Variation in use of androgen suppression with external-beam radiotherapy for nonmetastatic prostate cancer

Samuel Swisher-Mcclure, Craig Pollack, John P. Christodouleas, Thomas J. Guzzo, Naomi B. Haas, Neha Vapiwala, Justin E. Bekelman

Research output: Contribution to journalArticle

Abstract

Purpose: To describe practice patterns associated with androgen suppression (AS) stratified by disease risk group in patients undergoing external-beam radiotherapy (EBRT) for localized prostate cancer. Methods and Materials: We identified 2,184 low-risk, 2,339 intermediate-risk, and 2,897 high-risk patients undergoing EBRT for nonmetastatic prostate cancer diagnosed between January 1, 2004, and December 31, 2005, in the linked Surveillance, Epidemiology, and End Results - Medicare database. We examined the association of patient, clinical, and demographic characteristics with AS use by multivariate logistic regression. Results: The proportions of patients receiving AS for low-risk, intermediate-risk, and high-risk prostate cancer were 32.2%, 56.3%, and 81.5%, respectively. AS use among men in the low-risk disease category varied widely, ranging from 13.6% in Detroit to 47.8% in Kentucky. We observed a significant decline in AS use between 2004 and 2005 within all three disease risk categories. Men aged ≥75 years or with elevated comorbidity levels were more likely to receive AS. Conclusion: Our results identified apparent overuse and underuse of AS among men within the low-risk and high-risk disease categories, respectively. These results highlight the need for clinician and patient education regarding the appropriate use of AS. Practice patterns among intermediate-risk patients reflect the clinical heterogeneity of this population and underscore the need for better evidence to guide the treatment of these patients.

Original languageEnglish (US)
Pages (from-to)8-15
Number of pages8
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume83
Issue number1
DOIs
StatePublished - May 1 2012

Fingerprint

Androgens
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
retarding
epidemiology
logistics
Population Characteristics
Patient Education
surveillance
Medicare
Comorbidity
regression analysis
proportion
Epidemiology
education
Logistic Models
Demography
Databases

Keywords

  • Androgen suppression
  • External-beam radiation
  • Health services research
  • Prostate cancer
  • Quality of care

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Variation in use of androgen suppression with external-beam radiotherapy for nonmetastatic prostate cancer. / Swisher-Mcclure, Samuel; Pollack, Craig; Christodouleas, John P.; Guzzo, Thomas J.; Haas, Naomi B.; Vapiwala, Neha; Bekelman, Justin E.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 83, No. 1, 01.05.2012, p. 8-15.

Research output: Contribution to journalArticle

Swisher-Mcclure, Samuel ; Pollack, Craig ; Christodouleas, John P. ; Guzzo, Thomas J. ; Haas, Naomi B. ; Vapiwala, Neha ; Bekelman, Justin E. / Variation in use of androgen suppression with external-beam radiotherapy for nonmetastatic prostate cancer. In: International Journal of Radiation Oncology, Biology, Physics. 2012 ; Vol. 83, No. 1. pp. 8-15.
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abstract = "Purpose: To describe practice patterns associated with androgen suppression (AS) stratified by disease risk group in patients undergoing external-beam radiotherapy (EBRT) for localized prostate cancer. Methods and Materials: We identified 2,184 low-risk, 2,339 intermediate-risk, and 2,897 high-risk patients undergoing EBRT for nonmetastatic prostate cancer diagnosed between January 1, 2004, and December 31, 2005, in the linked Surveillance, Epidemiology, and End Results - Medicare database. We examined the association of patient, clinical, and demographic characteristics with AS use by multivariate logistic regression. Results: The proportions of patients receiving AS for low-risk, intermediate-risk, and high-risk prostate cancer were 32.2{\%}, 56.3{\%}, and 81.5{\%}, respectively. AS use among men in the low-risk disease category varied widely, ranging from 13.6{\%} in Detroit to 47.8{\%} in Kentucky. We observed a significant decline in AS use between 2004 and 2005 within all three disease risk categories. Men aged ≥75 years or with elevated comorbidity levels were more likely to receive AS. Conclusion: Our results identified apparent overuse and underuse of AS among men within the low-risk and high-risk disease categories, respectively. These results highlight the need for clinician and patient education regarding the appropriate use of AS. Practice patterns among intermediate-risk patients reflect the clinical heterogeneity of this population and underscore the need for better evidence to guide the treatment of these patients.",
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