Defining and Measuring Adherence in Observational Studies Assessing Outcomes of Real-world Active Surveillance for Prostate Cancer: A Systematic Review

doi:10.1016/j.euo.2019.06.009

Review

. 2021 Apr;4(2):192-201.

doi: 10.1016/j.euo.2019.06.009. Epub 2019 Jul 6.

Defining and Measuring Adherence in Observational Studies Assessing Outcomes of Real-world Active Surveillance for Prostate Cancer: A Systematic Review

Glenda Kith¹, Sarah Lisker², Urmimala Sarkar², Jill Barr-Walker³, Benjamin N Breyer⁴, Nynikka R Palmer⁵

Affiliations

¹ San Francisco Department of Public Health, San Francisco, CA, USA; Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA.
² Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, University of California, San Francisco, CA, USA.
³ ZSFG Library, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA.
⁴ Department of Urology, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
⁵ Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, University of California, San Francisco, CA, USA; Department of Urology, University of California, San Francisco, CA, USA. Electronic address: Nynikka.Palmer@ucsf.edu.

PMID: 31288992
PMCID: PMC6943197
DOI: 10.1016/j.euo.2019.06.009

Review

Defining and Measuring Adherence in Observational Studies Assessing Outcomes of Real-world Active Surveillance for Prostate Cancer: A Systematic Review

Glenda Kith et al. Eur Urol Oncol. 2021 Apr.

. 2021 Apr;4(2):192-201.

doi: 10.1016/j.euo.2019.06.009. Epub 2019 Jul 6.

Authors

Glenda Kith¹, Sarah Lisker², Urmimala Sarkar², Jill Barr-Walker³, Benjamin N Breyer⁴, Nynikka R Palmer⁵

Affiliations

¹ San Francisco Department of Public Health, San Francisco, CA, USA; Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA.
² Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, University of California, San Francisco, CA, USA.
³ ZSFG Library, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA.
⁴ Department of Urology, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
⁵ Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, University of California, San Francisco, CA, USA; Department of Urology, University of California, San Francisco, CA, USA. Electronic address: Nynikka.Palmer@ucsf.edu.

PMID: 31288992
PMCID: PMC6943197
DOI: 10.1016/j.euo.2019.06.009

Abstract

Context: Evidence-based guidelines for active surveillance (AS), a treatment option for men with low-risk prostate cancer, recommend regular follow-up at periodic intervals to monitor disease progression. However, gaps in monitoring can lead to delayed detection of cancer progression, leading to a missed window of curability.

Objective: We aimed to identify the extent to which real-world observational studies reported adherence to monitoring protocols among prostate cancer patients on AS. When reported, we sought to characterize definitions of adherence.

Evidence acquisition: We systematically reviewed observational studies assessing outcomes of prostate cancer patients on AS, published before March 22, 2019 in PubMed, Embase, and CENTRAL. Adherence definitions were considered time bound if they included prespecified time and binary if adherence was assessed but did not specify a time interval. We assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.

Evidence synthesis: Forty-five studies met our inclusion criteria. Eleven studies did not report any data on adherence to AS protocols. Twenty-five studies did not explicitly measure adherence, but provided relevant data (eg, number of patients who received a repeat biopsy). Six studies reported adherence using a time-bound definition, while three studies used a binary definition. Twenty-three studies provided information on patients lost to follow-up.

Conclusions: Most studies reporting outcomes of patients on AS did not measure or report adherence. When reported, adherence was often not time specific. As some AS patients will benefit from maintaining a window of curability, clinical practices and future studies should track and report adherence and associated factors.

Patient summary: We reviewed real-world observational studies examining outcomes of prostate cancer patients on active surveillance. Most studies did not clearly define or report adherence to monitoring protocols, which is important to consider for appropriate disease management.

Keywords: Ambulatory; Clinical protocols; Guideline adherence; Monitoring; Patient safety; Prostatic neoplasms.

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Conflict of interest statement

Conflict of Interest Disclosures: None.

Figures

**Figure 2:**
Flow diagram categorizing included studies

See this image and copyright information in PMC

Comment in

Adherence to Active Surveillance Protocols: Well Meant but Overconcerned?
van den Bergh RCN, van Leeuwen PJ. van den Bergh RCN, et al. Eur Urol Oncol. 2021 Apr;4(2):202-203. doi: 10.1016/j.euo.2019.07.016. Epub 2019 Sep 27. Eur Urol Oncol. 2021. PMID: 31570269 No abstract available.

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References

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. doi:10.3322/caac.21442 - DOI - PubMed
1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–386. doi:10.1002/ijc.29210 - DOI - PubMed
1. Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter. N Engl J Med. 2004;350(22):2239–2246. doi:10.1056/NEJMoa031918 - DOI - PubMed
1. Mohler J, Antonarakis E, Armstrong A, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate Cancer. National Comprehensive Cancer Network; 2019.
1. Final Recommendation Statement: Prostate Cancer: Screening - US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati.... Accessed June 15, 2018.

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[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. doi:10.3322/caac.21442 - DOI - PubMed

[2] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7–30. doi:10.3322/caac.21442 - DOI - PubMed

[3] Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–386. doi:10.1002/ijc.29210 - DOI - PubMed

[4] Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–386. doi:10.1002/ijc.29210 - DOI - PubMed

[5] Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter. N Engl J Med. 2004;350(22):2239–2246. doi:10.1056/NEJMoa031918 - DOI - PubMed

[6] Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter. N Engl J Med. 2004;350(22):2239–2246. doi:10.1056/NEJMoa031918 - DOI - PubMed

[7] Mohler J, Antonarakis E, Armstrong A, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate Cancer. National Comprehensive Cancer Network; 2019.

[8] Mohler J, Antonarakis E, Armstrong A, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Prostate Cancer. National Comprehensive Cancer Network; 2019.

[9] Final Recommendation Statement: Prostate Cancer: Screening - US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati.... Accessed June 15, 2018.

[10] Final Recommendation Statement: Prostate Cancer: Screening - US Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati.... Accessed June 15, 2018.

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Defining and Measuring Adherence in Observational Studies Assessing Outcomes of Real-world Active Surveillance for Prostate Cancer: A Systematic Review

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Defining and Measuring Adherence in Observational Studies Assessing Outcomes of Real-world Active Surveillance for Prostate Cancer: A Systematic Review

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