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Ann Surg Oncol. 2019 Feb;26(2):660-668. doi: 10.1245/s10434-018-6863-1. Epub 2018 Oct 11.

Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists.

Author information

1
Center for Quality and Outcomes, Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. simkim@me.com.
2
Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA. simkim@me.com.
3
Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA. simkim@me.com.
4
Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT, USA.
5
Department of Medicine, Yale University, New Haven, CT, USA.
6
Division of Health Policy and Research, Mayo Clinic, Rochester, MN, USA.
7
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
8
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
9
Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, USA.
10
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
11
Division of Urology, University of Texas Medical Branch, Galveston, TX, USA.
12
Department of Radiation Oncology, Yale University, New Haven, CT, USA.
13
Department of Radiation Oncology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
14
Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
15
Flatiron Health, New York, NY, USA.

Abstract

PURPOSE:

The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa.

METHODS:

In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS.

RESULTS:

We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, pā€‰<ā€‰0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, pā€‰<ā€‰0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent's specialty.

CONCLUSIONS:

Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.

PMID:
30311161
DOI:
10.1245/s10434-018-6863-1
[Indexed for MEDLINE]

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