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Castration-res istant prostate cancer (CRPC) management currently comprises several different treatments. However, evidence is currently lacking in terms of their uptake in the real-world setting. This study aims to assess factors associated with utilization of CRPC treatments in Quebec.
The cohort selected patients dying of prostate cancer from January 2001 to June 2013 from the Quebec public healthcare insurance program databases based on reception of CRPC treatments. Multivariable logistic regression was used to identify patient and geographic factors associated with the use of specific CRPC treatments (chemotherapy, bone-targeted therapy, and palliative radiotherapy).
The study cohort consists of 2898 patients overall, of which 19% of patients received chemotherapy, 26% received bone-targeted therapy and 21% received palliative radiotherapy. Following multivariable adjustments, use of chemotherapy was associated with age (odds ratio (OR): 0.94; 95% confidence interval (CI): 0.92-0.95), previous local primary treatment (OR: 1.36; 95%CI: 1.11-1.66), and residing close to a university-affiliated hospital (OR: 2.02, 95%CI: 1.55-2.63). Concerning bone- targeted therapy use, older age (OR: 0.97; 95%CI: 0.96-0.99) was associated with decreased use. Use of palliative radiotherapy was associated with age (OR: 0.96; 95%CI: 0.95-0.97), and previous local primary treatment (OR: 1.52; 95%CI: 1.26-1.84). Additionally, patients receiving one type of CRPC treatment also likely received the other types of CRPC treatments (ORs ranging from 1.50 to 3.35, all p<0.05).
In our cohort, the type of initial primary treatment was associated with certain treatment patterns in CRPC. Older age is also associated with decreased use of chemotherapy, bone-targeted therapy and palliative radiation.