Increasing access to fertility preservation for women with breast cancer: protocol for a stepped-wedge cluster randomized trial in France.

BACKGROUND: With the increase in the number of long-term survivors, interest is shifting from cancer survival to life and quality of life after cancer. These include consequences of long-term side effects of treatment, such as gonadotoxicity. Fertility preservation is becoming increasingly important in cancer management. International recommendations agree on the need to inform patients prior to treatments about the risk of fertility impairment and refer them to specialized centers to discuss fertility preservation. However, the literature reveals suboptimal access to fertility preservation on an international scale, and particularly in France, making information for patients and oncologists a potential lever for action. Our overall goal is to improve access to fertility preservation consultations for women with breast cancer through the development and evaluation of a combined intervention targeting the access and diffusion of information for these patients and brief training for oncologists. METHODS: Firstly, we will improve existing information tools and create brief training content for oncologists using a qualitative, iterative, user-centred and participatory approach (objective 1). We will then use these tools in a combined intervention to conduct a stepped-wedge cluster randomized trial (objective 2) including 750 women aged 18 to 40 newly treated with chemotherapy for breast cancer at one of the 6 participating centers. As the primary outcome of the trial will be the access to fertility preservation counselling before and after using the combined intervention (brochures and brief training for oncologists), we will compare the rate of fertility preservation consultations between the usual care and intervention phases using linear regression models. Finally, we will analyse our approach using a context-sensitive implementation analysis and provide key elements for transferability to other contexts in France (objective 3). DISCUSSION: We expect to observe an increase in access to fertility preservation consultations as a result of the combined intervention. Particular attention will be paid to the effect of this intervention on socially disadvantaged women, who are known to be at greater risk of inappropriate treatment. The user-centred design principles and participatory approaches used to optimize the acceptability, usability and feasibility of the combined intervention will likely enhance its impact, diffusion and sustainability. TRIAL REGISTRATION: Registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT05989776. Date of registration: 7th September 2023. URL: https://classic. CLINICALTRIALS: gov/ct2/show/NCT05989776 . PROTOCOL VERSION: Manuscript based on study protocol version 2.0, 21st may 2023.

The stake of informing patients of the risk of hypofertility after chemotherapy for breast cancer.

Introduction: Too few women with invasive breast cancer are informed of the risk of hypofertility after chemotherapy. However, this risk can be prevented by offering gamete preservation by a specialized team. We believe that if more women were informed about gamete preservation, more of them would accept it. Objectives: The primary objective is to describe each step of the oncofertility care pathway from provision of information to gamete preservation. The secondary objective is to estimate the impact of not receiving information by determining the proportion of women who would have undergone gamete preservation if they had been informed. Method: 575 women aged 18-40 years treated with chemotherapy for breast cancer between 2012 and 2017 in the Ouest-Occitanie region (~3 million inhabitants) were included. We first constructed a multivariate predictive model to determine the parameters influencing the uptake of the offer of gamete preservation among women who were informed and then applied it to the population of uninformed women. Results: Only 39% of women were informed of the risks of hypofertility related to chemotherapy and 11% ultimately received gamete preservation. If all had been informed of the risk, our model predicted an increase in gamete preservation of 15.35% in the youngest women (<30 years), 22.88% in women aged between 30 and 35 years and zero in those aged ≥36 years. We did not find any association with the European Deprivation Index (EDI). Conclusion: Oncologists should be aware of the need to inform patients aged ≤ 35 years about gamete preservation. If all received such information, the impact in terms of gamete preservation would likely be major.

Access to information and oncofertility consultation for young women with breast cancer: a population-based study.

Non-menopausal women with breast cancer treated with chemotherapy are at intermediate risk of post-treatment amenorrhea and decreased fertility. Although they should receive appropriate information, studies until now show that this is inadequate. We investigated the proportion of women who received information about this risk during the pre-treatment consultation, and those who received an oncofertility consultation to preserve their gametes. We also analysed the medical and non-medical factors influencing the transmission of information to patients and their uptake of oncofertility consultations. We included women aged 18-40 years treated with chemotherapy for breast cancer between 2012 and 2017 in the Midi-Pyrénées region (ca. 3 million inhabitants), France. Studied variables were included in a multilevel model. Among the 575 women, 41% of the women received information and 28% received an oncofertility consultation. These two steps on the care pathway were significantly influenced by the type of care structure, the woman's age, her parity at the time of diagnosis, and the metastatic status of the cancer. Female oncologist gender was significantly associated with higher transmission rate. We found no association between neoadjuvant chemotherapy status, level of deprivation (EDI), triple-negative status, marital status, and first-degree family history of cancer and information transmission or uptake of oncofertility consultation. Our study shows that not enough women are informed and have recourse to an oncofertility consultation. Despite a legal obligation, the health care system does not offer the necessary conditions for access to oncofertility care.

