is warranted to elucidate factors that influence the management of low-risk prostate cancer, including individual treatment center patterns.
OBJECTIVE: To identify factors associated with expectant management (EM) in a large cohort of men with low-risk prostate cancer based on cancer center type (community vs academic). EM, consisting of active surveillance or observation for men with low-risk prostate cancer, is an increasingly recognized management option, given the morbidity and lack of a survival benefit associated with definitive treatment. However, the influence of cancer center type on treatment selection is uncertain. MATERIALS AND METHODS: We performed a retrospective analysis of the National Cancer Data Base from 2010 to 2013. Men with low-risk prostate cancer were divided by management strategy into groups consisting of EM or definitive treatment. The association between management strategy and facility type (community vs academic) was characterized using 2-level hierarchical mixed effects logistic regression models. RESULTS: There were 52,417 (57%) men evaluated at community centers and 39,139 men (43%) evaluated at academic centers. Patients evaluated at academic centers were significantly more likely to receive EM than those at community centers (17% vs 8%, P < .001). After adjusting for pertinent covariates, evaluation at an academic vs community facility was independently associated with increased odds of EM utilization (adjusted odds ratio 2.70, 95% confidence interval 2.00-3.66). Fifty-one percent of the total variance was explained by interfacility variation. CONCLUSION: The likelihood of receiving EM for low-risk prostate cancer was significantly lower in men evaluated at community centers. Further investigation is warranted to elucidate factors that influence the management of low-risk prostate cancer, including individual treatment center patterns.
Authors: Stacy Loeb; Nataliya K Byrne; Binhuan Wang; Danil V Makarov; Daniel Becker; David R Wise; Herbert Lepor; Dawn Walter Journal: Eur Urol Date: 2020-02-22 Impact factor: 20.096