Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy: A Population-based Study

Paolo Dell'Oglio; Hiba Abou-Haidar; Sami-Ramzi Leyh-Bannurah; Zhe Tian; Alessandro Larcher; Giorgio Gandaglia; Nicola Fossati; Shahrokh F Shariat; Umberto Capitanio; Alberto Briganti; Francesco Montorsi; Markus Graefen; Fred Saad; Pierre I Karakiewicz

doi:10.1016/j.eururo.2016.02.057

Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy

Standard

Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy : A Population-based Study. / Dell'Oglio, Paolo; Abou-Haidar, Hiba; Leyh-Bannurah, Sami-Ramzi; Tian, Zhe; Larcher, Alessandro; Gandaglia, Giorgio; Fossati, Nicola; Shariat, Shahrokh F; Capitanio, Umberto; Briganti, Alberto; Montorsi, Francesco; Graefen, Markus; Saad, Fred; Karakiewicz, Pierre I.

In: EUR UROL, Vol. 70, No. 3, 09.2016, p. 429-35.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Dell'Oglio, P, Abou-Haidar, H, Leyh-Bannurah, S-R, Tian, Z, Larcher, A, Gandaglia, G, Fossati, N, Shariat, SF, Capitanio, U, Briganti, A, Montorsi, F, Graefen, M, Saad, F & Karakiewicz, PI 2016, 'Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy: A Population-based Study', EUR UROL, vol. 70, no. 3, pp. 429-35. https://doi.org/10.1016/j.eururo.2016.02.057

APA

Dell'Oglio, P., Abou-Haidar, H., Leyh-Bannurah, S-R., Tian, Z., Larcher, A., Gandaglia, G., Fossati, N., Shariat, S. F., Capitanio, U., Briganti, A., Montorsi, F., Graefen, M., Saad, F., & Karakiewicz, P. I. (2016). Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy: A Population-based Study. EUR UROL, 70(3), 429-35. https://doi.org/10.1016/j.eururo.2016.02.057

Vancouver

Dell'Oglio P, Abou-Haidar H, Leyh-Bannurah S-R, Tian Z, Larcher A, Gandaglia G et al. Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy: A Population-based Study. EUR UROL. 2016 Sep;70(3):429-35. https://doi.org/10.1016/j.eururo.2016.02.057

Bibtex

@article{f04fd29418d04a2180591273c16048c7,

title = "Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy: A Population-based Study",

abstract = "BACKGROUND: The National Comprehensive Cancer Network and the European Association of Urology guidelines recommend using radiation therapy (RT) with androgen deprivation therapy (ADT) to treat high-risk and locally advanced prostate cancer patients.OBJECTIVE: To evaluate the degree of adherence to these guidelines.DESIGN, SETTING, AND PARTICIPANTS: Between 2003 and 2009, in the Surveillance Epidemiology and End Results (SEER)-Medicare database, 14 180 patients were diagnosed with high-risk (T1-T2 with World Health Organization histologic grade 3) or locally advanced (T3-T4 with any histologic grade) prostatic adenocarcinoma.INTERVENTION: Administration of RT-ADT versus RT alone.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed the rate of adherence to guidelines with respect to use of RT-ADT in the overall population and after stratification according to stage-grade groupings (T1-T2 G3 vs T3-T4 any grade), age (66-69, 70-74, 75-79, ≥80 yr), Charlson Comorbidity Index (CCI) (0, 1, ≥2), and preexisting baseline cardiovascular (CV) disease. We depicted the rate of RT-ADT administration graphically over the study period. Multivariable logistic regression analyses were performed to assess the predictors of RT-ADT use.RESULTS AND LIMITATIONS: RT-ADT rates and guideline adherence were 58-75%, with the highest rate (75%) in 2003 and the lowest (58%) in 2009. When stratified according to stage-grade groupings, age, CCI, and preexisting baseline CV disease, similar results were obtained. In multivariable analyses, year of diagnosis (p<0.001), patient age (p<0.001), stage-grade groupings (p<0.001), CCI (p=0.036), race (p<0.001), marital status (p<0.001), population density (p<0.001), and US regions (p<0.001) were independent predictors of RT-ADT use. The limitations of our study include age >65 yr and exclusive Medicare coverage.CONCLUSIONS: The rate of guideline adherence regarding the use of RT-ADT is suboptimal and decreases with time instead of increasing.PATIENT SUMMARY: This population-based study provides evidence of low adherence to international urologic guidelines regarding the combination of radiation therapy (RT) with androgen deprivation therapy (ADT) for high-risk and locally advanced prostate cancer (PCa) patients. Despite the increasing number of randomized controlled trials over time that showed a survival benefit for patients with high-risk and locally advanced PCa treated with RT-ADT compared with RT alone, the rate of adherence to guidelines decreased with time.",