Treatment time interval in breast cancer: A population-based study on the impact of type and number of cancer centres attended.

OBJECTIVES: We studied both the independent and combined effects of the places of biopsy and treatment on the treatment time interval based on a population-based study. METHODS: We analysed the proportion of patients having a treatment time interval higher than the EUSOMA recommendation of 6 weeks, as a function of the number and the type of care centres the patients attended, from a French population-based regional cohort of women treated in 2015 for an incident invasive non-metastatic cancer (n = 505). RESULTS: About 33% [95% CI: 27; 38] of patients had a treatment time interval higher than 6 weeks. About 48% of the patients underwent their biopsy and their initial treatment in the different centres. Results from multivariable analyses supported the impact of the type and number of centres attended on the proportion of time intervals over 6 weeks. This proportion was higher among patients with biopsy and treatment in different centres and among patients treated in a university hospital. CONCLUSION: We pointed out the independent impact of the type and the number of care centres the patients attended, from biopsy to first treatment, on the treatment time interval, which is a well-known prognosis factor.

[Rethinking the management of elderly cancer patients : Proposals from the Age Cancer Priorities French Group]. / Repenser la prise en charge des sujets âgés atteints d'un cancer : propositions du groupe Priorités Âge Cancer.

The growing incidence of cancer associated with an aging population implies important health challenges that require questioning on the care management of older adults with cancer. There is a need to rethink the care management of older cancer patients with patient-centered decisions and an adjustment of the care pathway for this population. The Priorities Age Cancer (PAC) French group, made up of physicians, pharmacists and researchers in geriatric oncology, set up proposals to answer this need. First, the heterogeneity and the specificities of older adults as well as their preferences regarding cancer treatment goals, care management decisions must be patient-centered. The frailty screening tools should be generalized in clinical practice to provide geriatric assessment-guided recommendations and help for treatment decisions, and patients' involvement and shared decision should be developed. Second, older adults with cancer confront a complex health care system that demands a high level of health literacy. The caregivers, playing an essential role, may not be prepared for all these challenges. Thus, there is a need to promote health literacy by patient education, and patient-experts should be involved in health pathway. Third, there is a need to deal with dedicated partners and adjust the care pathway. New pathway careers as case-management nurses and specialized pharmacists should be involved in patient care and may play a central role together with other careers. Community-Hospital coordination should also be reinforced.

Adapting patients' oncological treatment through remote participation of general practitioners in multi-disciplinary consultation meetings: A feasibility study.

BACKGROUND: The general practitioner (GP) is central to managing patients with cancer, whose numbers are increasing worldwide. The GP's involvement requires better coordination between involved partners, in particular oncologists and GPs. OBJECTIVES: To conduct a feasibility study of remote participation of GPs in multi-disciplinary consultation meetings (MCMs). We analysed participation, participants' satisfaction, and their impact on therapeutic decisions. METHODS: We conducted a feasibility study in the regional cancer centre of Toulouse, France. All patient cases discussed in the MCMs for myelodysplasia from 1 January to 31 March 2016 were included. Cases of patients aged over 18 years, with a diagnosis of myelodysplasia and registered with a GP were included if patients gave informed consent. One investigator collected the data provided by GPs during three telephone or video calls: before, during, and after the MCM, respectively. RESULTS: Of 86 patient cases discussed during three months of MCMs, 44 were eligible for GP participation; 27 GPs participated in discussions of 27 patient cases. The GP's participation in the MCM led to a change in management in five cases, with four times treatment intensifications and once de-intensification. Medical, social, family-related, and psychological domains were discussed with input from the GPs. Overall, all participants were satisfied with the MCMs. CONCLUSION: Remote participation of GPs in MCMs is feasible and may result in adapting oncological and haematological management for patients. This patient-centred approach requires a specific organisation that, when implemented, satisfies the needs of all participants.

