Models of care and NCCN guideline adherence in very-low-risk prostate cancer.
NCCN Guidelines recommend active surveillance as the primary management option for patients with very-low-risk prostate cancer and an expected survival of less than 20 years, reflecting the favorable prognosis of these men and the lack of perceived benefit of immediate, definitive treatment. The authors hypothesized that care at a multidisciplinary clinic, where multiple physicians have an opportunity to simultaneously review and discuss each case, is associated with increased rates of active surveillance in men with very-low-risk prostate cancer, including those with limited life expectancy. Of 630 patients with low-risk prostate cancer managed at 1 of 3 tertiary care centers in Boston, Massachusetts in 2009, 274 (43.5%) had very-low-risk classification. Patients were either seen by 1 or more individual practitioners in sequential settings or at a multidisciplinary clinic, in which concurrent consultation with 2 or more of the following specialties was obtained: urology, radiation oncology, and medical oncology. Patients seen at a multidisciplinary prostate cancer clinic were more likely to select active surveillance than those seen by individual practitioners (64% vs 30%; P<.001), an association that remained significant on multivariable logistic regression (odds ratio [OR], 4.16; P<.001). When the analysis was limited to patients with an expected survival of less than 20 years, this association remained highly significant (72% vs 34%, P<.001; OR, 5.19; P<.001, respectively). Multidisciplinary care is strongly associated with selection of active surveillance, adherence to NCCN Guidelines and minimization of overtreatment in patients with very-low-risk prostate cancer.
From the aHarvard Radiation Oncology Program, and bDepartment of Radiation Oncology, Massachusetts General Hospital; cDepartment of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute; dDepartment of Medicine, Division of General Internal Medicine, Massachusetts General Hospital; eDepartment of Radiation Oncology, Beth Israel Deaconess Medical Center; fDepartment of Radiation Oncology, Division of Biostatistics and Biomathematics, Massachusetts General Hospital; gDepartment of Pathology, Brigham and Women's Hospital; and hDepartment of Pathology, iDepartment of Urology, and jDepartment of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Ayal A
AA
Aizer
Jonathan J
JJ
Paly
Anthony L
AL
Zietman
Paul L
PL
Nguyen
Clair J
CJ
Beard
Sandhya K
SK
Rao
Irving D
ID
Kaplan
Andrzej
A
Niemierko
Michelle S
MS
Hirsch
Chin-Lee
CL
Wu
Aria F
AF
Olumi
M Dror
MD
Michaelson
Anthony V
AV
D'Amico
Jason A
JA
Efstathiou
D000368:Aged; D003695:Delivery of Health Care / Q000592:standards*; D019033:Delivery of Health Care, Integrated / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors