Journal
CANCER
Volume 124, Issue 1, Pages 55-64Publisher
WILEY
DOI: 10.1002/cncr.30983
Keywords
active surveillance; expectant management; external-beam radiation therapy; practice patterns; prostatic neoplasms; radical prostatectomy; variation; watchful waiting
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Funding
- Heinrich Hertz Foundation of the Ministry of Innovation, Higher Education, and Research of North-Rhine Westphalia (Dusseldorf, Germany)
- Vattikuti Urology Institute
- Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation
- Genentech BioOncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology
- Jerome and Nancy Kohlberg Professorship in Medicine at Harvard Medical School
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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. (c) 2017 American Cancer Society.
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