957 - What clinical and non-clinical factors influence prostate cancer treatment decisions? A national clinical survey

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Prostate Cancer
Presenter John Fitzpatrick
Authors J.M. Fitzpatrick1, L. Sharp2, M. De Camargo Cancela3, H. Comber4
  • 1Surgical Professorial Unit, Mater Misericordiae University HospitalUniversity College Dublin, IE-7 - Dublin/IE
  • 2Research Department, National Cancer Registry, Ireland, Cork/IE
  • 3National Cancer Registry, Ireland, Cork/IE
  • 4Director, National Cancer Registry, Ireland, Cork/IE

Abstract

Background

Prostate cancer treatment remains controversial. Several population-based studies have revealed strikingly different treatment trends by patient age, suggesting treatment decisions may be influenced heavily by non-clinical considerations. To investigate factors considered important by clinicians we surveyed radiotherapists and urologists in Ireland.

Materials and methods

All radiotherapists and urologists were asked to complete a postal questionnaire involving patients scenarios rating 68 comorbid conditions (from ACE-27) in terms of their impact on treatment recommendations regarding radical prostatectomy (RP; urologists), radiotherapy (RT; radiotherapists) and androgen deprivation therapy (both). Respondents indicated which of 13 non-medical issues impacted on treatment.

Results

24 urologists (56%) and 12 radiotherapists (46%) responded. Performance assessment tools were used by more radiotherapists than urologists (92% vs 20%). All urologists and 10 radiotherapists prescribed ADT. Conditions rated as having the greatest impact on RP or RT treatment decisions were similar: severe dementia, acute stroke and recent bypass or amputation for gangrene. Non-clinical factors with the greatest impact were: life expectancy (urologists: 100%; radiotherapists: 100%) and patient's preference (100%, 92%), followed by age for urologists (96%) and patient quality-of-life for radiotherapists (83%). Conditions impacting on ADT recommendations were: recent pulmonary embolia, acute stroke and cirrhosis.

Conclusions

Radiotherapists were more heterogeneous than urologists in their views on which clinical factors influence treatment decisions. Many conditions which strongly influence treatment are uncommon in patients, therefore unlikely to explain treatment variations. Our findings confirm clinicians consider non-clinical factors important, suggesting these may influence treatment independently of comorbid status or fitness for treatment.

Disclosure

J.M. Fitzpatrick: This study was funded by Sanofi-Aventis,

L. Sharp: This study was funded by Sanofi-Aventis,

M. De Camargo Cancela: This study was funded by Sanofi-Aventis,

H. Comber: This study ws funded by Sanofi-Aventis