Advertisement

Journal of Cancer Education

, Volume 33, Issue 6, pp 1195–1200 | Cite as

Patterns of Care Related to Post-Operative Radiotherapy for Patients with Prostate Cancer among Canadian Radiation Oncologists and Urologists

  • Bonnie Bristow
  • Mohammed Aldehaim
  • Katija Bonin
  • Candice Chee Ka Lam
  • Stephanie J. Wan
  • Xingshan Cao
  • Ewa SzumacherEmail author
Article

Abstract

The American Society for Radiation Oncology (ASTRO) and American Urological Association (AUA) developed post-prostatectomy radiotherapy (RT) guidelines to aid patient counseling on adjuvant (ART) and salvage radiotherapy (SRT). Our study compared how aware and compliant Canadian radiation oncologists and urologists are to these guidelines. Our online survey was distributed through the Canadian Association of Radiation Oncology (CARO) and Canadian Urology Association (CUA) to radiation oncologists and urologists that treat prostate cancer. We used Wilcoxon rank-sum test and Chi-square test to compare radiation oncologists and urologists. P values for significant findings are reported. A total of 128 participants responded the survey, 52 radiation oncologists, and 76 urologists. The majority (82%) of radiation oncologists had read these guidelines, compared to only 49% of urologists (p < 0.001). Radiation oncologists were more likely to recommend ART >50% for adverse pathological findings post-radical prostatectomy compared to urologists (76 vs. 51%, p = 0.011). Urologists were more likely to monitor their patient’s PSA level post-prostatectomy compared to radiation oncologists (93 vs. 77%, p = 0.016). Post-thematic analysis of open-ended questions revealed that urologists rarely refer patients to radiation oncologists for ART, with radiation oncologists confirming that they rarely receive referrals. This study demonstrates the low compliance to ASTRO/AUA guidelines. While radiation oncologists were more aware and compliant to guidelines, urologists were significantly more likely to monitor their patient’s PSA. This study highlighted the need for better communication between urologists and radiation oncologists, especially in referrals for ART, to facilitate treatment delivery that is concordant with ASTRO/AUA guidelines.

Keywords

Radioterapy Prostate cancer Prostatectomy 

References

  1. 1.
    Canadian Cancer Society’s Advisory Committee on Cancer Statistics (2014) Canadian cancer statistics. Canadian Cancer Society, TorontoGoogle Scholar
  2. 2.
    Bolla M, van Poppel H, Tombal B et al (2012) Postoperative radiotherapy after radical prostatectomy for high-risk prostate cancer: long-term results of a randomised controlled trial (EORTC trial 22911). Lancet 380:2018–2027. doi: 10.1016/S0140-6736(12)61253-7 CrossRefPubMedGoogle Scholar
  3. 3.
    Thompson IM, Tangen CM, Paradelo J et al (2009) Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term follow up of a randomized clinical trial. J Urol 181:956–962. doi: 10.1016/j.juro.2008.11.032 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Wang L, Handorf E, Murphy C et al (2015) Contemporary trends in receipt of local therapy for men with clinically localized high-risk prostxate cancer. J Clin Oncol 33:111CrossRefGoogle Scholar
  5. 5.
    RTOG 0534 Protocol Information. Last accessed January 17, 2017. http://www.rtog.org/clinicaltrials/protocoltable/studydetails.aspx?study=0534. Accessed August 18, 2015.
  6. 6.
    Stephenson AJ, Scardino PT, Kattan MW et al (2007) Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy. J Clin Oncol 25:2035–2041. doi: 10.1200/JCO.2006.08.9607 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Thompson I, Valicenti R, Albertsen P et al (2013) Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol 190:441–449CrossRefPubMedGoogle Scholar
  8. 8.
    Stephenson A, Eggener SE, Hernandez AV et al (2014) Do margins matter? The influence of positive surgical margins on prostate cancer-specific mortality. Eur Urol 65:675–680. doi: 10.1016/j.eururo.2013.08.036 CrossRefPubMedGoogle Scholar
  9. 9.
    Hoffman K, Nguyen P, Chen M et al (2011) Recommendations for post-prostatectomy radiation therapy in the United States before and after the presentation of randomized trials. J Urol 185:116–120CrossRefPubMedGoogle Scholar
  10. 10.
    Showalter T, Ohri N, Teti K et al (2012) Physician beliefs and practices for adjuvant and salvage radiation therapy after prostatectomy. Int J Radiat Oncol Biol Phys 82:233–238CrossRefGoogle Scholar
  11. 11.
    Zimmermann M, Taussky D, Delouya G, Alenizi AM, Zorn KC (2015) Radiation therapy after radical prostatectomy: a single-centre radiation oncology experience in trends of referral and treatment practices. Can Urol Assoc J 9(9–10):E608–E612. doi: 10.5489/cuaj.2815 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Taggar A, Alghamdi M, Tilly D et al (2016) Assessing guideline impact on referral patterns of postprostatectomy patients to radiation oncologists. Can Urol Assoc J. 10(9–10):314. doi: 10.5489/cuaj.3539 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Casey DE (2013) Why don’t physicians (and patients) consistently follow clinical practice guidelines? JAMA Intern Med 173(17):1581. doi: 10.1001/jamainternmed.2013.7672 CrossRefPubMedGoogle Scholar
  14. 14.
    Cabana MD, Rand CS, Powe NR et al (1999) Why don’t physicians follow clinical practice guidelines? JAMA 282(15):1458. doi: 10.1001/jama.282.15.1458 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Prior M, Guerin M, Grimmer-Somers K (2008) The effectiveness of clinical guideline implementation strategies—a synthesis of systematic review findings. J Eval Clin Pract 14:888–897. doi: 10.1111/j.1365-2753.2008.01014.x CrossRefPubMedGoogle Scholar
  16. 16.
    Williams DJ, Edwards KM, Self WH et al (2015) Antibiotic choice for children hospitalized with pneumonia and adherence to national guidelines. Pediatrics 136:44–52. doi: 10.1542/peds.2014-3047 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wagner A, Ghia A, Shrieve D et al (2014) Adjuvant radiotherapy after prostatectomy: have randomized clinical trials had any impact? J Radiat Oncol Biol Phys 3:387–394CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2017

Authors and Affiliations

  • Bonnie Bristow
    • 1
  • Mohammed Aldehaim
    • 2
  • Katija Bonin
    • 3
  • Candice Chee Ka Lam
    • 3
  • Stephanie J. Wan
    • 3
  • Xingshan Cao
    • 4
  • Ewa Szumacher
    • 2
    Email author
  1. 1.Department of Radiation Therapy, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoCanada
  2. 2.Department of Radiation Oncology, Odette Cancer CentreSunnybrook Health Sciences CentreTorontoCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.Institute of Clinical Evaluative SciencesSunnybrook Health Sciences CentreTorontoCanada

Personalised recommendations