Advertisement

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

  • Simon P. Kim
  • Cary P. Gross
  • Nilay D. Shah
  • Jon. C. Tilburt
  • Badrinath Konety
  • Stephen B. Williams
  • Christopher J. Weight
  • James B. Yu
  • Aryavarta M. S. Kumar
  • Neal J. Meropol
Urologic Oncology

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, p < 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, p < 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.

Notes

Funding

This study was supported by a career development award for Dr. Simon Kim from the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO).

References

  1. 1.
    Welch HG, Albertsen PC. Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening: 1986–2005. J Natl Cancer Inst. 2009;101(19):1325–9.CrossRefGoogle Scholar
  2. 2.
    US Department of Health and Human Services, National Institutes of Health. Role of active surveillance in the management of men with localized prostate cancer. 2011. http://consensus.nih.gov/2011/prostategetinvolved.htm. Accessed 1 Feb 2013.
  3. 3.
    Mohler JL, Armstrong AJ, Bahnson RR, et al. Prostate cancer, Version 1.2016. J Natl Compr Cancer Netw. 2016;14(1):19–30.CrossRefGoogle Scholar
  4. 4.
    Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2017;71(4):618–29.CrossRefGoogle Scholar
  5. 5.
    Sanda MG, Cadeddu JA, Kirkby MS, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part 1: risk stratification, shared decision making, and care options. J Urol. 2018;199(3):683–90.CrossRefGoogle Scholar
  6. 6.
    Donovan JL, Hamdy FC, Lane JA, et al. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425–37.CrossRefGoogle Scholar
  7. 7.
    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(15):1415–24.CrossRefGoogle Scholar
  8. 8.
    Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367(3):203–13.CrossRefGoogle Scholar
  9. 9.
    Tosoian JJ, Mamawala M, Epstein JI, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol. 2015;33(30):3379–85.CrossRefGoogle Scholar
  10. 10.
    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(3):272–77.CrossRefGoogle Scholar
  11. 11.
    Dall’Era MA, Albertsen PC, Bangma C, et al. Active surveillance for prostate cancer: a systematic review of the literature. Eur Urol. 2012;62(6):976–83.CrossRefGoogle Scholar
  12. 12.
    Loeb S, Berglund A, Stattin P. Population based study of use and determinants of active surveillance and watchful waiting for low and intermediate risk prostate cancer. J Urol. 2013;190(5):1742–9.CrossRefGoogle Scholar
  13. 13.
    Maurice MJ, Abouassaly R, Kim SP, Zhu H. Contemporary nationwide patterns of active surveillance use for prostate cancer. JAMA Intern Med. 2015;175(9):1569–71.CrossRefGoogle Scholar
  14. 14.
    Krishna S, Fan Y, Jarosek S, Adejoro O, Chamie K, Konety B. Racial disparities in active surveillance for prostate cancer. J Urol. 2017;197(2):342–9.CrossRefGoogle Scholar
  15. 15.
    Womble PR, Montie JE, Ye Z, et al. Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer. Eur Urol. 2015;67(1):44–50.CrossRefGoogle Scholar
  16. 16.
    Taylor KL, Hoffman RM, Davis KM, et al. Treatment preferences for active surveillance versus active treatment among men with low-risk prostate cancer. Cancer Epidemiol Biomark Prevent. 2016;25(8):1240–50.CrossRefGoogle Scholar
  17. 17.
    Shen MJ, Nelson CJ, Peters E, et al. Decision-making processes among prostate cancer survivors with rising PSA levels: results from a qualitative analysis. Med Decis Making. 2015;35(4):477–86.CrossRefGoogle Scholar
  18. 18.
    Kim SP, Gross CP, Nguyen PL, et al. Perceptions of active surveillance and treatment recommendations for low-risk prostate cancer: results from a National Survey of Radiation Oncologists and Urologists. Med Care. 2014;52(7):579–85.CrossRefGoogle Scholar
  19. 19.
    Kinsella N, Stattin P, Cahill D, et al. Factors influencing men’s choice of and adherence to active surveillance for low-risk prostate cancer: a mixed-method systematic review. Eur Urol. 2018;74(3):261–80.CrossRefGoogle Scholar
  20. 20.
    Davison BJ, Breckon E. Factors influencing treatment decision making and information preferences of prostate cancer patients on active surveillance. Patient Educ Couns. 2012;87(3):369–74.CrossRefGoogle Scholar
  21. 21.
