This study analyzed data on 40,215 low-risk prostate cancer patients from 2012-2013 to evaluate the use of active surveillance. The results showed the rate of active surveillance was as low as 14% and varied significantly between facilities. Facility type, volume, and other institutional factors accounted for this variation. Specifically, academic facilities and those with higher patient volumes were more likely to utilize active surveillance. The study concludes there is a need to address non-clinical variations in care between cancer facilities to standardize the appropriate use of active surveillance.

1. Results Conclusions
• Active surveillance rates to
be as low as 14% in eligible
patients with low-risk prostate
cancer
• The variation in receipt of AS
was attributable to facility
related factors such as facility
type, facility volume, and the
institution
• Additionally, policy makers
need to address the variation
in care at Commission on
Cancer facilities
• Reports on the use of active surveillance for
localized prostate cancer have been
conflicting
• There is a growing need for studies that
identify sources of non-clinical variation
across all clinical settings and specialties
Purpose & Hypothesis
• Goal: To evaluate the contemporary use of
active surveillance for men with low-risk
prostate cancer
• Hypothesis: A wide variation exists in
institutional practices and the use of active
surveillance in the community remains
unfortunately low
Patients & Methods
• N=40,215 low risk prostate cancer patients
from 2012 to 2013 retrieved from the
National Cancer Data Base
• Chi-square test and the Mann-Whitney test
were used to compare baseline variables
• Logistic regression model was fitted to
predict the odds of receiving active
surveillance
• A mixed-effects logistic regression was
performed to assess association of patient
and hospital variable with active surveillance
Acknowledgements
Thank you to…
• Björn Löppenberg, MD;
• Quoc-Dien Trinh, MD;
• Emily McMains Ph.D;
• Karen Burns White;
• Stephania Libreros, Ph.D;
• Danielle Cook, Ph.D;
• Continuing Umbrella of Research
Experience Program;
• Funding support from:
• Biogen Foundation
• National Cancer Institute Cancer
Center Support Grant;
• Dana-Farber Harvard Cancer Center;
• Brigham and Women’s Hospital
Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer
Hawa Barry1,2; Björn Löppenberg, MD2; Quoc-Dien Trinh, MD1,2
1. Dana-Farber Harvard Cancer Center 2. Brigham and Women’s Hospital Center for Surgery and Public Health, Division of Urologic Surgery
Figure 1: Receipt of active
surveillance ranged from 0 to 100%
over facilities with 14% of eligible men,
receiving active surveillance
Figure 2: Very high volume facilities
are 2.6 times more like likely to use
active surveillance (95% CI 2.34-2.90;
p<0.001)
Figure 3: Community Cancer Programs
and Academic facilities are 2.1 times and
1.76 times more likely to utilize active
surveillance (95% CI 1.85-2.38; and 1.63-
1.91; with p<0.001, respectively)
Table 1: The single facility accounted for
35% of unexplained association with the
use of active surveillance
Background

2. Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer
Hawa Barry1,2; Björn Löppenberg, MD2; Quoc-Dien Trinh, MD1,2
1. Dana-Farber Harvard Cancer Center 2. Brigham and Women’s Hospital Center for Surgery and Public Health, Division of Urologic Surgery

3. Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer
Hawa Barry1,2; Björn Löppenberg, MD2; Quoc-Dien Trinh, MD1,2
1. Dana-Farber Harvard Cancer Center 2. Brigham and Women’s Hospital Center for Surgery and Public Health, Division of Urologic Surgery

4. Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer
Hawa Barry1,2; Björn Löppenberg, MD2; Quoc-Dien Trinh, MD1,2
1. Dana-Farber Harvard Cancer Center 2. Brigham and Women’s Hospital Center for Surgery and Public Health, Division of Urologic Surgery

5. Variation in the Use of Active Surveillance for Low-Risk Prostate Cancer
Hawa Barry1,2; Björn Löppenberg, MD2; Quoc-Dien Trinh, MD1,2
1. Dana-Farber Harvard Cancer Center 2. Brigham and Women’s Hospital Center for Surgery and Public Health, Division of Urologic Surgery