Facility volume, type linked with AS
Factors associated with receipt of AS were facility volume and facility type. The odds ratio of receipt of AS was 3.5 (95% CI: 1.84-6.68; p<.001) in facilities with the highest volume compared with lowest volume. The highest likelihood of receipt of AS was in community cancer programs and academic institutions. Relative to patients treated at comprehensive community cancer centers, patients treated at community cancer programs had an OR of 2.74 (95% CI: 1.94-3.88; p<.001) and those treated at academic institutions had an OR of 2.50 (95% CI: 1.77-3.54; p<.001).
“There are some high-volume facilities that almost never treat patient with AS,” Dr. Löppenberg said.
Adjusted for all factors, the mean probability of receiving AS was 0.033 (95% CI: 0.023-0.256).
The overall model explained 40% of the variation in receipt of AS. Of the unexplained variation, 35% could be attributed to a single facility, he said.
“Policies to achieve more consistent and higher rates of AS, when appropriate, should be a priority of professional societies and patient advocacy groups,” Dr. Löppenberg said.
The National Cancer Data Base captures about 70% of all newly diagnosed prostate cancer in the United States, he explained.
“The NCDB estimates that approximately 50% of all newly diagnosed prostate cancers are within their database,” he said. “So we think that quite a large proportion of these patients do not receive AS.”
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