Advertisement

Influence of Sociodemographic Factors on Definitive Intervention Among Low-risk Active Surveillance Patients

Published:February 09, 2021DOI:https://doi.org/10.1016/j.urology.2021.01.053

      ABSTRACT

      Objectives

      To investigate sociodemographic factors influencing decision of initially active surveillance (AS) prostate cancer (CaP) patients to opt for definitive therapy, and, specifically, choice of radical prostatectomy (RP) versus radiation therapy (XRT).

      Methods

      The Surveillance, Epidemiology, and End Results (SEER) Prostate with Watchful Waiting database was used to identify AS patients diagnosed with NCCN low-risk CaP between 2010 and 2015. We sought to determine predictors of treatment type using multivariable logistic regression analyses.

      Results

      Out of 32,874 men included, 21,255 (64.7%) underwent delayed treatment, with 3,751 (17.6%) and 17,463 (82.2%) opting for RP and XRT, respectively. Patients who were married (Odds Ratio [OR]: 1.18, P <.001), insured (OR 2.94, P <.001), of higher socioeconomic status (OR 1.67 for highest vs lowest, P <.01), and residing in a Southeastern or Midwestern region (ORs 1.26 and 1.22 vs Northeast, respectively, P <.01) were significantly more likely to undergo definitive intervention. A significant interaction between patient race and marital/socioeconomic statuses on the decision-making process was identified. Decision for XRT (vs RP) was more likely in older (OR 11.6 for 70-79 vs 50-59 years, P <.01), unmarried (OR 1.89, P <.01), African American (OR 1.41, P .018), and higher socioeconomic status (OR 1.54 for highest versus lowest quartile, P <.01) patients.

      Conclusion

      The majority of patients initially treated with AS underwent delayed treatment. After accounting for pathologic characteristics, the interaction of sociodemographic factors including race, socioeconomic status, marital status, insurance status, and region of residence are significantly associated with the likelihood of undergoing definitive therapy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Loeb S
        • Folkvaljon Y
        • Curnyn C
        • Robinson D
        • Bratt O
        • Stattin P.
        Uptake of Active Surveillance for Very-Low-Risk Prostate Cancer in Sweden.
        JAMA Oncol. 2017; 3: 1393-1398
        • Klotz L
        • Vesprini D
        • Sethukavalan P
        • et al.
        Long-term follow-up of a large active surveillance cohort of patients with prostate cancer.
        J Clin Oncol. 2015; 33: 272-277
        • Bockhorst LP
        • Valdagni R
        • Rannikko A
        • et al.
        A decade of active surveillance in the PRIAS study: an update and evaluation of the criteria used to recommend a switch to active treatment.
        Eur Urol. 2016; 70: 954-960
        • Hamdy FC
        • Donovan JL
        • Lane JA
        • et al.
        10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.
        N Engl J Med. 2016; 375: 1415-1424
        • Carroll PH
        • Mohler JL.
        NCCN guidelines updates: prostate cancer and prostate cancer early detection.
        J Natl Compr Canc Netw. 2018; 16: 620-623
      1. National Cancer Institute Surveillance, Epidemiology, and End Results Program Prostate With Watchful Waiting database. Washington D.C. National Cancer Institute.
        2020 (Accessed February 20, 2020)
        • Chandrasekar T
        • Klaassen Z
        • Goldberg H
        • Sayyid RK
        • Kulkarni GS
        • Fleshner NE.
        High competing risks minimize real-world utility of adjuvant targeted therapy in renal cell carcinoma: a population-based analysis.
        Oncotarget. 2018; 9: 16731-16743
        • Chandrasekar T
        • Klaassen Z
        • Goldberg H
        • Kulkarni GS
        • Hamilton RJ
        • Fleshner NE.
        Metastatic renal cell carcinoma: patterns and predictors of metastases-a contemporary population-based series.
        Urol Oncol. 2017; 35 (661.e7–e14)
        • Shelton JB
        • Buffington P
        • Augspurger R
        • et al.
        Contemporary management of incident prostate cancer in large community urology practices in the United States.
        Urology. 2019; 129: 79-86
        • Löppenberg B
        • Friedlander DF
        • Krasnova A
        • Tam A
        • Leow JJ
        • Nguyen PL
        • et al.
        Variation in the use of active surveillance for low-risk prostate cancer.
        Cancer. 2018; 124: 55-64
        • Loblaw A
        • Zhang L
        • Lam A
        • et al.
        Comparing prostate specific antigen triggers for intervention in men with stable prostate cancer on active surveillance.
        J Urol. 2010; 184: 1942-1946
        • Weiner AB
        • Conti RM
        • Eggener SE.
        National economic conditions and patient insurance status predict prostate cancer diagnosis rates and management decisions.
        J Urol. 2016; 195: 1383-1389
        • Abern MR
        • Bassett MR
        • Tsivian M
        • et al.
        Race is associated with discontinuation of active surveillance of low-risk prostate cancer: results from the duke prostate center.
        Prostate Cancer Prostatic Dis. 2013; 16: 85-90
        • Scherr KA
        • Fagerlin A
        • Hofer T
        • et al.
        Physician recommendations trump patient preferences in prostate cancer treatment decisions.
        Med Decis Making. 2017; 37: 56-69
        • Davison BJ
        • Breckon E.
        Factors Influencing Treatment Decision Making and Information Preferences of Prostate Cancer Patients on Active Surveillance.
        Patient Educ Couns. 2012; 87: 369-374
        • Watts S
        • Leydon G
        • Eyles C
        • et al.
        A quantitative analysis of the prevalence of clinical depression and anxiety in patients with prostate cancer undergoing active surveillance.
        BMJ Open. 2015; 5e006674
        • Xu J
        • Dailey RK
        • Eggly S
        • Neale AV
        • Schwartz KL.
        Men's perspectives on selecting their prostate cancer treatment.
        J Natl Med Assoc. 2011; 103: 468-478
        • Alibhai SMH
        • Leach M
        • Tomlinson G
        • et al.
        30-day mortality and major complications after radical prostatectomy: influence of age and comorbidity.
        JNCI. 2005; 97: 1525-1532
        • Augustin H
        • Hammerer P
        • Graefen M
        • et al.
        Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002.
        Eur Urol. 2003; 43: 113-118
        • Barocas D
        • Alvarez J
        • Resnick MJ
        • et al.
        Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years.
        JAMA. 2017; 317: 1126-1140
        • Fam MM
        • Yabes JG
        • Macleod LC
        • et al.
        Increasing utilization of multiparametric magnetic resonance imaging in prostate cancer active surveillance.
        Urology. 2019; 130: 99-105
        • Thygesen LC
        Ersboll. when the entire population is the sample: strengths and limitations in register-based epidemiology.
        Eur J Epidemiol. 2014; 29: 551-558
        • Jeong CW
        • Washington SL
        • Herlemann A
        • Gomez SL
        • Carroll PR
        • Cooperberg MR.
        The new surveillance, epidemiology, and end results prostate with watchful waiting database: opportunities and limitations.
        Eur Urol. 2020; 78: 335-344
        • Laviana AA
        • Luckenbaugh AN
        • Wallis CJD.
        Seeking the truth: understanding the impact of missing data on the validity of the new surveillance, epidemiology and end results prostate with watchful waiting database.
        Eur Urol. 2020; 78: 345-346