Late Breaking News
Watchful Waiting for Prostate Cancer Increases Only at VA
SAN DIEGO, CA - While the use of expectant management (EM) as a treatment course for prostate cancer did not increase in the United States overall in the last decade, active surveillance - also known as “watchful waiting” - went up more than 10% at the VA, according to a recent study.
The research was presented this spring at the 108th Annual Scientific Meeting of the American Urological Association (AUA).1
For the study, researchers from Louis Stokes Cleveland VA Medical Center in Cleveland, OH, queried the National Cancer Database for the years 2000-2009 to identify prostate cancers managed with EM. They then examined EM usage by cancer-risk group, age group, number of comorbidities and practice setting.
The investigators found that overall use of EM remained stable at 7.5-9.8 percent from 2000 to 2009 with a similar trend across Stage 1 cancer patients and those under 70 yearsold.
VA hospitals had a significantly higher and increasing EM rate - from19.7% to 30.8% from 2000 to 2009 - compared with other practice settings including comprehensive cancer centers, community hospitals and teaching hospitals, which showed no trend of increased adoption.
EM was increasingly used at the VA with Stage 1 cancer, 53.7%; veterans under 70, 27.9%; and those who had two or more additional comorbidities, 27.9%, according to the authors who noted that the pattern not shared by other practice settings.
Study presenters suggested that the increased use of expectant management at the VA, without a concomitant increase overall or in third-party payer practice settings, could suggest that reimbursement was at issue.
“The use of EM did not increase in the last decade overall or at third-party payer practice settings, even in patients with low-risk cancer or advanced age. Conversely, the VA led the U.S. in its adoption, especially for those with low-risk cancer or limited life expectancy. While the driving force behind this practice pattern is likely multifactorial, our analysis suggests that the type of reimbursement system may play an important role in EM adoption. This possibility needs to be explored further to minimize prostate cancer overtreatment,” according the presenters.
- Maurice M, Zhu H. “Persistent Underutilization of Expectant Management for Prostate Cancer Last Decade in The United States.” Presented at the American Urological Association Annual Meeting, May 4-8, San Diego, CA.