A Population-based Study Comparing Outcomes for Patients With Metastatic Castrate Resistant Prostate Cancer Treated by Urologists or Medical Oncologists With First Line Abiraterone Acetate or Enzalutamide

Autor: Antonio Finelli, Girish S. Kulkarni, Douglas C. Cheung, Christopher J.D. Wallis, Neil Fleshner, Refik Saskin, Christina Diong, Lisa J. Martin, Dixon T.S. Woon, Shabbir M.H. Alibhai
Rok vydání: 2021
Předmět:
Male
Canada
medicine.medical_specialty
Drug-Related Side Effects and Adverse Reactions
Urologists
Urology
Population
Abiraterone Acetate
030232 urology & nephrology
Antineoplastic Agents
Medical Oncology
03 medical and health sciences
chemistry.chemical_compound
Prostate cancer
0302 clinical medicine
Internal medicine
Nitriles
Phenylthiohydantoin
medicine
Humans
Enzalutamide
Neoplasm Metastasis
Practice Patterns
Physicians'
education
Disease burden
Aged
Neoplasm Staging
Oncologists
education.field_of_study
Proportional hazards model
business.industry
Hazard ratio
Abiraterone acetate
Steroid 17-alpha-Hydroxylase
Retrospective cohort study
medicine.disease
Hospitalization
Prostatic Neoplasms
Castration-Resistant
Outcome and Process Assessment
Health Care
chemistry
030220 oncology & carcinogenesis
Benzamides
business
Zdroj: Urology. 153:147-155
ISSN: 0090-4295
Popis: Objectives To compare toxicity and all-cause mortality for mCRPC patients receiving first line oral systemic therapy prescribed by medical oncologists and urologists. Methods Population-based retrospective cohort study of chemotherapy-naive men aged ≥66 years treated for mCRPC with first-line abiraterone or enzalutamide based on administrative health data (Ontario, Canada, 2012-2017). Primary outcomes were hospitalizations/ER visits for any cause or treatment-related toxicity during first-line mCRPC treatment. Secondary outcome was all-cause mortality. We calculated hazard ratios (HRs) comparing outcomes for different medical specialties using multivariable Cox proportional hazards models. Results Among 3405 mCRPC patients, 2407 (70.7%) received abiraterone and 998 (29.3%) received enzalutamide. 1786 (52.5%) patients visited the ER or were hospitalized. Men treated by medical oncologists had an increased risk of hospitalization/ER visits (HR1.16, 95%CI 1.03-1.31; P = .02), toxicity-related visits (HR1.34, 95%CI 1.08-1.69; P = .01), and mortality (HR1.16, 95%CI 1.02-1.33; P = .02) compared to urologists. Limited information was available, beyond PSA adjustment and prior treatment, on patient disease burden. Conclusion We observed fewer hospital visits overall and for treatment-related toxicity for mCRPC patients who were prescribed first line abiraterone or enzalutamide by urologists compared to medical oncologists. These differences may result from higher prostate cancer disease burden in patients managed by medical oncologists, and/or other unmeasured differences in patient management between specialties.
Databáze: OpenAIRE
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