Estimating the Impact of Randomised Control Trial Results on Clinical Practice: Results from a Survey and Modelling Study of Androgen Deprivation Therapy plus Radiotherapy for Locally Advanced Prostate Cancer

Annabelle South; Wendy R Parulekar; Matthew R Sydes; Bingshu E Chen; Mahesh K Parmar; Noel Clarke; Padraig Warde; Malcolm Mason

doi:10.1016/j.euf.2015.11.004

Estimating the Impact of Randomised Control Trial Results on Clinical Practice: Results from a Survey and Modelling Study of Androgen Deprivation Therapy plus Radiotherapy for Locally Advanced Prostate Cancer

Eur Urol Focus. 2016 Aug;2(3):276-283. doi: 10.1016/j.euf.2015.11.004.

Authors

Annabelle South¹, Wendy R Parulekar², Matthew R Sydes³, Bingshu E Chen², Mahesh K Parmar³, Noel Clarke⁴, Padraig Warde⁵, Malcolm Mason⁶

Affiliations

¹ Medical Research Council Clinical Trials Unit, University College London, London, UK. Electronic address: a.south@ucl.ac.uk.
² NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada.
³ Medical Research Council Clinical Trials Unit, University College London, London, UK.
⁴ Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.
⁵ Princess Margaret Hospital, Toronto, ON, Canada.
⁶ Cardiff University School of Medicine, Cardiff, UK.

Abstract

Background: Recent trials have shown that the addition of external beam radiotherapy (EBRT) to androgen deprivation therapy (ADT) improves survival among men with locally advanced prostate cancer.

Objective: To examine the potential impact of these trials on changes in clinical practice and life-years saved.

Design setting and participants: A model was developed to examine the impact of changes in clinical practice in the UK. A survey of clinicians who treat men with prostate cancer in the UK and Canada was performed.

Measurements: Outcomes of interest were the proportion of patients treated with different approaches and the predicted number of life-years saved due to changes in clinical practice. Survey data were cross-tabulated and Pearson's χ² tests were applied.

Results and limitations: The survey was completed by 193 clinicians (105 from the UK, 80 from Canada), of whom 70% were clinical/radiation oncologists, 8% were medical oncologists, and 15% were urologists. UK respondents were more likely to report a change in practice in response to the results (44% UK vs 21% Canada). Canadians were more likely to have already been using ADT plus radiotherapy (77% Canada vs 56% UK). The increase in the proportion of patients in the UK treated with ADT + EBRT could result in around 3730-5177 extra life-years at 15 yr from a cohort of 7930 men diagnosed in a single calendar year, compared to if all had been treated with ADT alone.

Conclusions: Trial findings have changed clinical practice, meaning that men with locally advanced prostate cancer are likely to survive longer.

Patient summary: Doctors in the UK have changed practice in response to evidence on the superiority of hormone therapy plus radiotherapy to hormone therapy alone. These changes will improve the survival of men with locally advanced prostate cancer. Further reductions in the use of hormone therapy alone could further improve survival.

Keywords: Androgen deprivation therapy; Clinical practice; External beam radiotherapy; Impact; Knowledge translation; Prostate cancer.

Grants and funding

MC_UU_12023/28/MRC_/Medical Research Council/United Kingdom