Poster, Podium & Video Sessions
Presentation Authors: John DeLancey*, Richard Matulewicz, Oliver Ko, Edward Schaeffer, Chicago, IL
Introduction: For men with high and very high risk prostate cancer, level I evidence supports the use of androgen deprivation therapy (ADT) with radiation to prolong disease-specific and overall survival. However, not all patients receive ADT with radiotherapy. We sought to evaluate trends and factors associated with ADT use with radiation therapy for clinically localized high and very high risk prostate cancer.
Methods: We identified patients diagnosed with high or very high risk prostate cancer in the National Cancer Database from 2004-2013 and underwent external beam radiotherapy (EBRT), brachytherapy (BT) or combined EBRT and BT. ADT use was defined as receipt of ADT prior to or at the time of radiation therapy. Trends in ADT use were assessed and multivariable logistic regression was used to evaluate associations between demographic and clinical factors and the receipt of ADT.
Results: Of 85,442 patients with high or very high risk prostate cancer treated with radiotherapy, the proportion of patients receiving ADT increased from 52.7% in 2004 to 65.6% in 2013 (p for trend <0.001). This proportion increased from 60.1% to 68.7% for EBRT and 45.9 to 65.7% for combination radiotherapy; however use decreased in BT patients from 35.8% to 29.7% (each p for trend <0.001). Controlling for covariates and year, we found decreased odds [OR (95%CI)] of ADT use in patients who underwent BT [0.29 (0.28-0.31)] or combination radiotherapy [0.69 (0.66-72)] (Table 1). We found increased odds of ADT use in very high risk patients [2.01 (1.91-2.10)], those over 75 years old [1.16 (1.11-1.22)], patients from suburban [1.34 (1.28-1.40)] and rural counties [1.71 (1.53-1.91)], those with Medicare or Medicaid insurance [1.14 (1.09-1.18)], and with Charlson-Deyo scores of 1 [1.10 (1.05-1.15)] or greater [1.13 (1.02-1.25)].
Conclusions: Use of ADT in patients undergoing radiotherapy for high or very high risk prostate cancer has increased over the past decade in patients undergoing EBRT and combination EBRT and BT. However, more than one third of these patients do not receive ADT, which represents an opportunity for quality improvement initiatives to impact the quality of prostate cancer care.
Source Of Funding: none
John Oliver DeLancey, MD, MPH is a PGY-4 urology resident in the Department of Urology and research fellow in the Surgical Outcomes and Quality Improvement Center at the Northwestern University Feinberg School of Medicine. His research interests include evaluation of hospital and physician quality indicators and quality improvement in prostate cancer care.
Monday, May 15
9:30 AM – 11:30 AM