Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists

Simon P. Kim, Cary P. Gross, Nilay D. Shah, Jon C. Tilburt, Badrinath Konety, Stephen Williams, Christopher J. Weight, James B. Yu, Aryavarta M.S. Kumar, Neal J. Meropol

    Research output: Contribution to journalArticle

    Abstract

    Purpose: The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa. Methods: In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS. Results: We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty. Conclusions: Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.

    Original languageEnglish (US)
    JournalAnnals of Surgical Oncology
    DOIs
    StateAccepted/In press - Jan 1 2018

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    Prostatic Neoplasms
    Prostate
    Odds Ratio
    Physicians
    Biopsy
    Patient Preference
    Postal Service
    Therapeutics
    Urologists
    Radiation Oncologists
    Surveys and Questionnaires
    Decision Making
    Radiotherapy
    Logistic Models
    Regression Analysis
    Survival

    ASJC Scopus subject areas

    • Surgery
    • Oncology

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    Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer : Results From a National Survey of Radiation Oncologists and Urologists. / Kim, Simon P.; Gross, Cary P.; Shah, Nilay D.; Tilburt, Jon C.; Konety, Badrinath; Williams, Stephen; Weight, Christopher J.; Yu, James B.; Kumar, Aryavarta M.S.; Meropol, Neal J.

    In: Annals of Surgical Oncology, 01.01.2018.

    Research output: Contribution to journalArticle

    Kim, Simon P. ; Gross, Cary P. ; Shah, Nilay D. ; Tilburt, Jon C. ; Konety, Badrinath ; Williams, Stephen ; Weight, Christopher J. ; Yu, James B. ; Kumar, Aryavarta M.S. ; Meropol, Neal J. / Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer : Results From a National Survey of Radiation Oncologists and Urologists. In: Annals of Surgical Oncology. 2018.
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    title = "Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists",
    abstract = "Purpose: The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa. Methods: In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS. Results: We received 691 completed surveys for an overall response rate of 37.3{\%}. A majority of respondents indicated that they felt comfortable recommending AS (90.0{\%}), agreed that high-level evidence supports it (82.3{\%}), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4{\%}). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9{\%}; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4{\%}; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty. Conclusions: Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.",
    author = "Kim, {Simon P.} and Gross, {Cary P.} and Shah, {Nilay D.} and Tilburt, {Jon C.} and Badrinath Konety and Stephen Williams and Weight, {Christopher J.} and Yu, {James B.} and Kumar, {Aryavarta M.S.} and Meropol, {Neal J.}",
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    T1 - Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer

    T2 - Results From a National Survey of Radiation Oncologists and Urologists

    AU - Kim, Simon P.

    AU - Gross, Cary P.

    AU - Shah, Nilay D.

    AU - Tilburt, Jon C.

    AU - Konety, Badrinath

    AU - Williams, Stephen

    AU - Weight, Christopher J.

    AU - Yu, James B.

    AU - Kumar, Aryavarta M.S.

    AU - Meropol, Neal J.

    PY - 2018/1/1

    Y1 - 2018/1/1

    N2 - Purpose: The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa. Methods: In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS. Results: We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty. Conclusions: Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.

    AB - Purpose: The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa. Methods: In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS. Results: We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty. Conclusions: Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.

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