Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer - Beyond the Abstract

Our recent study revealed the substantial variability in the adoption of focal therapy for localized prostate and kidney cancers across hospitals. Using data from the National Cancer Database, we observed that only 1.6% of prostate cancer and 6.3% of kidney cancer patients underwent focal therapy, with a wide range of adoption rates across institutions (from 0.13% to 32.17% for prostate cancer and from 1.16% to 30.48% for kidney cancer). This variance highlights significant disparities in treatment availability, likely influenced by hospital capabilities and geographical location.

We also discovered a weak correlation (Spearman’s ρ = 0.21; p<0.001) between the utilization of focal therapy for prostate versus kidney cancer within the same hospitals. This suggests that the decision to use focal therapy may be driven more by hospital-specific factors rather than a unified clinical strategy across urological malignancies. Factors such as the availability of technology and specialized personnel could play a critical role in the implementation of this treatment modality.

Moreover, certain demographic factors, such as age and race, and systemic issues like insurance coverage significantly may also impact the likelihood of patients receiving focal therapy. Hospitals in urban and technologically advanced regions may be more likely to provide such treatments, underscoring the influence of socio-economic and regional disparities.

Addressing these inconsistencies requires a comprehensive strategy aimed at standardizing focal therapy training, enhancing technological access, and expanding insurance coverage to reduce geographical and economic barriers. Such efforts could ensure that those who potentially may benefit from focal therapies have all treatment options available.

Written by: Zhiyu (Jason) Qian, MD, Division of Urological Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA

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