Marieke J Krimphove1, Alexander P Cole2, David F Friedlander2, David-Dan Nguyen2, Stuart R Lipsitz3, Paul L Nguyen4, Kerry L Kilbridge5, Adam S Kibel2, Luis A Kluth6, Quoc-Dien Trinh7. 1. Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. 2. Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 3. Division of General Internal Medicine and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 4. Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA. 5. Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA. 6. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. 7. Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: qtrinh@bwh.harvard.edu.
Abstract
BACKGROUND: A considerable number of prostate cancer (PCa) patients eligible for expectant management receive definitive treatment. We aimed to investigate the hospital-level contribution to overtreatment in the United States. METHODS: Using the National Cancer Database we identified two nonoverlapping cohorts: (1) men with a life expectancy <10 years harbouring low or intermediate risk PCa (2) men with life expectancy ≥10 years with low-risk PCa. Multivariable mixed models with patient characteristics as fixed and hospital-level intercept as random effect were used to assess the hospital-level risk-adjusted probability of definitive treatment in both groups. Pearson's correlation coefficient was calculated to investigate the correlation between the hospitals probabilities of treating patients of both cohorts. RESULTS: We found 33,431 men with a life expectancy <10 years and 122,514 men with a life expectancy ≥10 years and low-risk PCa. In the latter, the probability of treatment ranged from 29.0% in the bottom to 90.0% in the top decile and from 35.0% to 88.0% for men with a life expectancy <10 years. Age and race were independent predictors of low-value treatment in both cohorts. The correlation between 1,225 hospitals treating men of both cohorts was strong (Pearson's r = 0.66, P < 0.001). CONCLUSION: There is wide hospital-level variability in low-value treatment of men with limited life expectancies and low-risk PCa. Hospitals more likely to treat men with limited life expectancies were more likely to treat men with low-risk PCa and vice versa. Identifying drivers and modifying practice at these hospitals may represent an effective tool for reducing overtreatment.
BACKGROUND: A considerable number of prostate cancer (PCa) patients eligible for expectant management receive definitive treatment. We aimed to investigate the hospital-level contribution to overtreatment in the United States. METHODS: Using the National Cancer Database we identified two nonoverlapping cohorts: (1) men with a life expectancy <10 years harbouring low or intermediate risk PCa (2) men with life expectancy ≥10 years with low-risk PCa. Multivariable mixed models with patient characteristics as fixed and hospital-level intercept as random effect were used to assess the hospital-level risk-adjusted probability of definitive treatment in both groups. Pearson's correlation coefficient was calculated to investigate the correlation between the hospitals probabilities of treating patients of both cohorts. RESULTS: We found 33,431 men with a life expectancy <10 years and 122,514 men with a life expectancy ≥10 years and low-risk PCa. In the latter, the probability of treatment ranged from 29.0% in the bottom to 90.0% in the top decile and from 35.0% to 88.0% for men with a life expectancy <10 years. Age and race were independent predictors of low-value treatment in both cohorts. The correlation between 1,225 hospitals treating men of both cohorts was strong (Pearson's r = 0.66, P < 0.001). CONCLUSION: There is wide hospital-level variability in low-value treatment of men with limited life expectancies and low-risk PCa. Hospitals more likely to treat men with limited life expectancies were more likely to treat men with low-risk PCa and vice versa. Identifying drivers and modifying practice at these hospitals may represent an effective tool for reducing overtreatment.
Authors: Kelsey Chalmers; Paula Smith; Judith Garber; Valerie Gopinath; Shannon Brownlee; Aaron L Schwartz; Adam G Elshaug; Vikas Saini Journal: JAMA Netw Open Date: 2021-04-01