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Physician variation in management of low-risk prostate cancer: a population-based cohort study.

ABSTRACT: Up-front treatment of older men with low-risk prostate cancer can cause morbidity without clear survival benefit; however, most such patients receive treatment instead of observation. The impact of physicians on the management approach is uncertain.To determine the impact of physicians on the management of low-risk prostate cancer with up-front treatment vs observation.Retrospective cohort of men 66 years and older with low-risk prostate cancer diagnosed from 2006 through 2009. Patient and tumor characteristics were obtained from the Surveillance, Epidemiology, and End Results cancer registries. The diagnosing urologist, consulting radiation oncologist, cancer-directed therapy, and comorbid medical conditions were determined from linked Medicare claims. Physician characteristics were obtained from the American Medical Association Physician Masterfile. Mixed-effects models were used to evaluate management variation and factors associated with observation.No cancer-directed therapy within 12 months of diagnosis (observation).A total of 2145 urologists diagnosed low-risk prostate cancer in 12,068 men, of whom 80.1% received treatment and 19.9% were observed. The case-adjusted rate of observation varied widely across urologists, ranging from 4.5% to 64.2% of patients. The diagnosing urologist accounted for 16.1% of the variation in up-front treatment vs observation, whereas patient and tumor characteristics accounted for 7.9% of this variation. After adjustment for patient and tumor characteristics, urologists who treat non-low-risk prostate cancer (adjusted odds ratio [aOR], 0.71 [95% CI, 0.55-0.92]; P =?.01) and graduated in earlier decades (P =?.004) were less likely to manage low-risk disease with observation. Treated patients were more likely to undergo prostatectomy (aOR, 1.71 [95% CI, 1.45-2.01]; P

SUBMITTER: Hoffman KE

PROVIDER: S-EPMC4372187 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Physician variation in management of low-risk prostate cancer: a population-based cohort study.

Hoffman Karen E KE Niu Jiangong J Shen Yu Y Jiang Jing J Davis John W JW Kim Jeri J Kuban Deborah A DA Perkins George H GH Shah Jay B JB Smith Grace L GL Volk Robert J RJ Buchholz Thomas A TA Giordano Sharon H SH Smith Benjamin D BD

JAMA internal medicine 20140901 9

<h4>Importance</h4>Up-front treatment of older men with low-risk prostate cancer can cause morbidity without clear survival benefit; however, most such patients receive treatment instead of observation. The impact of physicians on the management approach is uncertain.<h4>Objective</h4>To determine the impact of physicians on the management of low-risk prostate cancer with up-front treatment vs observation.<h4>Design, setting, and participants</h4>Retrospective cohort of men 66 years and older wi ...[more]

PMID: 25023650

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Project description:BackgroundPatients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa.MethodsSemi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area.ResultsPatients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians' perceptions largely mirrored patients' perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients' prior knowledge and the support of family/friends as facilitators of clinical conversations.ConclusionsOur study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.

Dataset Information

Physician variation in management of low-risk prostate cancer: a population-based cohort study.

Publications

Physician variation in management of low-risk prostate cancer: a population-based cohort study.

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