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Expectant management of veterans with early‐stage prostate cancer
Author(s) -
Filson Christopher P.,
Shelton Jeremy B.,
Tan HungJui,
Kwan Lorna,
Skolarus Ted A.,
Saigal Christopher S.,
Litwin Mark S.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29785
Subject(s) - medicine , expectant management , comorbidity , odds ratio , odds , obstetrics , gynecology , logistic regression , pregnancy , genetics , gestation , biology
BACKGROUND For certain men with low‐risk prostate cancer, aggressive treatment results in marginal survival benefits while exposing them to urinary and sexual side effects. Nevertheless, expectant management has been underused. In the current study, the authors evaluated the association between various factors and expectant management use among veterans diagnosed with prostate cancer. METHODS The authors identified men diagnosed with prostate cancer in 2008. The outcome of interest was use of expectant management, based on documentation captured through an in‐depth chart review. Multivariable regression models were fit to examine associations between use of expectant management and patient demographics, cancer severity, and facility characteristics. The authors assessed variation across 21 tertiary care regions and 52 facilities by generating predicted probabilities for receipt of expectant management. RESULTS Expectant management was more common among patients aged ≥75 years (40% vs 27% for those aged < 55 years; odds ratio, 2.57) and those with low‐risk tumors (49% vs 20% for patients with high‐risk tumors; odds ratio, 5.35). There was no association noted between patient comorbidity and receipt of expectant management ( P = .90). There were also no associations found between facility factors and use of expectant management (all P >.05). Among ideal candidates for expectant management, receipt of expectant management varied considerably across individual facilities (0%‐85%; P <.001). CONCLUSIONS Patient age and tumor risk were found to be more strongly associated with use of expectant management than patient comorbidity. Although use of expectant management appears broadly appropriate, there was variation in expectant management noted between hospitals that was apparently not attributable to facility factors. Research determining the basis of this variation, with a focus on providers, will be critical to help optimize prostate cancer treatment for veterans. Cancer 2016;122:626–633. © 2015 American Cancer Society .