Longitudinal evaluation of urologic cancer treatment landscape, toxicity, and molecular testing: a decade of real-world evidence
Principal Investigator : Dr. Alice Dragomir
Institution: McGill University Health Centre (MUHC)
Sponsor: PROVEM
Scientific background
Urologic cancers, including prostate, bladder, and kidney cancers, represent a substantial portion of the oncology burden in Canada. Over the past decade, their management has evolved considerably with the introduction of multiple therapeutic innovations, including androgen receptor pathway inhibitors, PARP inhibitors, immune checkpoint inhibitors, targeted therapies, and radioligand therapies.
At the same time, the growing use of molecular profiling and expanded diagnostic panels has transformed treatment strategies within precision oncology. These innovations have significantly expanded treatment options while also increasing the complexity of clinical decision-making and treatment sequencing.
With this rapid evolution, the understanding of optimal treatment sequencing, real-world adoption of innovations, and their impact on patient outcomes remains limited in routine clinical practice.
Objectives
This project aims to provide an integrated characterization of real-world treatment trajectories in urologic oncology to better understand the use and impact of clinical innovations over the past decade in order to:
- Describe how treatment patterns have evolved across urologic cancers
- Evaluate whether new therapies have translated into improvements in real-world patient outcomes
- Examine the adoption dynamics of therapeutic innovations and transitions between lines of therapy
- Assess how molecular testing and genomic profiling influence the uptake of targeted therapies
- Identify variability in the adoption of innovations and their association with outcomes and healthcare resource utilization
Population and data mobilized
- Population:
Adult patients diagnosed with urologic cancer (prostate, bladder, or kidney) between January 1, 2015 and January 1, 2025 at the MUHC.
Patients will be followed longitudinally from diagnosis until the study cutoff date: July 31, 2025. - Data sources:
The project leverages rich clinical data from the MUHC data warehouse, including:- Patient demographics and clinical characteristics
- Tumor diagnoses and staging information
- Surgical procedures
- Systemic therapies and radiotherapy
- Laboratory results
- Pharmacy prescriptions
- Hospitalizations and emergency visits
The richness and granularity of these clinical datasets enable detailed analysis of care trajectories and treatment decision-making in real-world settings.
Methodological approach
This study uses a retrospective longitudinal cohort design based on real-world clinical data extracted from hospital data warehouse.
The analytic framework includes:
- Descriptive analyses of patient characteristics and treatment patterns
- Survival analyses using Kaplan-Meier curves and Cox proportional hazards models
- Treatment sequence analysis and trajectory visualization
This approach enables the reconstruction of complex treatment sequences and the identification of real-world treatment patterns in relation to clinical outcomes and healthcare resource utilization.
This project complements other PROVEM initiatives by providing in-depth clinical analysis of care trajectories using detailed hospital data.
Project status
Current phase: protocol submitted to the ethics committee and preparation of data extraction and analysis phases.
Upcoming steps include:
- Ethics approval
- Data extraction from the MUHC data warehouse
- Initial descriptive analyses.
Institutional signature
PROVEM is a platform dedicated to the mobilization and analysis of real-world oncology data in Quebec, integrating clinical, administrative, and patient-reported data to generate multi-level analyses that inform decision-making.