Spreading geriatric oncology culture through professional caregivers: Results of a French massive open online course (MOOC).

Geriatric oncology is based on the synergy between several professionals whose common goal is to improve care for older patients with cancer. This requires sharing a common core of knowledge to facilitate collaboration between them. To date, training in geriatric oncology has been limited in scope and difficult to access for caregivers, particularly nurses and healthcare aides. To meet this need, a massive open online course (MOOC), in geriatric oncology has been developed in France. This kind of course aims to provide simultaneous access for a large number of participants and to foster communication with the pedagogical team through discussion forums. The first session of the MOOC, which has been set up in the Occitania region of France, went online nationwide from March 6 to June 23, 2020. Despite the SARS CoV-2 global health crisis, 1020 people subscribed to the first session and 417 (40.9%) were certified at the end of the course. Most are nurses (35.2%) and work outside Occitania (56.3%). A survey revealed a high satisfaction level regarding relevance of lessons (97.9%), pedagogical quality of teaching team (97.9%), knowledge acquisition (93.6%), meeting learners' needs (90.4%) and practical value of the course (88.3%). This preliminary experience demonstrates the ability of this MOOC to spread the culture of geriatric oncology and the educational potential of this new type of online training.

How does comorbidity affect colon cancer patients' care trajectory? Results from the French EvaCCoR cohort study.

OBJECTIVE: Due to their advanced age in average, colon cancer patients are likely to be exposed to comorbidity. However, the influence of comorbidity on patients' care trajectory and survival is largely under-explored. Hence, we investigate the effect of comorbidity on patients care trajectory and survival based on an observational study in "real-life" setting. METHODS: This prospective observational study in two French regions includes patients aged over 18 and firstly treated for a colon cancer, stage II and III, diagnosed between 1st January and 31st December 2010. We assessed the influence of comorbidity (severe vs moderate or none), using the Charlson Comorbidity Index, on overall survival and patients' management steps. RESULTS: We analyzed 762 patients. We found comorbidity to be associated with adjuvant treatment delivery with a longer delay between surgery and chemotherapy initiation among patients with severe comorbidity. Severe comorbidity had an independent detrimental effect on overall survival that is slightly downsized after adjustment for adjuvant treatment delivery. CONCLUSION: Using observational "real-life" data, we showed that comorbidity impacts the colon cancer patients' care trajectory directly but also through indirect pathways involving adjuvant chemotherapy delivery. However, further studies are needed to better understand this mechanism.

Management of colon cancer patients: A comprehensive analysis of the absence of multidisciplinary team meetings in two French departments.

BACKGROUND: The care management of colorectal cancers has evolved, particularly since the implementation of multidisciplinary team meetings (MDTm). The aim of this study was to identify factors associated with the non-presentation of colon cancer patients in MDTm (no-MDTm) and to assess the association between no-MDTm and the diagnostic and therapeutic care management, in two areas in France, in 2010. METHODS: Patients over 18 years diagnosed for invasive colon cancer in Gironde and Tarn during 2010 were included from the cancer registries of these two departments. We used five indicators to evaluate the care management of colon cancer patients (about diagnosis, treatment and selection of patients for chemotherapy). RESULTS: No-MDTm patients were more likely to die early after diagnosis (OR=2.94, 95% CI=[1.52-5.66]). Elderly patients and those living in more disadvantaged areas were less often presented in MDTm (OR≥85years=2.10, 95% CI=[1.06-4.18]; OREDIQ4-Q5=1.96, 95% CI=[1.23-3.14]). After adjusting for patient-related variables (age, comorbidities, deprivation) and tumor (stage at diagnosis), we found that thoracic CT scan was less often performed among no-MDTm patients (OR=0.40, 95% CI=[0.24-0.65]). There was no association between the absence of MDTm and the therapeutic care management indicators. CONCLUSION: In conclusion, therapeutic care management was not associated with the absence of MDTm but with patient and tumor characteristics, including age, comorbidities and level of deprivation, that influence the non-presentation in MDTm.

[Regional cancers networks, collaborative work in adults and pediatricians]. / Réseaux régionaux en cancérologie, collaboration équipes adulte et pédiatrique.

Regional cancer networks missions have been defined by successive "Plan Cancer" and are focused on coordination and the safety and quality of care. Regional pediatric oncology networks, considering the specific care pathways, have these same coordination missions. The examples of partnership of the oncoped-PL (Pays de Loire) and oncomip (Occitanie) networks are successful collaboration models.

[COVID-19 impact on the cancer care structuration: Example of the multidisciplinary team meeting dedicated to oncology in Occitanie]. / Impact du SARS-CoV2 sur la structuration de la prise en charge du cancer : exemple de la tenue des RCP de cancérologie en Occitanie.

This work examines the impact of the SARS-CoV2 epidemic and the organizational recommendations that have been issued since March 16 on tumor boards (TB) activity. The tumor board activity was measured from tumor board sheets extracted from the oncologic electronic file between January 7, 2019 and April 24, 2020. The pre-containment activity was compared to the activity of the containment periods but also to the equivalent periods in 2019. The number of meetings held, the average number of files reviewed per meeting including first presentations and the average number of physicians' attendance were the evaluation criteria. The study covered 191 TB that held 3943 multidisciplinary team meetings (MTM) and reviewed 72,070 files (including 30,127 first submissions). There was a moderate decrease of 8 % in the number of meetings after March 16, 2020. The number of files examined decreased by 23 % in the following month and even more by 33 % in the third period. The physicians' number who attended MTM also decreased by 25 %. The negative impact was higher in the Mediterranean part of the region. This first study of tumor board activity, covering a large region but little affected by the pandemic, shows that its impact on the participation to the MTM has been moderate. In addition, tumor boards have followed the recommendations for optimizing quorum. However, the decrease in average MTM activity, particularly for first submissions, suggests a potential delay in patient management. Complementary qualitative and quantitative works are warranted to estimate the real impact on carcinologic outcomes.

Outcomes of patients with Goodpasture syndrome: A nationwide cohort-based study from the French Society of Hemapheresis.

The overall and renal outcomes of patients with Goodpasture syndrome (GS), a rare autoimmune disorder characterized by circulating anti-GBM antibodies and rapidly progressive glomerulonephritis and/or pulmonary hemorrhage, have mostly been reported in small-sized cohorts or by aggregating patients receiving a variety of therapies that include aggressive (i.e., combined plasma exchanges, corticosteroids, and cyclophosphamide) and less aggressive (i.e., either plasma exchanges or immunosuppressive drugs, or no treatment). To address the prognosis of GS patients with relatively homogeneous management including plasma exchanges, we conducted a multicenter retrospective study on GS patients included in the registry of the French Society of Hemapheresis. 122 patients were included (kidney alone (n = 28), lung alone (n = 5), or combined involvement (n = 89)). All 122 patients received plasma exchanges (median number of sessions: 13 [9-17]), either alone (n = 8) or associated with combined corticosteroids and oral or IV cyclophosphamide (n = 101) or with corticosteroids alone (n = 12) or cyclophosphamide alone (n = 2). One-year survival was 86.9%. 7/16 patients died from severe infection. In multivariate analyses (Cox's regression model), being aged <60 years, and number of plasma exchanges were correlated to overall survival. The use of alternative immunosuppressive drugs (because of refractory or relapsing GS) was correlated to mortality at one year. Superiority of oral cyclophosphamide compared to intravenous intake was close to significant. Using a logistic regression model, renal survival in patients alive at 1 year was only predicted by serum creatinine <500 µmol/L at presentation. This large series describes the predictive factors for overall and renal survival of GS patients treated by plasma exchanges. Interventional studies that compare oral and intravenous cyclophosphamide, as well as testing new immunosuppressive therapies, are warranted.

Primary care physicians and oncologists are partners in cancer announcement.

