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Factors influencing treatment of veterans with advanced prostate cancer
Author(s) -
Caram Megan E. V.,
Burns Jennifer,
Kumbier Kyle,
Sparks Jordan B.,
Tsao Phoebe A.,
Chapman Christina H.,
Bauman Jordan,
Hollenbeck Brent K.,
Shahinian Vahakn B.,
Skolarus Ted A.
Publication year - 2021
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.33485
Subject(s) - docetaxel , enzalutamide , medicine , ketoconazole , prostate cancer , oncology , androgen deprivation therapy , abiraterone , cabazitaxel , cancer , dermatology , androgen receptor , antifungal
Background Treatments for metastatic castration‐resistant prostate cancer (CRPC) differ in toxicity, administration, and evidence. In this study, clinical and nonclinical factors associated with the first‐line treatment for CRPC in a national delivery system were evaluated. Methods National electronic laboratory and clinical data from the Veterans Health Administration were used to identify patients with CRPC (ie, rising prostate‐specific antigen [PSA] on androgen deprivation) who received abiraterone, enzalutamide, docetaxel, or ketoconazole from 2010 through 2017. It was determined whether clinical (eg, PSA) and nonclinical factors (eg, race, facility) were associated with the first‐line treatment selection using multilevel, multinomial logistic regression. The average marginal effects (AMEs) were calculated of patient, disease, and facility characteristics on ketoconazole versus more appropriate CRPC therapy. Results There were 4998 patients identified with CRPC who received first‐line ketoconazole, docetaxel, abiraterone, or enzalutamide. After adjustment, increasing age was associated with receipt of abiraterone (adjusted odds ratio [aOR], 1.07; 95% credible interval [CrI], 1.06‐1.09) or enzalutamide (aOR, 1.10; 95% CrI, 1.08‐1.11) versus docetaxel. Greater preexisting comorbidity was associated with enzalutamide versus abiraterone (aOR, 1.53; 95% CrI, 1.23‐1.91). Patients with higher PSA values at the start of treatment were more likely to receive docetaxel than oral agents and less likely to receive ketoconazole than other oral agents. African American men were more likely to receive ketoconazole than abiraterone, enzalutamide, or docetaxel (AME, 2.8%; 95% CI, 0.7%‐4.9%). This effect was attenuated when adjusting for facility characteristics (AME, 1.9%; 95% CI, –0.4% to 4.1%). Conclusions Clinical factors had an expected effect on the first‐line treatment selection. Race may be associated with the receipt of a guideline‐discordant first‐line treatment.