title: Expectant management of veterans with early-stage prostate cancer.
abstract: BACKGROUND
  For certain men with low-risk prostate cancer, aggressive treatment results in marginal survival benefits while exposing them to urinary and sexual side effects. Nevertheless, expectant management has been underused. In the current study, the authors evaluated the association between various factors and expectant management use among veterans diagnosed with prostate cancer.
  
  
  METHODS
  The authors identified men diagnosed with prostate cancer in 2008. The outcome of interest was use of expectant management, based on documentation captured through an in-depth chart review. Multivariable regression models were fit to examine associations between use of expectant management and patient demographics, cancer severity, and facility characteristics. The authors assessed variation across 21 tertiary care regions and 52 facilities by generating predicted probabilities for receipt of expectant management.
  
  
  RESULTS
  Expectant management was more common among patients aged ≥75 years (40% vs 27% for those aged < 55 years; odds ratio, 2.57) and those with low-risk tumors (49% vs 20% for patients with high-risk tumors; odds ratio, 5.35). There was no association noted between patient comorbidity and receipt of expectant management (P = .90). There were also no associations found between facility factors and use of expectant management (all P>.05). Among ideal candidates for expectant management, receipt of expectant management varied considerably across individual facilities (0%-85%; P<.001).
  
  
  CONCLUSIONS
  Patient age and tumor risk were found to be more strongly associated with use of expectant management than patient comorbidity. Although use of expectant management appears broadly appropriate, there was variation in expectant management noted between hospitals that was apparently not attributable to facility factors. Research determining the basis of this variation, with a focus on providers, will be critical to help optimize prostate cancer treatment for veterans.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Veterans Affairs Atlanta Healthcare System, Decatur, Georgia.|Department of Urology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.|Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Shelton
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.|Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.|Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.|Department of Health Policy and Management, University of California at Los Angeles Fielding School of Public Health, Los Angeles, California.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D014728:Veterans; D057832:Watchful Waiting / Q000706:statistics & numerical data*
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: active surveillance; expectant management; prostate cancer; veterans' health; watchful waiting