Guideline adherence down for combination RT-ADT
Examination of individual patient characteristics indicates random variability
San Diego—Adherence to guidelines for the use of combination radiation therapy and androgen deprivation therapy (ADT) in the United States for the treatment of high-risk or locally advanced prostate cancer has decreased over time, according to data presented by Paolo Dell’Oglio, MD.
Moreover, examination of individual patient characteristics indicates random variability in adherence to guidelines, he said at the 2016 AUA annual meeting in San Diego, where the study was first reported. It was subsequently published in European Urology (2016; 70:429-35).
The combination of radiation therapy and androgen deprivation therapy (ADT) has been proven definitively to be superior to radiation therapy alone followed by deferred ADT on relapse in the treatment of patients with high-risk and locally advanced prostate cancer, as demonstrated by several phase III randomized trials.
For this reason, the National Comprehensive Cancer Network and the European Association of Urology guidelines recommend using radiation therapy with ADT for the treatment of these patient groups.
Dr. Dell’Oglio and colleagues sought to examine the rate of adherence to these guidelines within a large-scale population-based data repository.
“We hypothesized near-perfect guideline adherence,” he said.
The study population consisted of 14,180 patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database who were diagnosed with high-risk (clinical T1-T2 with WHO histological grade 3) or locally advanced (clinical T3-T4) prostate cancer between 2003 and 2009.
To qualify for inclusion, patients needed to receive treatment with either first-line radiation therapy alone or first-line radiation therapy with concomitant adjuvant ADT within 6 months from prostate cancer diagnosis.
Study authors assessed the annual rates of adherence to guidelines with respect to use of radiation therapy-ADT in the overall population and after stratification according to stage-grade groupings, Charlson comorbidity index, and pre-existing cardiovascular disease. Multivariate logistic regression analyses were performed to assess predictors of radiation therapy-ADT use.