Abstract
Introduction
Deferred treatment is a growing management strategy for low-risk prostate cancer.
However, it is unknown whether this growth is mediated by patient factors. In this
study, we sought to evaluate factors associated with deferred treatment in patients
with low-risk prostate cancer and shifts in these factors after recent incorporation
of active surveillance into national guidelines.
Materials and Methods
We identified 137,915 men diagnosed with low-risk prostate cancer (prostate-specific
antigen <10 ng/mL, Gleason score ≤6, stage cT1-cT2a) in the National Cancer Database
from 2010 to 2017. Multivariate logistic regression models were used to determine
factors associated with deferred treatment. Interaction variables were added to determine
whether trends in use of deferred treatment over time depend on race, income, education,
and insurance status.
Results
The use of deferred treatment among men with low-risk prostate cancer increased from
14.7% in 2010-2011 to 46.3% in 2016-2017 (P < .001). On multivariate analysis, deferred treatment was associated with older age,
more contemporary year of diagnosis, black race, lower income, higher educational
attainment, government insurance, being uninsured, treatment at an academic/research
facility, and treatment at a facility in New England (each P < .05). Incorporation of interaction variables showed that black race, belonging
to the two lowest income quartiles, government insurance, and being uninsured became
less associated with deferred treatment in recent years.
Conclusions
The use of deferred treatment among men with low-risk prostate cancer increased significantly
from 2010 to 2017. However, patients who were black, low-income, and not privately
insured experienced smaller increases in deferred treatment. Interventions to increase
uptake in these groups present opportunities to improve quality of care.
Keywords
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Article info
Publication history
Published online: May 10, 2022
Accepted:
May 8,
2022
Received in revised form:
May 6,
2022
Received:
February 14,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
