INTRODUCTON: The overtreatment of early @entity263 has become a major public health concern. Expectant management (EM) is a strategy to minimize overtreatment, but little is known about its pattern of use. We sought to examine national EM utilization over the preceding decade. METHODS: We examined @entity263 treatment utilization from 2000 to 2009 using the National @entity5 Database. EM use was analyzed in relation to other treatments and by @entity5 stage, age group, Charlson score, and hospital practice setting. RESULTS: Overall, 109 997 (8.2%) @entity1 were managed initially with EM. EM usage remained stable at 7.6% to 9.5% from 2000 to 2009 with no appreciable increase for @entity5 . Usage was only slightly higher in elderly @entity1 and in @entity1 with multiple comorbidities. Veterans Affairs and low-volume hospitals had a much higher and increasing EM rate (range: 18.8%-29.8% and 15.1%-24.2%, respectively), compared to community hospitals, comprehensive @entity5 centres, and teaching hospitals, which showed no increased adoption. On further analysis, EM use remained high for @entity5 at Veterans Affairs and low-volume hospitals (24.0% and 19.1%, respectively), regardless of age or comorbidity, a pattern not shared by other practice settings. CONCLUSIONS: EM utilization remained low and stable last decade, regardless of disease or @entity1 characteristics. Conversely, Veterans Affairs and low-volume hospitals led the trend in national EM adoption, particularly in @entity1 with @entity5 and limited life expectancies. The limitations of this dataset preclude any determination of the appropriateness of EM utilization. Nonetheless, further study is needed to identify factors influencing EM adoption to ensure its proper use in the future.

American trends in expectant management utilization for XXXX from 2000 to 2009.

@entity5 :: ('MESH:D009369', 'Disease') :: ['cancer', 'low-stage cancers', 'Cancer'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient', 'men'] @entity263 :: ('MESH:D011471', 'Disease') :: ['prostate cancer']
@entity263 :: (MESH:D011471,Disease) :: ['prostate cancer']
