Journal article
Declining brachytherapy utilization for high-risk prostate cancer-Can clinical pathways reverse the trend?
Brachytherapy, v 17(6), pp 895-898
Nov 2018
PMID: 30217434
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Although external beam radiation therapy (EBRT) plus a brachytherapy boost (BB) offers a 20% improvement in biochemical progression-free survival compared with dose-escalated EBRT alone for men with intermediate and high-risk prostate cancer, population studies show a concerning decline in BB utilization.
We modified our clinical pathway (CP) in January 2016 to indicate EBRT with BB as first-choice modality for high-risk prostate cancer, based on preliminary findings of Androgen Suppression Combined with Elective Nodal and Dose-Escalated Radiation Therapy. A retrospective review was performed on 659 patients with high-risk prostate cancer treated with definitive intent EBRT ± BB within a network of 19 sites between December 2011 and July 2017. χ
test was used to determine changes in practice pattern before vs. after CP modification.
Before CP modification, 25.2% of patients were planned for BB, compared with 45.4% afterward (p < 0.001). Among 23 nonbrachytherapist physicians, utilization of BB increased from 3.4% to 14.8% (p < 0.001) after CP modification. Among nine brachytherapists, utilization increased from 46.4% to 55.6% (p = 0.120). Among patients treated by a nonbrachytherapist who did not receive BB, the reason was physician preference in 59.7%, patient preference in 19.9%, and other in 20.4%.
Based on recent evidence suggesting improved biochemical progression-free survival with use of BB for high-risk prostate cancer, we modified our CP, after which we observed increased use of a BB across a network, especially among physicians who do not perform brachytherapy. However, physician preference remains the most significant factor in the nonutilization of BB. New mechanisms are needed to overcome this barrier.
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Details
- Title
- Declining brachytherapy utilization for high-risk prostate cancer-Can clinical pathways reverse the trend?
- Creators
- Diane C Ling - UPMC Hillman Cancer CenterPooja Karukonda - UPMC Hillman Cancer CenterRyan P Smith - UPMC Hillman Cancer CenterDwight E Heron - UPMC Hillman Cancer CenterSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Brachytherapy, v 17(6), pp 895-898
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000451361500009
- Scopus ID
- 2-s2.0-85053067313
- Other Identifier
- 991021897264104721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging