The authors utilized the National Cancer Database (NCDB) to identify 49,586 men with metastatic prostate cancer at presentation, defined as clinical M1 disease, between 2004-2014. Treatments codes for hormone therapy and single drug chemotherapy were categorized and compared between years of diagnosis according to the following groups: private insurance, Medicare, Medicaid, and no insurance.
Among men meeting inclusion criteria, the percentage of men receiving hormone therapy steadily increased over time, regardless of insurance status. The largest increase in utilization was observed in men without insurance: 66% in 2004, to 82% in 2014. Comparatively, for those with private insurance, hormonal treatment increased from 79% to 85%. The use of single agent chemotherapy among all patients was low (2-5%) from 2004-2013. However, in the final year of the analysis (2014), chemotherapy utilization rose dramatically (3-5 fold) in all men, particularly those with private insurance (5% to 24%) likely secondary to publication of level-1 evidence in this disease space [2-4].
In summary, the utilization of hormone therapy for metastatic prostate cancer has increased significantly over the last decade, with almost 80% of all patients receiving hormone therapy as a component of their primary treatment plan. Importantly, this improvement in delivery and adherence to guideline-driven care was seen in men with and without insurance. As of 2014, single agent chemotherapy use has started to increase, but still constitutes a minority of patients. In the context of recent level 1 evidence for use of upfront docetaxel, this utilization trend will likely continue.
1. Weiner AB, Matulewicz RS, Tosoian JJ, et al. The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004-2013). Urol Onc 2017 Nov 15 [Epub ahead of print].
2. Gravis G, Boher JM, Joly F, et al. Androgen Deprivation Therapy (ADT) Plus Docetaxel Versus ADT Alone in Metastatic Non castrate Prostate Cancer: Impact of Metastatic Burden and Long-term Survival Analysis of the Randomized Phase 3 GETUG-AFU15 Trial. Eur Urol. 2016;70(2):256-262.
3. Sweeney CJ, Chen YH, Carducci M, et al. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med. 2015;373(8):737-746.
4. James ND, Sydes MR, Clarke NW, et al. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet. 2016;387(10024):1163-1177.
Presented by: Jared Schober, MD, Lahey Hospital and Medical Center, Burlington, MA
Co-Authors: Kristian Stensland MD MPH, Alireza Moinzadeh MD, Harras Zaid MD and David Canes MD
Affiliation: Lahey Hospital and Medical Center, Burlington MA
Written by: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC