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Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study

SIMPLE SUMMARY: According to international guidelines, the treatment of prostate cancer in men aged 70 or over should consider the patient’s health status. Although these guidelines were published more than ten years ago, the level of their implementation in routine clinical practice has not been ev...

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Autores principales: González Serrano, Adolfo, Martínez Tapia, Claudia, de la Taille, Alexandre, Mongiat-Artus, Pierre, Irani, Jacques, Bex, Axel, Paillaud, Elena, Audureau, Etienne, Barnay, Thomas, Laurent, Marie, Canouï-Poitrine, Florence
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468518/
https://www.ncbi.nlm.nih.gov/pubmed/34572921
http://dx.doi.org/10.3390/cancers13184694
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author González Serrano, Adolfo
Martínez Tapia, Claudia
de la Taille, Alexandre
Mongiat-Artus, Pierre
Irani, Jacques
Bex, Axel
Paillaud, Elena
Audureau, Etienne
Barnay, Thomas
Laurent, Marie
Canouï-Poitrine, Florence
author_facet González Serrano, Adolfo
Martínez Tapia, Claudia
de la Taille, Alexandre
Mongiat-Artus, Pierre
Irani, Jacques
Bex, Axel
Paillaud, Elena
Audureau, Etienne
Barnay, Thomas
Laurent, Marie
Canouï-Poitrine, Florence
author_sort González Serrano, Adolfo
collection PubMed
description SIMPLE SUMMARY: According to international guidelines, the treatment of prostate cancer in men aged 70 or over should consider the patient’s health status. Although these guidelines were published more than ten years ago, the level of their implementation in routine clinical practice has not been evaluated. Here, we studied the degree of implementation of these guidelines and the association between their implementation and patients’ survival. We found that the selected treatment was not guideline-compliant in almost half the patients, that non-metastatic disease was a factor related to non-compliance with the guidelines and that non-compliance with the guidelines was associated with worse survival. ABSTRACT: The guidelines on prostate cancer treatment in older men recommend evaluating the patient’s underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline–discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41–51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17–0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): −3.1 months (−5.3, −1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: −3.3 months (−6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics.
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spelling pubmed-84685182021-09-27 Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study González Serrano, Adolfo Martínez Tapia, Claudia de la Taille, Alexandre Mongiat-Artus, Pierre Irani, Jacques Bex, Axel Paillaud, Elena Audureau, Etienne Barnay, Thomas Laurent, Marie Canouï-Poitrine, Florence Cancers (Basel) Article SIMPLE SUMMARY: According to international guidelines, the treatment of prostate cancer in men aged 70 or over should consider the patient’s health status. Although these guidelines were published more than ten years ago, the level of their implementation in routine clinical practice has not been evaluated. Here, we studied the degree of implementation of these guidelines and the association between their implementation and patients’ survival. We found that the selected treatment was not guideline-compliant in almost half the patients, that non-metastatic disease was a factor related to non-compliance with the guidelines and that non-compliance with the guidelines was associated with worse survival. ABSTRACT: The guidelines on prostate cancer treatment in older men recommend evaluating the patient’s underlying health status before treatment selection. We aimed to evaluate the frequency of a guideline–discordant treatment (GDT), identify factors associated with GDT, and assess the relationship between GDT and overall survival. We studied patients with prostate cancer aged 70 or older included in the ELCAPA cohort between 2010 and 2019. Multivariable logistic regression assessed GDT-associated factors. The restricted mean survival time (RMST) assessed the 24- and 36-month OS using stabilized inverse probability of treatment weighting of propensity scores. We included 356 patients (median age: 81 years), and 164 (46%) received a GDT (95% confidence interval (CI) = (41–51%)). Patients with metastases were less likely to receive a GDT (adjusted odds ratio (95% CI) = 0.34 (0.17–0.69); p = 0.003). After weighting, the RMST at 24 months was shorter in the GDT group (13.9 months, vs. 17 months for compliant treatments; difference (95% CI): −3.1 months (−5.3, −1.0); p = 0.004). RMST at 36 months was 18.5 months, vs. 21.8 months (difference: −3.3 months (−6.7, 0.0); p = 0.053). GDT is common in older patients with prostate cancer and especially those with non-metastatic disease. GDT was associated with worse survival, independently of health status and tumour characteristics. MDPI 2021-09-18 /pmc/articles/PMC8468518/ /pubmed/34572921 http://dx.doi.org/10.3390/cancers13184694 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
González Serrano, Adolfo
Martínez Tapia, Claudia
de la Taille, Alexandre
Mongiat-Artus, Pierre
Irani, Jacques
Bex, Axel
Paillaud, Elena
Audureau, Etienne
Barnay, Thomas
Laurent, Marie
Canouï-Poitrine, Florence
Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study
title Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study
title_full Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study
title_fullStr Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study
title_full_unstemmed Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study
title_short Adherence to Treatment Guidelines and Associated Survival in Older Patients with Prostate Cancer: A Prospective Multicentre Cohort Study
title_sort adherence to treatment guidelines and associated survival in older patients with prostate cancer: a prospective multicentre cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468518/
https://www.ncbi.nlm.nih.gov/pubmed/34572921
http://dx.doi.org/10.3390/cancers13184694
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