keywords = "Adenocarcinoma, Age Factors, Aged, Aged, 80 and over, Androgen Receptor Antagonists, Antineoplastic Combined Chemotherapy Protocols, Chemotherapy, Adjuvant, Comorbidity, Continental Population Groups, Gonadotropin-Releasing Hormone, Guideline Adherence, Humans, Male, Marital Status, Medicare, Neoplasm Grading, Neoplasm Staging, Population Density, Practice Guidelines as Topic, Prostatic Neoplasms, Radiotherapy, SEER Program, United States, Journal Article",

author = "Paolo Dell'Oglio and Hiba Abou-Haidar and Sami-Ramzi Leyh-Bannurah and Zhe Tian and Alessandro Larcher and Giorgio Gandaglia and Nicola Fossati and Shariat, {Shahrokh F} and Umberto Capitanio and Alberto Briganti and Francesco Montorsi and Markus Graefen and Fred Saad and Karakiewicz, {Pierre I}",

year = "2016",

month = sep,

doi = "10.1016/j.eururo.2016.02.057",

language = "English",

volume = "70",

pages = "429--35",

journal = "EUR UROL",

issn = "0302-2838",

publisher = "Elsevier",

number = "3",

}

RIS

TY - JOUR

T1 - Assessment of the Rate of Adherence to International Guidelines for Androgen Deprivation Therapy with External-beam Radiation Therapy

T2 - A Population-based Study

AU - Dell'Oglio, Paolo

AU - Abou-Haidar, Hiba

AU - Leyh-Bannurah, Sami-Ramzi

AU - Tian, Zhe

AU - Larcher, Alessandro

AU - Gandaglia, Giorgio

AU - Fossati, Nicola

AU - Shariat, Shahrokh F

AU - Capitanio, Umberto

AU - Briganti, Alberto

AU - Montorsi, Francesco

AU - Graefen, Markus

AU - Saad, Fred

AU - Karakiewicz, Pierre I

PY - 2016/9

Y1 - 2016/9

N2 - BACKGROUND: The National Comprehensive Cancer Network and the European Association of Urology guidelines recommend using radiation therapy (RT) with androgen deprivation therapy (ADT) to treat high-risk and locally advanced prostate cancer patients.OBJECTIVE: To evaluate the degree of adherence to these guidelines.DESIGN, SETTING, AND PARTICIPANTS: Between 2003 and 2009, in the Surveillance Epidemiology and End Results (SEER)-Medicare database, 14 180 patients were diagnosed with high-risk (T1-T2 with World Health Organization histologic grade 3) or locally advanced (T3-T4 with any histologic grade) prostatic adenocarcinoma.INTERVENTION: Administration of RT-ADT versus RT alone.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed the rate of adherence to guidelines with respect to use of RT-ADT in the overall population and after stratification according to stage-grade groupings (T1-T2 G3 vs T3-T4 any grade), age (66-69, 70-74, 75-79, ≥80 yr), Charlson Comorbidity Index (CCI) (0, 1, ≥2), and preexisting baseline cardiovascular (CV) disease. We depicted the rate of RT-ADT administration graphically over the study period. Multivariable logistic regression analyses were performed to assess the predictors of RT-ADT use.RESULTS AND LIMITATIONS: RT-ADT rates and guideline adherence were 58-75%, with the highest rate (75%) in 2003 and the lowest (58%) in 2009. When stratified according to stage-grade groupings, age, CCI, and preexisting baseline CV disease, similar results were obtained. In multivariable analyses, year of diagnosis (p<0.001), patient age (p<0.001), stage-grade groupings (p<0.001), CCI (p=0.036), race (p<0.001), marital status (p<0.001), population density (p<0.001), and US regions (p<0.001) were independent predictors of RT-ADT use. The limitations of our study include age >65 yr and exclusive Medicare coverage.CONCLUSIONS: The rate of guideline adherence regarding the use of RT-ADT is suboptimal and decreases with time instead of increasing.PATIENT SUMMARY: This population-based study provides evidence of low adherence to international urologic guidelines regarding the combination of radiation therapy (RT) with androgen deprivation therapy (ADT) for high-risk and locally advanced prostate cancer (PCa) patients. Despite the increasing number of randomized controlled trials over time that showed a survival benefit for patients with high-risk and locally advanced PCa treated with RT-ADT compared with RT alone, the rate of adherence to guidelines decreased with time.

