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2019 ASCO Annual Meeting!


Session: Health Services Research, Clinical Informatics, and Quality of Care II

Type: Oral Abstract Session

Time: Sunday June 2, 8:00 AM to 11:00 AM

Location: S404

Population-based cohort of prostate cancer patients on active surveillance (AS): guideline adherence, conversion to treatment and decisional regret.

Sub-category:
Quality of Care/Quality Improvement

Category:
Health Services Research, Clinical Informatics, and Quality of Care

Meeting:
2019 ASCO Annual Meeting

Abstract No:
6512

Citation:
J Clin Oncol 37, 2019 (suppl; abstr 6512)

Author(s): Sabrina Peterson, Ramsankar Basak, Dominic Himchan Moon, Claire Liang, Ram S Basak, Sarah Walden, Aaron J Katz, Ronald C. Chen; University of North Carolina School of Medicine, Chapel Hill, NC; University of North Carolina at Chapel Hill, Chapel Hill, NC; University of North Carolina, Chapel Hill, NC; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC

Abstract Disclosures

Abstract:

Background: AS is recommended for early-stage prostate cancer, for which over-treatment has been widely described. In published studies from large academic institutions and/or controlled clinical trials, where patients are monitored rigorously, AS is safe and results in low rates of cancer-specific mortality. However, active surveillance in the community setting has not been previously examined. Methods: In collaboration with the North Carolina state cancer registry, 346 men with newly-diagnosed low- or intermediate-risk prostate cancer throughout the state from 2011–13 who pursued active surveillance were enrolled in an observational cohort; medical records and patient-reported outcomes (validated measures of prostate cancer anxiety [MAX-PC] and Clark’s prostate cancer decision regret) were collected prospectively. Guideline-adherent monitoring during active surveillance was assessed using contemporary NCCN guidelines: PSA testing every 3–6 months and prostate biopsy within 18 months of initial diagnosis. Results: 58% of patients received adequate PSA testing and 45% prostate biopsy; overall, 32% of patients received guideline-adherent monitoring. Urology follow-up in Year 1 was 97% but dropped to 67% in Year 2. Within the first 2 years, 16% of patients converted to treatment. Multivariable analysis showed MAX-PC scores (OR 1.8, p = 0.008) and younger age were significantly associated with conversion; no other sociodemographic (race, education, marital status, rural/urban) or diagnostic variable (risk group) was associated. At 2 years, 94% expressed no regret. Conclusions: In a non-controlled setting of patients pursuing AS in the community, adherence to guideline-recommended monitoring was only 32%. Few patients expressed decisional regret. Conversion to treatment was likely driven by patient anxiety but not disease-related factors. While there are continued efforts to increase AS uptake, these results highlight the importance of behavioral interventions during active surveillance to reduce anxiety and improve monitoring adherence. Whether AS in non-controlled settings is safe and effective requires further study.

 
Other Abstracts in this Sub-Category:

 

1. Effect of montelukast and rupatadine on rituximab infusion time, rate, severity of reactions, and cost of administration.

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2. Comparison of normal saline versus heparin flush solutions for maintaining patency of central venous catheter in cancer patients.

Meeting: 2019 ASCO Annual Meeting Abstract No: 6501 First Author: Amy Pai
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3. Preventing excess narcotic prescriptions in MIS urologic oncology discharges (PENN): A prospective cohort quality improvement initiative.

Meeting: 2019 ASCO Annual Meeting Abstract No: 6502 First Author: Ruchika Talwar
Category: Health Services Research, Clinical Informatics, and Quality of Care - Quality of Care/Quality Improvement

 

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