Pd01-02 Differences in Barriers and Facilitators to First-Line Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer Between Urologists and Oncologists: A Sub-Analysis of the Implement Study

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) I (PD01)1 May 2024PD01-02 DIFFERENCES IN BARRIERS AND FACILITATORS TO FIRST-LINE TREATMENT INTENSIFICATION IN METASTATIC CASTRATION-SENSITIVE PROSTATE CANCER BETWEEN UROLOGISTS AND ONCOLOGISTS: A SUB-ANALYSIS OF THE IMPLEMENT STUDY Stacy Loeb, Neeraj Agarwal, Nader El-Chaar, Laura de Ruiter, Janet Kim, Jesse Mack, Christopher Bland, Sarah Rich-Zendel, Jin Su Joo, and Judith Dyson Stacy LoebStacy Loeb , Neeraj AgarwalNeeraj Agarwal , Nader El-ChaarNader El-Chaar , Laura de RuiterLaura de Ruiter , Janet KimJanet Kim , Jesse MackJesse Mack , Christopher BlandChristopher Bland , Sarah Rich-ZendelSarah Rich-Zendel , Jin Su JooJin Su Joo , and Judith DysonJudith Dyson View All Author Informationhttps://doi.org/10.1097/01.JU.0001009540.33579.43.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite evidence of benefits and guidelines recommending first-line treatment intensification (TI) (androgen-deprivation therapy [ADT] with chemotherapy, novel hormonal therapies, or both) in metastatic castrate-sensitive prostate cancer (mCSPC), TI is used in only 13% and 37% of patients treated by urologists and oncologists, respectively. The IMPLEMENT study identified several barriers to TI, including knowledge gaps, costs, habit, and anticipated regret. The objective of this analysis was to examine differences in barriers and facilitators to TI between specialties. METHODS: We conducted double-blind, 1:1, semi-structured, web-based interviews with 18 urologists and 18 oncologists who manage mCSPC in the US, using an interview guide based on the Theoretical Domains Framework. Belief statements were coded into 11 domains of the framework and themes to identify barriers and facilitators, which were descriptively compared between urologists and oncologists. Differences in the frequency of belief statements were reported, with ≥20% considered notable, as previously established appropriate for an N=18 sample upper bound on a 90% binomial confidence interval. RESULTS: Within the domains identified to be strongly associated with TI, notable differences between specialties were found in Social/Professional Role and Identity, Beliefs about Consequences, Decision Processes, and Environmental Context and Resources (Table 1). No notable differences were detected in terms of Knowledge. CONCLUSIONS: Urologists and oncologists differed in their experience of barriers and facilitators to TI. Oncologists were more likely to report facilitators to TI, including ability to appropriately consider the impact of age and performance status on treatment, and having adequate clinical support, while indicating delayed urologist referral as a barrier. Urologists more commonly reported barriers to TI, including insufficient clinical support and habitually starting patients on ADT alone or with a first-generation anti-androgen, but reported a good collaboration with oncologists as a facilitator. Source of Funding: This study was funded by Astellas Pharma Inc. and Pfizer Inc., the co-developers of enzalutamide © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e62 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Stacy Loeb More articles by this author Neeraj Agarwal More articles by this author Nader El-Chaar More articles by this author Laura de Ruiter More articles by this author Janet Kim More articles by this author Jesse Mack More articles by this author Christopher Bland More articles by this author Sarah Rich-Zendel More articles by this author Jin Su Joo More articles by this author Judith Dyson More articles by this author Expand All Advertisement PDF downloadLoading ...