Focal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the 2 cancers to discern health system determinants affecting the adoption of these treatments.
The study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed interhospital variability through ranked caterpillar plots and Spearman correlation coefficient.
Among 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The interhospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; P < .001).
Our analysis revealed a substantial hospital-level discrepancy in the utilization of focal therapy. Despite this, there was a limited correlation between the use of focal therapy for these two types of cancer within the same hospital. Our findings emphasize the presence of multifaceted factors influencing the adoption of focal therapy, both at facility and healthcare system levels.
Clinical genitourinary cancer. 2024 Jul 31 [Epub ahead of print]
Zhiyu Qian, Dejan K Filipas, Mara Koelker, Benjamin V Stone, Edoardo Beatrici, Muhieddine Labban, Kemal Tuncali, Stuart Lipsitz, Quoc-Dien Trinh, Alexander P Cole
Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA., Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA., Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA., Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA. Electronic address: .