Exploration of first line treatment patterns in metastatic castration sensitive prostate cancer at a rural community-based health system.

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173 Background: In metastatic castrate sensitive prostate cancer (mCSPC), treatment intensification with docetaxel, novel hormone therapies (NHTs), or both, have shown to improve overall survival compared to androgen depravation therapy. Despite these benefits, real world evidence suggests that adaptation of treatment intensification is suboptimal. We aimed to explore treatment pattern trends of mCSPC patients at a rural community-based medical center and compare these trends to state, regional, and national benchmarks. A secondary aim was to investigate whether patient social determinants of health (SDOH), such as rural versus urban residence, predict a lack of treatment intensification. Methods: This study was a retrospective observational analysis at a rural community-based medical center focusing on patients diagnosed with mCSPC over a five-year period from January 1,2018, to December 31, 2022. Primary outcome was the proportion of patients who received treatment intensification, defined as the use of NHT, chemotherapy, or a combination of both, as part of their first-line treatment regimen. Data was retrieved from the Electronic Medical Record. National, regional, and state treatment pattern estimates were leveraged using IQVIA Anonymized Patient Longitudinal Data, a dataset of fully adjudicated pharmacy and medical claims. Results: Over the study period, the percentage of mCSPC patients receiving first-line treatment intensification demonstrated variability. On an institutional level, we saw an increase in patients treated with an intensified regimen from 60% to 80%. These trends highlight both challenges and successes in implementing treatment intensification in a rural setting, with a return to high adoption rates in the latter part of the study period. Comparing our institutional rates to state and national benchmarks, our institution consistently outperformed South Dakota (p < 0.05), indicating a statistically significant difference. No statistically significant difference was observed in comparison to Midwest (p = 0.5) and national benchmarks (p = 0.3). These findings suggest that our practices are well-aligned with national and regional standards while significantly surpassing state-level performance. However, a logistic regression analysis showed no significant association between rural-urban residence and treatment intensification. This suggests that other factors may have a stronger influence on treatment decisions. Conclusions: This study demonstrates that health systems can deliver effective cancer care that meets or exceeds national standards for all patients, while also highlighting the need for a nuanced understanding of SDOH influences on treatment patterns. Efforts to optimize cancer care delivery must consider both systemic and individual-level barriers to ensure equitable outcomes for all patients.

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