Perceptions of Barriers Towards Active Surveillance for Low-Risk Prostate Cancer: Results From a National Survey of Radiation Oncologists and Urologists
- Yale University, Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center (United States)
- Mayo Clinic, Division of Health Policy and Research (United States)
- Mayo Clinic, Division of General Internal Medicine (United States)
- University of Minnesota, Department of Urology (United States)
- University of Texas Medical Branch, Division of Urology (United States)
- Louis Stokes Cleveland VA Medical Center, Department of Radiation Oncology (United States)
- Case Western Reserve University, Case Comprehensive Cancer Center (United States)
Purpose: The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa. Methods: In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS. Results: We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent’s specialty. Conclusions: Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.
- OSTI ID:
- 22927889
- Journal Information:
- Annals of Surgical Oncology (Online), Vol. 26, Issue 2; Other Information: Copyright (c) 2019 Society of Surgical Oncology; Country of input: International Atomic Energy Agency (IAEA); ISSN 1534-4681
- Country of Publication:
- United States
- Language:
- English
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