Population-Based Assessment of Determining Treatments for Prostate Cancer

Karim Chamie, Stephen Williams, Jim C. Hu

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: To determine population-based predictors for treatment and use of watchful waiting or active surveillance for indolent prostate cancer.

DESIGN, SETTING, AND PARTICIPANTS: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. A total of 37,621 men in the general community diagnosed as having prostate cancer from 2004 to 2007 were followed until December 31, 2009.

EXPOSURES: Watchful waiting or active surveillance, radiation therapy, or radical prostatectomy.

MAIN OUTCOMES AND MEASURES: We used mixed-effects logistic regression analysis to determine the factors associated with aggressive treatment and use of watchful waiting or active surveillance for men with prostate cancer.

RESULTS: The most common treatment type is radiation therapy (57.9% [95% CI, 57.4%-58.4%]), followed by radical prostatectomy (19.1% [95% CI, 18.7%-19.5%]) and watchful waiting or active surveillance (9.6% [95% CI, 9.3%-9.9%]). Moreover, patients and providers significantly integrate age (odds ratio [OR], 0.32 [95% CI, 0.29-0.35]) and comorbidities (OR, 0.62 [95% CI, 0.56-0.68]) when determining radical prostatectomy, while regional variation (OR, 0.57 [95% CI, 0.47-0.68]) and referral patterns (OR, 44.46 [95% CI, 41.04-48.17]) influence the use of radiation therapy. Patient demographics and tumor characteristics significantly account for 40% of patients undergoing prostatectomy, 12% choosing watchful waiting or active surveillance, and only 3% undergoing radiotherapy.

CONCLUSIONS AND RELEVANCE: There is increased use of radiotherapy among patients with indolent prostate cancer with limited to no correlation with tumor biology. Active surveillance was underused, and a significant proportion of the variance was unexplained. Further research into qualitatively describing the contributing factors that drive decision-making recommendations for prostate cancer patients is needed.

IMPORTANCE: Many men with indolent prostate cancer often opt for radical prostatectomy or radiotherapy treatment for their disease. These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments. Without a better understanding of the mutable agents and predictors of treatment types, diffusion of expectant management among these men will be slow.

Original languageEnglish (US)
Pages (from-to)60-67
Number of pages8
JournalJAMA oncology
Volume1
Issue number1
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

Fingerprint

Watchful Waiting
Prostatectomy
Prostatic Neoplasms
Radiotherapy
Odds Ratio
Population
Therapeutics
Poisons
Medicare
Comorbidity
Neoplasms
Decision Making
Epidemiology
Referral and Consultation
Logistic Models
Regression Analysis
Quality of Life
Demography
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Population-Based Assessment of Determining Treatments for Prostate Cancer. / Chamie, Karim; Williams, Stephen; Hu, Jim C.

In: JAMA oncology, Vol. 1, No. 1, 01.04.2015, p. 60-67.

Research output: Contribution to journalArticle

@article{2f7238b5f2ec4c3cbfe7c25a879292a8,
title = "Population-Based Assessment of Determining Treatments for Prostate Cancer",
abstract = "OBJECTIVE: To determine population-based predictors for treatment and use of watchful waiting or active surveillance for indolent prostate cancer.DESIGN, SETTING, AND PARTICIPANTS: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. A total of 37,621 men in the general community diagnosed as having prostate cancer from 2004 to 2007 were followed until December 31, 2009.EXPOSURES: Watchful waiting or active surveillance, radiation therapy, or radical prostatectomy.MAIN OUTCOMES AND MEASURES: We used mixed-effects logistic regression analysis to determine the factors associated with aggressive treatment and use of watchful waiting or active surveillance for men with prostate cancer.RESULTS: The most common treatment type is radiation therapy (57.9{\%} [95{\%} CI, 57.4{\%}-58.4{\%}]), followed by radical prostatectomy (19.1{\%} [95{\%} CI, 18.7{\%}-19.5{\%}]) and watchful waiting or active surveillance (9.6{\%} [95{\%} CI, 9.3{\%}-9.9{\%}]). Moreover, patients and providers significantly integrate age (odds ratio [OR], 0.32 [95{\%} CI, 0.29-0.35]) and comorbidities (OR, 0.62 [95{\%} CI, 0.56-0.68]) when determining radical prostatectomy, while regional variation (OR, 0.57 [95{\%} CI, 0.47-0.68]) and referral patterns (OR, 44.46 [95{\%} CI, 41.04-48.17]) influence the use of radiation therapy. Patient demographics and tumor characteristics significantly account for 40{\%} of patients undergoing prostatectomy, 12{\%} choosing watchful waiting or active surveillance, and only 3{\%} undergoing radiotherapy.CONCLUSIONS AND RELEVANCE: There is increased use of radiotherapy among patients with indolent prostate cancer with limited to no correlation with tumor biology. Active surveillance was underused, and a significant proportion of the variance was unexplained. Further research into qualitatively describing the contributing factors that drive decision-making recommendations for prostate cancer patients is needed.IMPORTANCE: Many men with indolent prostate cancer often opt for radical prostatectomy or radiotherapy treatment for their disease. These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments. Without a better understanding of the mutable agents and predictors of treatment types, diffusion of expectant management among these men will be slow.",
author = "Karim Chamie and Stephen Williams and Hu, {Jim C.}",
year = "2015",
month = "4",
day = "1",
doi = "10.1001/jamaoncol.2014.192",
language = "English (US)",
volume = "1",
pages = "60--67",
journal = "JAMA oncology",
issn = "2374-2437",
publisher = "American Medical Association",
number = "1",

