CUA 2018: Educational Needs of Canadian Physicians in the Management of Advanced Prostate Cancer

Halifax, Nova Scotia ( Since 2010, the treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has rapidly evolved, with many new treatment options now available. As a result, the role of physicians is also changing, with many urologists and radiation oncologists now managing patients with mCRPC (treating patients with abiraterone, enzalutamide, Radium-223, etc), a role traditionally served by medical oncologists. Physician education is critical, given the increase of treatment options, earlier indications for therapy, and sequencing possibilities. At the CUA 2018 annual meeting, Alan So, MD, and colleagues presented results of their study investigating which educational topics are most critical to physicians treating patients with mCRPC. 

This study included a 59-item questionnaire developed by a multidisciplinary steering committee of the Canadian Genitourinary Research Consortium, a national collaboration of physicians who treat advanced prostate cancer with interest in research, education, and best practice. The questionnaire was designed to measure aspects of mCRPC management, including educational needs and preferred learning formats. Questionnaire development involved face and content validity assessment and pre-testing of the instrument before implementation for research. The questionnaire was composed of open and closed content areas including (i) patient load, roles, and referrals, (ii) treatment and reimbursement, (iii) multidisciplinary care, (iv) services and education, and (v) prostate cancer research. The survey was delivered to 93 physicians, including urologists, radiation oncologists, and medical oncologists, who are actively involved in the treatment of mCRPC patients.

This survey was delivered between April 17 and May 17, 2017, with a response rate of 53% (49 respondents). The regional trend of respondents was as follows:

Figure 1. Regional Representation
Regional Representation was greatest in Ontario (59%), followed by British Columbia (14%), Alberta (13%), Quebec (10%), and Atlantic Canada (4%).
UroToday CUA 2018 Educational Needs of Canadian Physicians PCa
Most physicians responding were urologists/urologic oncologists (55%), followed by medical oncologists (33%) and radiation oncologists (10%). Physicians identified their most important treatment goals for mCRPC patients to be improved quality of life (90%) and overall survival (78%). The top two educational topics selected were sequencing strategies (71%) and individualization of therapy (65%). The preferred format for learning among respondents was expert roundtables or live lectures, with fewer preferring web-based platforms or live case-based presentations. 

The strength of this study is the first to directly survey providers across several specialties involved in treating mCRPC patients with regards to how they gain information for keeping abreast of new mCRPC developments. Sequencing strategies and precision medicine were the top two learning requirements. Indeed, there are several ongoing trials assessing the appropriate sequence of delivering therapy (i.e. sequencing and a combination of abiraterone, enzalutamide, docetaxel, and Radium-223), and translational studies continue to provide exciting results as we move closer to precision medicine (ie. AR-V7 mutations, whole genome sequencing, etc). Dr. So concluded noting that the recent increase in novel treatment options for mCRPC has resulted in both opportunities and challenges in management. This treatment landscape is reflected in the results of the survey, which showed the highest preference for education in sequencing strategies and individualization of therapy. Despite the trend of physician education moving to a more digital platform, physicians still value face-to-face methods for learning.

Presented by: Alan So, MD, Prostate Centre at Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
Co-Authors: Brita Danielson1, Christina Canil2, Jason Izard3, Anil Kapoor4, Sandeep Sehdev2, Jean-Baptiste Lattouf5, Kim N. Chi6, Fred Saad5, Marni Robertson7, Laura Park-Wyllie7.
Author Information:
1. Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
2. The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
3. Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
4. St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
5. Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC, Canada
6. BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
7. Medical Affairs, Janssen Inc, Toronto, ON, Canada

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia


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