Hospital-Level Variations in the Utilization of Focal Therapy for Localized Prostate and Kidney Cancer
Zhiyu (Jason) Qian, MD, Dejan Filipas, MD, Mara Koelker, MD, Edoardo Beatrici, MD, Benjamin V. Stone, MD, Muhieddine Labban, MD, Steven L. Chang, MD, MS, Stuart Lipsitz, ScD, Quoc-Dien Trinh, MD, MBA, Alexander P. Cole, MD.
Brigham and Women's Hospital, Boston, MA, USA.
Background: Focal therapy or focal ablation is a relatively novel, minimally invasive procedure that uses image guidance to deliver focal energy and achieve local control of kidney and prostate cancer. Little is known about the current institutional landscape of how focal therapies are being used in localized prostate and kidney cancer.
Methods: Adult patients diagnosed with localized prostate and kidney cancer from the National Cancer Database were included. The proportion of patients who received focal therapy was calculated for each facility. A multivariable mixed-effects logistic regression analysis was performed with a hospital-level random effects term to identify factors associated with the receipt of focal therapy. The variability in utilization between hospitals was analyzed using ranked caterpillar plots for both prostate and kidney cancer.
Results: There were 1,559,334 individuals with prostate cancer and 425,753 individuals with kidney cancer; of those, 1.6% received focal therapy for prostate cancer and 6.3% for kidney cancer. The variation between hospitals ranged from 0.13% (95% CI 0.12-0.13) in the bottom decile to 32.17% (95% CI 29.64-34.70) in the top decile for prostate cancer and from 1.16% (95% CI 1.11-1.21) in the bottom decile to 30.48% (95% CI 28.87-32.09) in the top decile for kidney cancer. For both cancers, age and Black race were associated with increased odds of focal therapy (Table 2). The hospital-level odds of focal therapy for prostate and kidney cancer using unadjusted probabilities (observed proportions) were minimally correlated (Spearman's ρ = 0.21; p < 0.001).
Conclusions: Our analysis revealed a substantial discrepancy in the utilization of focal therapy across hospitals for prostate and kidney cancer. 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 existence of complex factors affecting the utilization of focal therapy, both at the hospital and healthcare system level.
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