PURPOSE: The primary care physician (PCP) is central to cancer patients' management. Announcement of the diagnosis is a critical time for patients, even if they wish to be fully informed. The French National Cancer Plan, developed 10 years ago, includes a diagnosis disclosure procedure (DDP) to be used by oncologists, which makes specific provision for a time of communication with PCPs. So, we asked PCPs about their role in cancer announcement since the launching of the DDP. METHODS: A cross-sectional prospective study by postal questionnaire was sent to 500 PCPs in the largest region of France. It addressed (1) the characteristics of cancer disclosure, (2) PCPs' source of information of the diagnosis, (3) time of disclosure, (4) information exchange, and (5) the physicians' knowledge of the DDP. RESULTS: The response rate was 48 %. In 20 % of cases, oncologists delegated the announcement to PCPs. In 19 % of cases, it was the patient or their family who informed the PCP of the diagnosis. We identified three announcement phases of cancer diagnosis in the physicians' clinical practice: pre-disclosure, disclosure, and repeat disclosure. In 57 % of cases, PCPs lacked information on prognosis and in 60 % on treatment. Regarding the DDP, nearly half of PCPs did not know the procedure itself or its content. CONCLUSION: PCPs announce the cancer diagnosis, even if they have not received the necessary information to do so. The DDP needs to be adapted for use in primary care practice.

[Improving practice in breast pathology: 34-months experience of the regional SENOPATH network and webinars as a tool for diagnosis of difficult lesions of the breast]. / Amélioration des pratiques en pathologie mammaire : bilan à 34 mois du groupe régional de relecture SENOPATH et télépathologie pour les lésions de diagnostic difficile.

Pathologists commonly face breast lesions that are difficult to diagnose. To reduce second opinion delay, erase geographical barrier and provide continuing education, we aimed to develop a telepathology-based regional network of pathologists. With the support of ONCOMIP network, we founded a peer-group named SENOPATH, composed of experienced breast pathologists practising in private laboratories, university hospitals or comprehensive cancer center in the region of Midi-Pyrénées in France. Submitted cases are digitalized at the University Hospital, stored in a shared space with a possible access via Internet prior to the SENOPATH sessions. The group meets monthly, via a synchronized webinar and multihead microscope session. A consensual diagnosis and final pathology report is issued for each case, and sent to the referring clinician via the patient medical file securely hosted by ONCOMIP. Between 2012 and 2014, 142 cases were reviewed, for either diagnostic 'routine' difficulty or rare histological type. The SENOPATH group, also regularly called by oncologists to solve difficult cases, has considerably improved the pathologist network in Southern France. Supported by the webinar tool, its educational impact is prominent, with a considerable progress in the region with regards to standardization of pathology processes, literature review and knowledge sharing.

A longitudinal study of non-medical determinants of adherence to R-CHOP therapy for diffuse large B-cell lymphoma: implication for survival.

BACKGROUND: Adherence to therapy has been established for years as a critical parameter for clinical benefit in medical oncology. This study aimed to assess, in the current practice, the influence of the socio-demographical characteristics and the place of treatment on treatment adherence and overall survival among diffuse large B-cell lymphoma patients. METHODS: We analysed data from 380 patients enrolled in a French multi-centre regional cohort, with diffuse large B-cell lymphoma receiving first-line treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CHOP-like regimens. Direct examination of administrative and medical records yielded the date of death. We studied the influence of patients' socio-demographic characteristics and place of treatment on the treatment adherence and overall survival, adjusted for baseline clinical characteristics. Treatment adherence was measured by the ratio between received and planned dose Intensity (DI), called relative DI (RDI) categorized in "lesser than 85%" and "at least 85%". RESULTS: During the follow-up, among the final sample 70 patients had RDI lesser than 85% and 94 deceased. Multivariate models showed that advanced age, poor international prognosis index (IPI) and treatment with R-CHOP 14 favoured RDI lesser than 85%. The treatment in a public academic centre favoured RDI greater than or equal to 85%. Poor adherence to treatment was strongly associated with poor overall survival whereas being treated in private centres was linked to better overall survival, after adjusting for confounders. No socioeconomic gradient was found on both adherence to treatment and overall survival. CONCLUSIONS: These results reinforce adherence to treatment as a critical parameter for clinical benefit among diffuse large B-cell lymphoma patients under R-CHOP. The place of treatment, but not the socioeconomic status of these patients, impacted both RDI and overall survival.

Guideline sheets on the side effects of anticancer drugs are useful for general practitioners.