AB - BACKGROUND: The National Comprehensive Cancer Network and the European Association of Urology guidelines recommend using radiation therapy (RT) with androgen deprivation therapy (ADT) to treat high-risk and locally advanced prostate cancer patients.OBJECTIVE: To evaluate the degree of adherence to these guidelines.DESIGN, SETTING, AND PARTICIPANTS: Between 2003 and 2009, in the Surveillance Epidemiology and End Results (SEER)-Medicare database, 14 180 patients were diagnosed with high-risk (T1-T2 with World Health Organization histologic grade 3) or locally advanced (T3-T4 with any histologic grade) prostatic adenocarcinoma.INTERVENTION: Administration of RT-ADT versus RT alone.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed the rate of adherence to guidelines with respect to use of RT-ADT in the overall population and after stratification according to stage-grade groupings (T1-T2 G3 vs T3-T4 any grade), age (66-69, 70-74, 75-79, ≥80 yr), Charlson Comorbidity Index (CCI) (0, 1, ≥2), and preexisting baseline cardiovascular (CV) disease. We depicted the rate of RT-ADT administration graphically over the study period. Multivariable logistic regression analyses were performed to assess the predictors of RT-ADT use.RESULTS AND LIMITATIONS: RT-ADT rates and guideline adherence were 58-75%, with the highest rate (75%) in 2003 and the lowest (58%) in 2009. When stratified according to stage-grade groupings, age, CCI, and preexisting baseline CV disease, similar results were obtained. In multivariable analyses, year of diagnosis (p<0.001), patient age (p<0.001), stage-grade groupings (p<0.001), CCI (p=0.036), race (p<0.001), marital status (p<0.001), population density (p<0.001), and US regions (p<0.001) were independent predictors of RT-ADT use. The limitations of our study include age >65 yr and exclusive Medicare coverage.CONCLUSIONS: The rate of guideline adherence regarding the use of RT-ADT is suboptimal and decreases with time instead of increasing.PATIENT SUMMARY: This population-based study provides evidence of low adherence to international urologic guidelines regarding the combination of radiation therapy (RT) with androgen deprivation therapy (ADT) for high-risk and locally advanced prostate cancer (PCa) patients. Despite the increasing number of randomized controlled trials over time that showed a survival benefit for patients with high-risk and locally advanced PCa treated with RT-ADT compared with RT alone, the rate of adherence to guidelines decreased with time.

KW - Adenocarcinoma

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Androgen Receptor Antagonists

KW - Antineoplastic Combined Chemotherapy Protocols

KW - Chemotherapy, Adjuvant

KW - Comorbidity

KW - Continental Population Groups

KW - Gonadotropin-Releasing Hormone

KW - Guideline Adherence

KW - Humans

KW - Male

KW - Marital Status

KW - Medicare

KW - Neoplasm Grading

KW - Neoplasm Staging

KW - Population Density

KW - Practice Guidelines as Topic

KW - Prostatic Neoplasms

KW - Radiotherapy

KW - SEER Program

KW - United States

KW - Journal Article

U2 - 10.1016/j.eururo.2016.02.057

DO - 10.1016/j.eururo.2016.02.057

M3 - SCORING: Journal article

C2 - 26951945

VL - 70

SP - 429

EP - 435

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 3

ER -