TY - JOUR
T1 - Variation in the Prescription of Androgen Deprivation Therapy in Intermediate- and High-risk Prostate Cancer Patients Treated with Radiotherapy in the Netherlands, and Adherence to European Association of Urology Guidelines
T2 - A Population-based Study
AU - Rijksen, Barbara Lily Thérèse
AU - Pos, Floris J
AU - Hulshof, Maarten C C M
AU - Vernooij, Robin W M
AU - Jansen, Hanneke
AU - van Andel, George
AU - Wijsman, Bart P
AU - Somford, Diederink M
AU - Busstra, Martijn B
AU - van Moorselaar, Reindert J A
AU - Kaa, Christina A Hulsbergen-van de
AU - van Leenders, Geert J L H
AU - Hamberg, Paul
AU - van den Berkmortel, Franchette
AU - Fütterer, Jurgen J
AU - Kiemeney, Lambertus A
AU - van Oort, Inge M
AU - Aben, Katja K H
N1 - Funding Information:
Other: None. Financial disclosures: Barbara Lily Th?r?se Rijksen certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: None. Acknowledgements: ProZIB is funded by the Dutch Cancer Society (KWF2013-5942). The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry.
Funding Information:
The variation in the prescription of ADT in patients with intermediate-risk PCa between institutions is substantial. This suggests that the prescription of ADT in these patients is largely dependent on different departmental policies. One of the explanations might be differences in recommendations between the Dutch and European guidelines. Nevertheless, given the firm and clear recommendations in the guidelines, adherence could be improved. Author contributions: Barbara Lily Thérèse Rijksen had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Aben, Pos, Hulshof. Acquisition of data: Vernooij, Jansen. Analysis and interpretation of data: None. Drafting of the manuscript: None. Critical revision of the manuscript for important intellectual content: None. Statistical analysis: None. Obtaining funding: None. Administrative, technical, or material support: None. Supervision: van Andel, Wijsman, D.M. Somford, M.B. Busstra, R.J.A. van Moorselaar, C.A. Hulsbergen-van de Kaa, G.J.L.H. van Leenders, P. Hamberg, F. van den Berkmortel, J.J. Fütterer, L.A. Kiemeney, I.M. van Oort. Other: None. Financial disclosures: Barbara Lily Thérèse Rijksen certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: None. Acknowledgements: ProZIB is funded by the Dutch Cancer Society ( KWF2013-5942 ). The authors thank the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry.
Publisher Copyright:
© 2019 European Association of Urology
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - BACKGROUND: According to (inter-)national guidelines, (neo-)adjuvant and concurrent androgen deprivation therapy (ADT) in combination with external beam radiotherapy (EBRT) is optional for intermediate-risk prostate cancer (PCa) patients and is the recommended standard treatment for high-risk PCa patients.OBJECTIVE: The aim of this study is to provide insight into the prescription of ADT in intermediate- and high-risk PCa patients treated with EBRT in the Netherlands, and to evaluate adherence to European Association of Urology guidelines and factors affecting prescription.DESIGN, SETTING, AND PARTICIPANTS: All intermediate- and high-risk PCa patients between October 2015 and April 2016 were identified through the population-based Netherlands Cancer Registry. Variation in the prescription of ADT in patients with EBRT was evaluated. Multivariable multilevel logistic regression analyses were performed to determine the probability of ADT and to examine the role of patient-, tumour-, and hospital-related factors.RESULTS AND LIMITATIONS: Overall, 29% of patients with intermediate-risk PCa received ADT varying from 3% to 73% between institutions. From the multivariable regression analysis, higher Gleason grade, magnetic resonance imaging, and computed tomography (CT)-positron-emission tomography/CT prior to radiotherapy appeared to be associated with increased prescription of ADT. Among high-risk patients, 83% received ADT, varying from 57% to 100% between departments. A higher prostate-specific antigen level, more advanced tumour stage, and a higher Gleason grade were associated with increased prescription.CONCLUSIONS: Less than one-third of intermediate-risk PCa patients treated with EBRT receive ADT. The variation in the prescription of ADT between different institutions is substantial. This suggests that the prescription is largely dependent on different institutional policies. The guideline adherence in high-risk PCa is fairly good, as the vast majority of patients received ADT as recommended. However, given the clear recommendations in the guidelines, adherence could be improved.PATIENT SUMMARY: In this review, we looked at the variation of hormonal treatment in intermediate- and high-risk prostate cancer patients. We found substantial variation between institutions.
AB - BACKGROUND: According to (inter-)national guidelines, (neo-)adjuvant and concurrent androgen deprivation therapy (ADT) in combination with external beam radiotherapy (EBRT) is optional for intermediate-risk prostate cancer (PCa) patients and is the recommended standard treatment for high-risk PCa patients.OBJECTIVE: The aim of this study is to provide insight into the prescription of ADT in intermediate- and high-risk PCa patients treated with EBRT in the Netherlands, and to evaluate adherence to European Association of Urology guidelines and factors affecting prescription.DESIGN, SETTING, AND PARTICIPANTS: All intermediate- and high-risk PCa patients between October 2015 and April 2016 were identified through the population-based Netherlands Cancer Registry. Variation in the prescription of ADT in patients with EBRT was evaluated. Multivariable multilevel logistic regression analyses were performed to determine the probability of ADT and to examine the role of patient-, tumour-, and hospital-related factors.RESULTS AND LIMITATIONS: Overall, 29% of patients with intermediate-risk PCa received ADT varying from 3% to 73% between institutions. From the multivariable regression analysis, higher Gleason grade, magnetic resonance imaging, and computed tomography (CT)-positron-emission tomography/CT prior to radiotherapy appeared to be associated with increased prescription of ADT. Among high-risk patients, 83% received ADT, varying from 57% to 100% between departments. A higher prostate-specific antigen level, more advanced tumour stage, and a higher Gleason grade were associated with increased prescription.CONCLUSIONS: Less than one-third of intermediate-risk PCa patients treated with EBRT receive ADT. The variation in the prescription of ADT between different institutions is substantial. This suggests that the prescription is largely dependent on different institutional policies. The guideline adherence in high-risk PCa is fairly good, as the vast majority of patients received ADT as recommended. However, given the clear recommendations in the guidelines, adherence could be improved.PATIENT SUMMARY: In this review, we looked at the variation of hormonal treatment in intermediate- and high-risk prostate cancer patients. We found substantial variation between institutions.
KW - Adherence
KW - Androgen deprivation therapy
KW - Guidelines
KW - Prostate cancer
KW - Variation
UR - http://www.scopus.com/inward/record.url?scp=85075366475&partnerID=8YFLogxK
U2 - 10.1016/j.euf.2019.11.005
DO - 10.1016/j.euf.2019.11.005
M3 - Article
C2 - 31748122
VL - 7
SP - 332
EP - 339
JO - European Urology Focus
JF - European Urology Focus
SN - 2405-4569
IS - 2
ER -