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Acta Oncologica Jubilee Article

Population-based study on use of chemotherapy in men with castration resistant prostate cancer

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Pages 1593-1601 | Received 06 Nov 2012, Accepted 09 Feb 2013, Published online: 21 Feb 2013
 

Abstract

Background. Chemotherapy prolongs life and relieves symptoms in men with castration resistant prostate cancer (CRPC). There is limited information on a population level on the use of chemotherapy for CRPC. Material and methods. To assess the use of chemotherapy in men with CRPC we conducted a register-based nationwide population-based study in Prostate Cancer data Base Sweden (PCBaSe) and a nationwide in-patient drug register (SALT database) between May 2009 and December 2010. We assumed that men who died of prostate cancer (PCa) underwent a period of CRPC before they died. Results. Among the 2677 men who died from PCa during the study inclusion period, 556 (21%) had received chemotherapy (intravenous or per oral) detectable within the observation period in SALT database. Specifically, 239 (61%) of men < 70 years had received chemotherapy, 246 (30%) of men between 70 and 79 years and 71 (5%) men older than 80 years. The majority of men 465/556 (84%) had received a docetaxel-containing regimen. Among chemotherapy treated men, 283/556 (51%) received their last dose of chemotherapy during the last six months prior to death. Treatment with chemotherapy was more common among men with little comorbidity and high educational level, as well as in men who had received curatively intended primary treatment. Conclusion. A majority of men younger than 70 years with CRPC were treated with chemotherapy in contrast to men between 70 and 79 years of whom half as many received chemotherapy. Chemotherapy treatment was often administered shortly prior to death. The low uptake of chemotherapy in older men with CRPC may be caused by concerns about tolerability of treatment, as well as treatment decisions based on chronological age rather than global health status.

Acknowledgements

This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden (NPCR Swe) steering group: Pär Stattin (chairman), Anders Widmark, Camilla Thellenberg, Ove Andrén, Anna Bill-Axelson, Ann-Sofi Fransson, Magnus Törnblom, Stefan Karlsson, Marie Hjälm- Eriksson, Bodil Westman, Bill Petersson, David Robinsson, Mats Andén, Jan-Erik Damber, Jonas Hugosson, Ingela Franck Lissbrant, Maria Nyberg, Göran Ahlgren, Ola Bratt, René Blom, Rolf Lundgren, Lars Egevad, Calle Waller, Jan-Erik Johansson, Olof Akre, Per Fransson, Eva Johansson, Fredrik Sandin, Hans Garmo, Mats Lambe, Karin Hellström, Erik Holmberg and Annette Wigertz. This study was supported by funding from Swedish Research Council 825-2010-5950.

Declaration of interest: The authors alone are responsible for the content and writing of the paper. Anders Widmark is working part time as medical advisor for Sanofi Oncology, Sweden and has received travel and lecture honorarium from Astellas. Ingela Franck Lissbrant, Hans Garmo and Pär Stattin have no conflicts of interest to declare.