}

TY - JOUR

T1 - Population-Based Assessment of Determining Treatments for Prostate Cancer

AU - Chamie, Karim

AU - Williams, Stephen

AU - Hu, Jim C.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - OBJECTIVE: To determine population-based predictors for treatment and use of watchful waiting or active surveillance for indolent prostate cancer.DESIGN, SETTING, AND PARTICIPANTS: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. A total of 37,621 men in the general community diagnosed as having prostate cancer from 2004 to 2007 were followed until December 31, 2009.EXPOSURES: Watchful waiting or active surveillance, radiation therapy, or radical prostatectomy.MAIN OUTCOMES AND MEASURES: We used mixed-effects logistic regression analysis to determine the factors associated with aggressive treatment and use of watchful waiting or active surveillance for men with prostate cancer.RESULTS: The most common treatment type is radiation therapy (57.9% [95% CI, 57.4%-58.4%]), followed by radical prostatectomy (19.1% [95% CI, 18.7%-19.5%]) and watchful waiting or active surveillance (9.6% [95% CI, 9.3%-9.9%]). Moreover, patients and providers significantly integrate age (odds ratio [OR], 0.32 [95% CI, 0.29-0.35]) and comorbidities (OR, 0.62 [95% CI, 0.56-0.68]) when determining radical prostatectomy, while regional variation (OR, 0.57 [95% CI, 0.47-0.68]) and referral patterns (OR, 44.46 [95% CI, 41.04-48.17]) influence the use of radiation therapy. Patient demographics and tumor characteristics significantly account for 40% of patients undergoing prostatectomy, 12% choosing watchful waiting or active surveillance, and only 3% undergoing radiotherapy.CONCLUSIONS AND RELEVANCE: There is increased use of radiotherapy among patients with indolent prostate cancer with limited to no correlation with tumor biology. Active surveillance was underused, and a significant proportion of the variance was unexplained. Further research into qualitatively describing the contributing factors that drive decision-making recommendations for prostate cancer patients is needed.IMPORTANCE: Many men with indolent prostate cancer often opt for radical prostatectomy or radiotherapy treatment for their disease. These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments. Without a better understanding of the mutable agents and predictors of treatment types, diffusion of expectant management among these men will be slow.

AB - OBJECTIVE: To determine population-based predictors for treatment and use of watchful waiting or active surveillance for indolent prostate cancer.DESIGN, SETTING, AND PARTICIPANTS: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. A total of 37,621 men in the general community diagnosed as having prostate cancer from 2004 to 2007 were followed until December 31, 2009.EXPOSURES: Watchful waiting or active surveillance, radiation therapy, or radical prostatectomy.MAIN OUTCOMES AND MEASURES: We used mixed-effects logistic regression analysis to determine the factors associated with aggressive treatment and use of watchful waiting or active surveillance for men with prostate cancer.RESULTS: The most common treatment type is radiation therapy (57.9% [95% CI, 57.4%-58.4%]), followed by radical prostatectomy (19.1% [95% CI, 18.7%-19.5%]) and watchful waiting or active surveillance (9.6% [95% CI, 9.3%-9.9%]). Moreover, patients and providers significantly integrate age (odds ratio [OR], 0.32 [95% CI, 0.29-0.35]) and comorbidities (OR, 0.62 [95% CI, 0.56-0.68]) when determining radical prostatectomy, while regional variation (OR, 0.57 [95% CI, 0.47-0.68]) and referral patterns (OR, 44.46 [95% CI, 41.04-48.17]) influence the use of radiation therapy. Patient demographics and tumor characteristics significantly account for 40% of patients undergoing prostatectomy, 12% choosing watchful waiting or active surveillance, and only 3% undergoing radiotherapy.CONCLUSIONS AND RELEVANCE: There is increased use of radiotherapy among patients with indolent prostate cancer with limited to no correlation with tumor biology. Active surveillance was underused, and a significant proportion of the variance was unexplained. Further research into qualitatively describing the contributing factors that drive decision-making recommendations for prostate cancer patients is needed.IMPORTANCE: Many men with indolent prostate cancer often opt for radical prostatectomy or radiotherapy treatment for their disease. These men may experience considerable detriments of quality of life owing to sexual, urinary, and/or rectal toxic effects associated with these treatments. Without a better understanding of the mutable agents and predictors of treatment types, diffusion of expectant management among these men will be slow.

UR - http://www.scopus.com/inward/record.url?scp=84989771083&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84989771083&partnerID=8YFLogxK

U2 - 10.1001/jamaoncol.2014.192

DO - 10.1001/jamaoncol.2014.192

M3 - Article

C2 - 26182305

AN - SCOPUS:84989771083

VL - 1

SP - 60

EP - 67

JO - JAMA oncology

JF - JAMA oncology

SN - 2374-2437

IS - 1

ER -