El Sebaaly Ralph, Mansour Mazen, Labban Muhieddine, Jaafar Rola F, Armache Alexandre, Mukherji Deborah, El Hajj Albert
American University of Beirut Medical Center, Beirut, Lebanon.
Prostate Int. 2020 Mar;8(1):41-48. doi: 10.1016/j.prnil.2019.11.001. Epub 2019 Nov 30.
Prostate cancer is the most common cancer among Lebanese men. Management of prostate cancer includes medical, radiological, and surgical intervention. In addition, active surveillance (AS) is proven as a valid option in patients with low-risk prostate cancer. Currently, data from the Middle East about AS are scarce. The aim of this study is to assess the rate of implementation of AS by physicians, determine the selection and follow-up criteria used by physicians, and identify potential barriers to its widespread adoption.
After receiving ethical approval, a LimeSurvey electronic questionnaire was mailed to 206 eligible urologists, oncologists, and radiation oncologists registered in the order of physicians in Lebanon. The questionnaire included dichotomous, multiple choice questions, and multiple answer questions. The 23 questions tackled sociodemographic information, physician's attitude toward AS, and their current practices. Predictors of AS use were identified using the chi-squared and Fisher's exact test. Then, multivariate logistic regression model for the predictors of AS practice was conducted.
The response rate was 25%, and the analysis was run on 52 respondents. Although most of the respondents agreed that AS is a valid modality for low-risk prostate cancer, only 34 (65.4%) of them had patients on active surveillance. The rate of patients on AS was also very low. Urologists, physicians with >15 years of experience, and those who practiced in a university hospital were all predictors of AS usage ( = 0.005; = 0.002; = 0.025, respectively). However, physicians with fear of patient noncompliance had the odds of resorting to this modality [odds ratio (OR) = 0.07 (0.01 - 0.76)].
The main obstacles to implementing AS were fear of patient noncompliance and lack of national awareness as well as acceptance among the Lebanese uro-oncological body. Efforts to decentralize knowledge and expertize to new health-care practitioners and community hospitals would encourage its implementation.
前列腺癌是黎巴嫩男性中最常见的癌症。前列腺癌的治疗包括药物、放射和手术干预。此外，主动监测（AS）已被证明是低风险前列腺癌患者的一种有效选择。目前，中东地区关于主动监测的数据很少。本研究的目的是评估医生实施主动监测的比例，确定医生使用的选择和随访标准，并找出其广泛应用的潜在障碍。
获得伦理批准后，通过LimeSurvey电子问卷向黎巴嫩按医生顺序注册的206名合格泌尿科医生、肿瘤内科医生和放射肿瘤内科医生发送问卷。问卷包括二分法、多项选择题和多项答案题。这23个问题涉及社会人口统计学信息、医生对主动监测的态度及其当前做法。使用卡方检验和费舍尔精确检验确定主动监测使用的预测因素。然后，对主动监测实践的预测因素进行多变量逻辑回归模型分析。
回复率为25%，对52名受访者进行了分析。尽管大多数受访者同意主动监测是低风险前列腺癌的一种有效方式，但其中只有34人（65.4%）有患者接受主动监测。接受主动监测的患者比例也非常低。泌尿科医生、有超过15年经验的医生以及在大学医院执业的医生都是主动监测使用的预测因素（分别为P = 0.005；P = 0.002；P = 0.025）。然而，担心患者不依从的医生采用这种方式的几率较低[比值比（OR）= 0.07（0.01 - 0.76）]。
实施主动监测的主要障碍是担心患者不依从、缺乏全国性认识以及黎巴嫩泌尿肿瘤学界的接受度。将知识和专业技能分散到新的医疗从业者和社区医院的努力将鼓励其实施。
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