Physician Reasons for or Against Treatment Intensification in Patients With Metastatic Prostate Cancer.

IF 10.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Neeraj Agarwal, Daniel J George, Zachary Klaassen, Rickard Sandin, Jake Butcher, Amanda Ribbands, Liane Gillespie-Akar, Birol Emir, David Russell, Agnes Hong, Krishnan Ramaswamy, Stephen J Freedland
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引用次数: 0

Abstract

Importance: Clarifying the underutilization of treatment intensification (TI) for metastatic castration-sensitive prostate cancer (mCSPC) may improve implementation of evidence-based medicine and survival outcomes.

Objective: To investigate physicians' beliefs about TI in mCSPC to understand the gap between evidence-based guidelines and clinical practice.

Design, setting, and participants: This survey study analyzed data from the Adelphi Real World retrospective survey, which comprised physician surveys that were linked to medical record reviews of US adult patients treated for mCSPC between July 2018 and January 2022.

Main outcomes and measures: The survey included questions on physician and practice demographics. Physicians completed patient record forms, based on patient medical records with information including patient demographics, clinical characteristics, and patient management. Physicians recalled reasons for prescribing decisions using 48 precoded and open-text responses. Bivariate and multivariable analyses assessed the likelihood of their patients receiving first-line TI; the main outcome was the likelihood of their patients receiving TI using odds ratios (ORs).

Results: In total, 617 male patients met the analysis criteria (mean [SD] age, 68.6 [8.1] years). Among these patients, 349 (56.6%) were Medicare beneficiaries. Overall, 430 (69.7%) did not receive first-line TI with androgen receptor pathway inhibitors and/or chemotherapy. The 107 US-based physicians' top reasons for treatment choice for their patients were tolerability concerns (TI: 121 [64.7%]; no TI: 252 [58.6%]; P = .18) and following guideline recommendations (TI: 115 [61.5%]; no TI: 230 [53.5%]; P = .08). In the bivariate analysis, physicians seeking to reduce prostate-specific antigen (PSA) by 75% to 100% were more likely to provide first-line TI compared with physicians who aimed to lower PSA by 0% to 49% (OR, 1.63 [95% CI, 1.04-2.56]; P = .03). In the multivariable analysis, patients whose physicians based treatment choice on guidelines were more likely to receive TI than patients whose physicians did not report this reason (OR, 3.46 [95% CI, 1.32-9.08]; P = .01).

Conclusions and relevance: The findings of this study, which analyzed data from a medical records-linked clinical practice survey, indicated low rates of first-line TI for mCSPC despite guideline recommendations. Barriers to TI included lack of knowledge about guidelines and published efficacy and safety data. Physicians with greater PSA reduction goals were more likely to use TI. Physician education on treatment guidelines and clinical trial data, while raising expectations for PSA response, may increase rates of first-line TI in mCSPC.

转移性前列腺癌患者强化治疗的内科原因。
重要性:阐明转移性去势敏感前列腺癌(mCSPC)强化治疗(TI)的未充分利用可能会改善循证医学的实施和生存结果。目的:调查医生对mCSPC中TI的看法,以了解循证指南与临床实践之间的差距。设计、环境和参与者:本调查研究分析了来自Adelphi Real World回顾性调查的数据,该调查包括与2018年7月至2022年1月期间接受mCSPC治疗的美国成年患者的病历审查相关的医生调查。主要结果和测量:调查包括医生和执业人口统计学问题。医生根据包含患者人口统计、临床特征和患者管理等信息的患者医疗记录完成患者记录表格。医生使用48个预编码和开放文本回复来回忆处方决定的原因。双变量和多变量分析评估了患者接受一线TI治疗的可能性;主要结果是使用比值比(or)评估患者接受TI治疗的可能性。结果:符合分析标准的男性患者共617例(平均[SD]年龄68.6[8.1]岁)。其中349例(56.6%)为Medicare受益人。总体而言,430例(69.7%)未接受一线TI治疗,同时接受雄激素受体途径抑制剂和/或化疗。107名美国医生对患者治疗选择的主要原因是耐受性问题(TI: 121 [64.7%];非TI: 252 [58.6%];P = 0.18)和以下指南建议(TI: 115 [61.5%];no TI: 230 [53.5%];p = .08)。在双变量分析中,寻求将前列腺特异性抗原(PSA)降低75%至100%的医生比旨在将PSA降低0%至49%的医生更有可能提供一线TI (OR, 1.63 [95% CI, 1.04-2.56];p = .03)。在多变量分析中,医生根据指南进行治疗选择的患者比医生没有报告这一原因的患者更有可能接受TI治疗(OR, 3.46 [95% CI, 1.32-9.08];p = 0.01)。结论和相关性:本研究分析了一项与医疗记录相关的临床实践调查的数据,结果表明尽管有指南建议,mCSPC的一线TI率很低。TI的障碍包括缺乏关于指南和已发表的疗效和安全性数据的知识。具有更高PSA降低目标的医生更有可能使用TI。医生在治疗指南和临床试验数据方面的教育,虽然提高了对PSA反应的期望,但可能会增加mCSPC一线TI的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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