Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow‐up survey of Australia‐based urologists

Brown, Bernadette; Egger, Sam; Young, Jane; Kneebone, Andrew; Brooks, Andrew J.; Dominello, Amanda; Haines, Mary

doi:10.1111/1754-9485.12483

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…The differences between specialty groups regarding the use and timing of post-prostatectomy RT is consistent with previous Australian and North American surveys which demonstrated low rates of referral to ROs for high-risk patients in the 6 months following RP, and greater hesitancy amongst urologists than ROs to recommend adjuvant RT in a variety of hypothetical scenarios. [9][10][11][12] Of note, these patterns of practice surveys were conducted prior to the recent publication of several large, randomised trials supporting the oncological efficacy of early salvage RT over immediate adjuvant RT. The reasons for these low rates of referrals may include selection and referral biases, patient-related factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Patterns of practice regarding use of radiation therapy following radical prostatectomy: A survey of Radiation Oncologists and Urologists in Australia and New Zealand

et al. 2023

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IntroductionThis study aimed to investigate the patterns of practices of radiation oncologists (ROs) and urologists in Australia and New Zealand with respect to the utilisation of post‐prostatectomy radiation therapy (RT) and help guide the development of an update to the existing Faculty of Radiation Oncology Genito‐Urinary Group post‐prostatectomy guidelines.MethodsROs and urologists with subspecialty practice in prostate cancer from Australia and New Zealand were invited to participate in an online survey comprised of clinical scenarios regarding post‐prostatectomy RT.ResultsSixty‐five ROs and 28 urologists responded to the survey. In the setting of low‐risk biochemical relapse, the threshold for initiating RT was lower for ROs than urologists. ROs were more likely than urologists to recommend adjuvant RT for node‐positive disease. When salvage RT was advised for a pT3N0R1 recurrence, there was no consensus amongst ROs on whether to add either ADT or nodal treatment over prostate bed RT alone. For a solitary PSMA‐avid pelvic lymph node recurrence, whole pelvis RT with androgen deprivation therapy was the preferred treatment option (72% ROs, 43% urologists). Most ROs (92%) recommended conventionally fractionated RT to 66–70 Gy, with a boost to any PSMA PET avid recurrent disease.ConclusionThis survey highlights the marked discordance in practice for the management of prostate cancer relapse post‐prostatectomy. This is seen not only between specialties but also within the radiation oncology community. This emphasises the need for an updated evidence‐based guideline to be produced.

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Section: Discussionmentioning

confidence: 99%

Patterns of practice regarding use of radiation therapy following radical prostatectomy: A survey of Radiation Oncologists and Urologists in Australia and New Zealand

et al. 2023

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“…Evidence of urologists’ scepticism of adjuvant radiotherapy’s benefits can be found in a 2012 survey of 157 Australian urologists in which only about half of the respondents agreed with the proposition that guideline‐recommended adjuvant radiotherapy is based on a valid interpretation of the underpinning evidence . Agreement with this proposition was subsequently found to be even lower in a 2015 follow‐up survey . With regard to radiation oncologists, the results of two US surveys comparing radiation oncologists’ and urologists’ attitudes towards adjuvant radiotherapy are informative .…”

Section: Discussionmentioning

confidence: 99%

Urologists’ referral and radiation oncologists’ treatment patterns regarding high‐risk prostate cancer patients receiving radiotherapy within 6 months after radical prostatectomy: A prospective cohort analysis

et al. 2019

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Introduction Previous studies have observed low rates of adjuvant radiotherapy after radical prostatectomy (RP) for high‐risk prostate cancer patients. However, it is not clear the extent to which these low rates are driven by urologists’ referral and radiation oncologists’ treatment patterns. Method The Clinician‐Led Improvement in Cancer Care (CLICC) implementation trial was conducted in nine public hospitals in New South Wales, Australia. Men who underwent RP for prostate cancer during 2013–2015 and had at least one high‐risk pathological feature of extracapsular extension, seminal vesicle invasion and/or positive surgical margins were included in these analyses. Outcomes were as follows: (i) referral to a radiation oncologist within 4 months after RP (‘referred’); (ii) commencement of radiotherapy within 6 months after RP among those who consulted a radiation oncologist (‘radiotherapy after consultation’). Results Three hundred and twenty‐five (30%) of 1071 patients were ‘referred’, and 74 (61%) of 121 patients received ‘radiotherapy after consultation’. Overall, the probability of receiving radiotherapy within 6 months after RP was 15%. The probability of being ‘referred’ increased according to higher 5‐year risk of cancer‐recurrence (P < 0.001). Conclusion Only 30% of patients with high‐risk features are referred to a radiation oncologist with the likelihood of referral being influenced by the perceived risk of cancer‐recurrence as well as the urologist’s institutional/personal preference. When patients are seen by a radiation oncologist, 61% receive radiotherapy within 6 months after RP with the likelihood of receiving radiotherapy not being heavily influenced by increasing risk of recurrence. This suggests many suitable patients would receive radiotherapy if referred and seen by a radiation oncologist.

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What Promotes Surgeon Practice Change? A Scoping Review of Innovation Adoption in Surgical Practice

et al. 2020

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Objective: The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. Background: In an era of accelerated innovations, surgeons face the difficult decision to either acknowledge and implement or forgo new advances. Although changing surgical practice to align with evidence is an imperative of health systems, evidence-based guidelines have not translated into consistent change. The literature on practice change is limited and has largely focused on synthesizing information on methods and trials to evaluate innovative surgical interventions. No reviews to date have grounded their analysis within an implementation science framework. Methods: A systematic review of the literature on surgical practice change was performed. Abstracts and full-text articles were reviewed for relevance using inclusion and exclusion criteria and data were extracted from each article. Cited facilitators and barriers were then mapped across domains within the implementation science Theoretical Domains Framework and expanded to the Capability, Opportunity, Motivation, and Behavior model. Results: Components of the Capability, Opportunity, Motivation, and Behavior model were represented across the Theoretical Domains Framework domains and acted as both facilitators and barriers to practice change depending on the circumstances. Domains that most affected surgical practice change, in order, were: opportunity (environmental context and resources and social influences), capability (knowledge and skills), and motivation (beliefs about consequences and reinforcement). Conclusions: Practice change is predicated on a conducive environment with adequate resources, but once that is established, the surgeon's individual characteristics, including skills, motivation, and reinforcement determine the likelihood of successful change. Deficiencies in the literature underscore the need for further study of resource interventions and the role of surgical team dynamics in the adoption of innovation. A better understanding of these areas is needed to optimize our ability to disseminate and implement best practices in surgery.

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Changing attitudes towards management of men with locally advanced prostate cancer following radical prostatectomy: A follow‐up survey of Australia‐based urologists

Cited by 4 publications

References 34 publications

Patterns of practice regarding use of radiation therapy following radical prostatectomy: A survey of Radiation Oncologists and Urologists in Australia and New Zealand

Patterns of practice regarding use of radiation therapy following radical prostatectomy: A survey of Radiation Oncologists and Urologists in Australia and New Zealand

Urologists’ referral and radiation oncologists’ treatment patterns regarding high‐risk prostate cancer patients receiving radiotherapy within 6 months after radical prostatectomy: A prospective cohort analysis

What Promotes Surgeon Practice Change? A Scoping Review of Innovation Adoption in Surgical Practice

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