Contemporary prostate cancer radiation therapy in the United States: Patterns of care and compliance with quality measures

被引:13
|
作者
Lee, Daniel J. [1 ]
Barocas, Daniel A. [1 ]
Zhao, Zhiguo [2 ]
Huang, Li-Ching [2 ]
Koyama, Tatsuki [2 ]
Resnick, Matthew J. [1 ]
Conwill, Ralph [3 ]
McCollum, Dan [3 ]
Cooperberg, Matthew R. [4 ]
Goodman, Michael [5 ]
Greenfield, Sheldon [6 ,7 ]
Hamilton, Ann S. [8 ]
Hashibe, Mia [9 ]
Kaplan, Sherrie H. [10 ]
Paddock, Lisa E. [11 ]
Stroup, Antoinette M. [11 ]
Wu, Xiao-Cheng [12 ]
Penson, David F. [13 ]
Hoffman, Karen E. [14 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Urol, A1302 Med Ctr North, Nashville, TN 37232 USA
[2] Vanderbilt Univ, Med Ctr, Dept Biostat, Nashville, TN 37232 USA
[3] Vanderbilt Ingram Canc Ctr, Nashville, TN USA
[4] Univ Calif San Francisco, Dept Urol, San Francisco Med Ctr, San Francisco, CA USA
[5] Emory Univ, Dept Epidemiol, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA
[6] Univ Calif Irvine, Ctr Hlth Policy Res, Irvine, CA USA
[7] Univ Calif Irvine, Dept Med, Irvine, CA 92717 USA
[8] Univ Southern Calif, Keck Sch Med, Dept Preventat Med, Los Angeles, CA USA
[9] Univ Utah, Dept Family & Preventat Med, Salt Lake City, UT USA
[10] Univ Calif Irvine, Hlth Policy Res Inst, Irvine, CA USA
[11] Rutgers State Univ, Rutgers Canc Inst New Jersey, New Brunswick, NJ USA
[12] Louisiana State Univ, Sch Publ Hlth, Hlth Sci Ctr, New Orleans, LA USA
[13] Tennessee Valley Vet Adm Hlth Syst, Nashville, TN USA
[14] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
基金
美国医疗保健研究与质量局;
关键词
ANDROGEN-DEPRIVATION THERAPY; PHASE-III TRIAL; EXTERNAL-BEAM RADIOTHERAPY; PELVIC IRRADIATION; RACIAL DISPARITIES; RANDOMIZED-TRIAL; OF-CARE; RISK; MEN; SUPPRESSION;
D O I
10.1016/j.prro.2018.04.009
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Quality measures represent the standards of appropriate treatment agreed upon by experts in the field and often supported by data. The extent to which providers in the community adhere to quality measures in radiation therapy (RT) is unknown. Methods and materials: The Comparative Effectiveness Analysis of Surgery and Radiation study enrolled men with clinically localized prostate cancer in 2011 and 2012. Patients completed surveys and medical records were reviewed. Patients were risk-stratified according to D'Amico classification criteria. Patterns of care and compliance with 8 quality measures as endorsed by national consortia as of 2011 were assessed. Results: Overall, 926 men underwent definitive RT (69% external beam radiation therapy [EBRT]), 17% brachytherapy (BT), and 14% combined EBRT and BT with considerable variation in radiation techniques across risk groups. Most men who received EBRT had dose-escalated EBRT (>75 Gy; 93%) delivered with conventional fractionation (<2 Gy; 95%), intensity modulated RT (76%), and image guided RT (85%). Most men treated with BT received I125 (77%). Overall, 73% of the men received EBRT that was compliant with the quality measures (dose-escalation, image-guidance, appropriate use of androgen deprivation therapy, and appropriate treatment target) but only 60% of men received BT that was compliant with quality measures (postimplant dosimetry and appropriate dose). African-American men (64%) and other minorities (62%) were less likely than white men (77%) to receive EBRT that was compliant with quality measures. Conclusions: Most men who received RT for localized prostate cancer were treated with an appropriately high dose and received image guidance and intensity modulated RT. However, compliance with some nationally recognized quality measures was relatively low and varied by race. There are significant opportunities to improve the delivery of RT and especially for men of a minority race. (C) 2018 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:307 / 316
页数:10
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