Presentation Authors: Marieke Johanna Krimphove*, Alexander Putnam Cole, David Fallon Friedlander, David-Dan Nguyen, Stuart R. Lipsitz, Paul L. Nguyen, Kerry L. Kilbridge, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA
Introduction: A considerable number of men eligible for expectant management of prostate cancer receive definitive treatment. Underlying health-system factors are unknown. We sought to investigate the hospital-level contribution to overtreatmentin men diagnosed with localized prostate between 2010-2015
Methods: We queried the National Cancer Database and included men of two non-overlapping cohorts: (1) men with a life expectancy < 10 years harbouring prostate cancer of any risk group and (2) men with life expectancy â‰¥10 years with low-risk prostate cancer. Multivariable mixed models with patient characteristics as fixed and hospital-level intercept as random effect were used to assess the hospital-level risk-adjusted probability of definitive treatment (radical prostatectomy or radiation therapy within 180 days from diagnosis) in both groups. Pearson&[prime]s correlation coefficient was calculated to investigate the correlation between the hospitals probabilities of treating patients of both cohorts
Results: We found 58,903 men with a life expectancy < 10 years and 122,514 men with a life expectancy â‰¥10 years and low-risk prostate cancer. In the latter, the probability of treatment ranged from 29.0% in the bottom to 90.0% in the top decile and from 38.6% to 88.7% for men with a life expectancy < 10 years. Age, black race and not having insurance were independent predictors of low-value treatment in both cohorts. The correlation between hospitals treating men of both cohorts was strong (Pearson&[prime]s r=0.64, p < 0.001).
Conclusions: There is wide hospital-level variability in low-value treatment of men with limited life expectancies and low-risk prostate cancer. Hospitals more likely to treat men with limited life expectancies were more likely to treat men with low-risk prostate cancer and vice versa. Identifying drivers and modifying practice at these hospitals may represent an effective tool for reducing overtreatment.
Source of Funding: Brigham Research Institute, Bruce A. Beal and Robert L. Beal Surgical Fellowship, Conquer Cancer Foundation, Defense Health Agency, Intuitive Surgical, Prostate Cancer Foundation, Vattikuti Urology Institute.