PURPOSE: General practitioners (GPs) are more and more involved in the treatment of cancer patients but feel not informed enough about anticancer treatments and associated side effects. Better communication with treatment centers is needed. We hypothesized that information sheets could improve communication. METHODS: This prospective, multicentric, and interventionist study aimed at implementing and assessing therapeutic sheets describing the side effects of anticancer drugs used for digestive and gynecological cancers and their recommended management. GPs' phone interviews were done through three successive phases and two independent cohorts. The first phase (T1; 242 GPs with one patient recently treated) listed their expectations, the second (T2; 158 GPs with one patient beginning treatment) assessed the GPs' opinion regarding the sheets, and the third (T3; responder GPs 4 months after the start of T2) assessed their usefulness in practice. RESULTS: In T1, 94% of GPs declared their need of having information sheets, notably for the management of side effects. Thirty-one one-page sheets were created. In T2, 83.5% gave a favorable opinion about sheets and 80% envisaged their use in the case of side effect. In T3, 56% of GPs whose patient had experienced a side effect had used successfully the sheets for its management, and 21% of patients with side effect were hospitalized. A strong correlation existed between the use of the sheet by GPs and the hospitalization (OR 7.35 in the case of no use vs use). CONCLUSION: The guideline sheets represent a simple and low-cost solution to help GPs managing drugs' side effects and perhaps decrease the rate of unplanned hospitalizations.

[Compensable occupational disease and cancer: how to improve the recognition rate? "Cursus Laboris" Project in Midi-Pyrenees: feasibility study]. / Cancer et maladie professionnelle indemnisable : comment améliorer le taux de reconnaissance ? Projet Cursus Laboris en Midi-Pyrénées : étude de faisabilité

Five to ten percent of cancers are of occupational origin but only 0.5% of cancers are compensable occupational diseases recognized in 2001. The project "Curriculum Laboris" was launched in Midi-Pyrenees with the objective to establish an organization to improve the identification, reporting and recognition of occupational cancers. The project consisted firstly in creating an online training module for professionals. Furthermore, a pilot has identified patients with lung, bladder, head and neck or hematologic cancer. Afterwards, four investigators realized an interview with the patients "marked" to define their careers. Finally, a group of experts produced advice, providing the general practitioner, the aid element in drafting the initial medical certificate (CMI) as part of the recognition process. Twenty-three patients were identified, 21 surveys were carried out. Six returns were filed and actually recognized. The generalization of our device measures meet the Cancer Plan II 2009 to 2013 and may improve the number of cancers recognized as compensable occupational diseases.

[Completeness and quality of multidisciplinary team meetings: the example of breast cancer in Tarn]. / Exhaustivité et qualité des réunions de concertation pluridisciplinaire : l'exemple du cancer du sein dans le département du Tarn.

To facilitate multidisciplinary team meetings' (MTM) management, the cancer research networks developed a communicating file. The Midi-Pyrénées region includes the Oncomip network and a cancer registry in the department of Tarn. Their collaboration allows the assessment of the care given to patients. The objectives of this study were to measure the completeness of the presentation to MTM of patients and its determinants (age and prognostic factors), and to study the quality of MTM for breast cancer diagnosed in the Tarn in 2007. A track of presentation to MTM chronologically conform was found in 70.5%. The completeness of presentation seemed lower for the oldest women and the parameters conditioning the decision of a non-surgical treatment were associated with a more frequent presentation to MTM. The quorum was respected for 53.9% of cases presented before all treatment and for 71.3% of cases presented after surgery. The partnership, which exists between the Tarn cancer registry and the Oncomip network, makes the realization of similar studies in population with other type of cancer possible.

Cost study of the clinical management of prostate cancer in France: results on the basis of population-based data.

Prostate cancer is an important disease in terms of economic implications because of its increasing incidence and health care costs. We assessed the direct costs of the clinical management of prostate cancer in France. A retrospective study based on population-based data was carried out. Eight hundred and seventy-nine cases of prostate cancer diagnosed in five departments were included in a 5-year follow-up study. The economic analysis adopted the health-care payer's perspective and took into account only the direct costs. The mean cost of managing patients was estimated at euro12,731. It is composed of 49 to 82% of initial treatments according to the therapeutic strategy. The follow-up constituted between 3 and 11%, the costs of treatments for side effects between 1 and 3% and the travel cost between 3 and 7%. Cumulative total costs over 5 years for each treatment group showed variation in costs. Costs were highest for patients who were treated with external-beam radiotherapy and lowest for those with watchful waiting. The cost burden of prostate cancer is high and varies according to the treatment type. This study yielded a cost analysis of the different management practices of patients with prostate cancer.