Harvard Radiation Oncology Program, Boston, MA
Ayal A. Aizer , Jonathan J. Paly , Anthony L. Zietman , Paul Linh Nguyen , Clair Beard , Sandhya K. Rao , Irving D. Kaplan , Andrzej Niemierko , Michelle S. Hirsch , Chin-Lee Wu , Aria F. Olumi , M. Dror Michaelson , Anthony Victor D'Amico , Jason Alexander Efstathiou
Background: The National Comprehensive Cancer Network (NCCN) recommends active surveillance (AS) as the primary management option for patients with very low-risk prostate cancer (VLRPC) and an expected survival of <20 years. Factors associated with selection of AS are therefore of clinical importance. We hypothesized that care at a multidisciplinary clinic (MC), where multiple physicians simultaneously review each case, will be associated with increased rates of AS in men with VLRPC, including those with limited life expectancy. Methods: Of 630 patients with low-risk prostate cancer managed at one of three tertiary care centers in Boston, MA in 2009, 274 (43.5%) had VLRPC. Patients were either seen by one or more individual providers in sequential visits (N=178) or at an MC (N=96), in which concurrent consultation with two or more of the following specialties was obtained: urology, medical oncology, and radiation oncology. Results: Patients seen at an MC were more likely to select AS than those seen by individual providers (64% vs 30%, p<.001), an association which remained significant on multivariable logistic regression (OR=4.16, p<.001), see Table. When the analysis was limited to patients with an expected survival of <20 years based on the 2007 Social Security Life Table, this association remained highly significant (OR=5.19, p<.001). Conclusions: Multidisciplinary care is strongly associated with selection of AS, adherence to NCCN guidelines, and minimization of over-treatment in patients with VLRPC.
Variable | OR (95% CI) | p |
---|---|---|
Age (per yr incr) | 1.08 (1.03-1.13) | <.001 |
Race (black vs white, ref=white) | 1.87 (0.34-10.41) | .47 |
Marital status (married vs single, ref=married) | 1.95 (0.91-4.16) | .09 |
Charlson score (0 vs ≥1, ref=0) | 1.68 (0.84-3.37) | .14 |
Family history (yes vs no, ref=no) | 0.97 (0.46-2.02) | .92 |
PSA (per ng/mL) | 0.92 (0.77-1.10) | .37 |
% positive cores (per 1% incr) | 0.91 (0.85-0.98) | .02 |
Greatest individual core involvement (per 1% incr) | 0.95 (0.92-0.98) | <.001 |
Mean experience of physicians met (per yr incr) | 1.04 (1.00-1.07) | .03 |
Multidisciplinary clinic (no vs yes, ref=no) | 4.16 (1.98-8.75) | <.001 |
Institution | ||
1 | 1.0 (ref) | |
2 | 1.89 (0.76-4.73) | .17 |
3 | 1.60 (0.64-4.01) | .31 |
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