Active Surveillance for Prostate Cancer: Are Patients Being Lost to Follow-up?
Posted: Tuesday, November 6, 2018
Active surveillance of men with prostate cancer works to help prevent death from the disease—but only if the participating men actually participate. Examining records from 44 Michigan academic and community urology practices from 2011 to 2017, Kevin B. Ginsburg, MD, of Detroit’s Wayne State University School of Medicine, and colleagues found that about 10% of men assigned to active surveillance were lost to follow-up, meaning an 18-month period passed in which there was no notation of pertinent surveillance testing.
“African American men and generally unhealthy patients were at increased risk” of being lost to follow-up, the authors reported in European Urology. However, “patients of all races, ages, and Charlson Comorbidity Index [scores] are at risk for lost to follow-up,” they wrote.
In African American patients compared with those of other races, prostate cancers can be more aggressive and may present an increased risk of disease progression. In fact, clinicians should pay more diligent attention to surveillance schedules in general, “with increased emphasis placed on patients who are at a [statistically] higher risk for becoming lost to follow-up,” suggested Dr. Ginsburg and colleagues.
In 2017, the 44-practice collaborative adopted a system to alert participating practices when clinical information was not entered into the registry for a patient within 19 months of starting surveillance. “We are optimistic that this automated system will increase compliance with longitudinal monitoring and decrease rates of lost to follow-up.”