    Mishra MV, Bennett M, Vincent A, et al. Identifying barriers to patient acceptance of active surveillance: content analysis of online patient communications. PLoS ONE. 2013;8(9):e68563.CrossRefGoogle Scholar
  22. 22.
    Scherr KA, Fagerlin A, Hofer T, et al. Physician recommendations trump patient preferences in prostate cancer treatment decisions. Med Decis Making. 2017;37(1):56–69.CrossRefGoogle Scholar
  23. 23.
    Kim SP, Gross CP, Nguyen PL, et al. Specialty bias in treatment recommendations and quality of life among radiation oncologists and urologists for localized prostate cancer. Prostate Cancer Prostatic Dis. 2014;17(2):163–9.CrossRefGoogle Scholar
  24. 24.
    Lin GA, Aaronson DS, Knight SJ, Carroll PR, Dudley RA. Patient decision aids for prostate cancer treatment: a systematic review of the literature. CA Cancer J Clin. 2009;59(6):379–90.CrossRefGoogle Scholar
  25. 25.
    Violette PD, Agoritsas T, Alexander P, et al. Decision aids for localized prostate cancer treatment choice: systematic review and meta-analysis. CA Cancer J Clin. 2015;65(3):239–51.CrossRefGoogle Scholar
  26. 26.
    Johnson DC, Mueller DE, Deal AM, et al. Integrating patient preference into treatment decisions for men with prostate cancer at the point of care. J Urol. 2016;196(6):1640–44.CrossRefGoogle Scholar
  27. 27.
    Makarov DV, Chrouser K, Gore JK, et al. AUA White paper on implementation of shared decision making into urolgoical practice. Urol Pract. 2016;3:355–63.CrossRefGoogle Scholar
  28. 28.
    Adsul P, Wray R, Spradling K, Darwish O, Weaver N, Siddiqui S. Systematic review of decision aids for newly diagnosed patients with prostate cancer making treatment decisions. J Urol. 2015;194(5):1247–52.CrossRefGoogle Scholar
  29. 29.
    Wang EH, Gross CP, Tilburt JC, et al. Shared decision making and use of decision AIDS for localized prostate cancer: perceptions from radiation oncologists and urologists. JAMA Intern Med. 2015;175(5):792–99.CrossRefGoogle Scholar
  30. 30.
    Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol. 2017.Google Scholar
  31. 31.
    Sanda MG, Cadeddu JA, Kirkby E, et al. Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part II: recommended approaches and details of specific care options. J Urol. 2018;199(4):990–7.CrossRefGoogle Scholar
  32. 32.
    Elwyn G, O’Connor AM, Bennett C, et al. Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi). PLoS ONE. 2009;4(3):e4705.CrossRefGoogle Scholar
  33. 33.
    Blumenthal-Barby JS, Cantor SB, Russell HV, Naik AD, Volk RJ. Decision aids: when ‘nudging’ patients to make a particular choice is more ethical than balanced, nondirective content. Health Aff (Millwood). 2013;32(2):303–10.CrossRefGoogle Scholar
  34. 34.
    Ehdaie B, Assel M, Benfante N, Malhotra D, Vickers A. A systematic approach to discussing active surveillance with patients with low-risk prostate cancer. Eur Urol. 2017;71(6):866–71.CrossRefGoogle Scholar
  35. 35.
    Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50(10):1129–36.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Simon P. Kim
    • 1
    • 2
    • 3
  • Cary P. Gross
    • 3
    • 4
  • Nilay D. Shah
    • 5
    • 6
  • Jon. C. Tilburt
    • 7
    • 8
  • Badrinath Konety
    • 9
  • Stephen B. Williams
    • 10
  • Christopher J. Weight
    • 9
  • James B. Yu
    • 3
    • 11
  • Aryavarta M. S. Kumar
    • 12
  • Neal J. Meropol
    • 2
    • 13
  1. 1.Center for Quality and Outcomes, Urology Institute, Case Western Reserve University School of MedicineUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandUSA
  3. 3.Cancer Outcomes and Public Policy Effectiveness Research (COPPER) CenterYale UniversityNew HavenUSA
  4. 4.Department of MedicineYale UniversityNew HavenUSA
  5. 5.Division of Health Policy and ResearchMayo ClinicRochesterUSA
  6. 6.Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterUSA
  7. 7.Division of General Internal MedicineMayo ClinicRochesterUSA
  8. 8.Biomedical Ethics Research ProgramMayo ClinicRochesterUSA
  9. 9.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  10. 10.Division of UrologyUniversity of Texas Medical BranchGalvestonUSA
  11. 11.Department of Radiation OncologyYale UniversityNew HavenUSA
  12. 12.Department of Radiation OncologyLouis Stokes Cleveland VA Medical CenterClevelandUSA
  13. 13.Flatiron HealthNew YorkUSA

Personalised recommendations