Declining brachytherapy utilization for high-risk prostate cancer-Can clinical pathways reverse the trend?

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• External beam radiation therapy (EBRT) plus brachytherapy boost (BB) improves biochemical progression-free survival by 20% for high-risk prostate cancer.
• Population studies indicate a declining utilization of BB despite its proven benefits.

Purpose of the Study:

• To evaluate the impact of a modified clinical pathway (CP) on the utilization of BB in high-risk prostate cancer.
• To identify factors influencing BB adoption after CP modification.

Main Methods:

• A retrospective review of 659 high-risk prostate cancer patients treated with EBRT ± BB across 19 sites.
• Analysis of practice patterns before and after CP modification in January 2016 using chi-squared tests.

Main Results:

• BB utilization increased from 25.2% to 45.4% after CP modification (p < 0.001).
• Significant increase in BB use among non-brachytherapist physicians (3.4% to 14.8%, p < 0.001).
• Physician preference was the primary reason for non-utilization (59.7%).

Conclusions:

• A modified CP successfully increased BB utilization for high-risk prostate cancer, particularly among non-brachytherapists.
• Physician preference remains a significant barrier to BB adoption.
• Novel strategies are required to overcome physician preference barriers and enhance BB use.