About My Health Careers Internship MedBlogs Contact us
Medindia LOGIN REGISTER
Advertisement

Diagnosing Physicians Tend to Influence Therapy Decisions for Prostate Cancer Patients

by Dr. Enozia Vakil on July 15, 2014 at 1:11 PM
Font : A-A+

 Diagnosing Physicians Tend to Influence Therapy Decisions for Prostate Cancer Patients

A new research has shed light on how a urologist plays a role in diagnosing older men with lower risk of prostate cancer.

The findings, published in JAMA Internal Medicine, sought to examine why active surveillance, a management program for low-risk disease, which includes repeat PSAs, prostate exams and biopsies, is underused in this patient population.

Advertisement

According to the American Cancer Society, 233,000 new cases of prostate cancer will be diagnosed this year, making it the most common non-skin cancer in men. Previous studies have shown mortality rates are similar for those who opt for surveillance versus treatment in this older population, yet many men continue to incur unnecessary treatment harms.

"What's striking was just how much variation exists in managing prostate cancer, with the diagnosing physician playing as much a role, if not more of a role, than accepted patient factors that impact surveillance use," said Karen Hoffman, M.D., assistant professor in Radiation Oncology and lead author.
Advertisement

Using the Surveillance, Epidemiology and End Results (SEER) registry, researchers identified 12,068 men ages 66 and older diagnosed with low-risk prostate cancer from 2006—2009. Physician characteristics were obtained from linked Medicare claims to determine variations attributable to medical degree, year of training, training location and board certifications.

The main outcome was no cancer-directed therapy within 12 months of diagnosis. Researchers also set to determine the impact of the diagnosing urologist on treatment decisions, quantify the rate of surveillance versus treatment and identify urologist and patient factors associated with surveillance selection.

Results Indicate Widespread Differences

Of the 12,068 men, 80 percent received treatment and only 20 percent underwent observation. Observation rates varied significantly across urologists, from 4.5 to 64.2 percent, and radiation oncologists, from 2 to 47 percent.

Interestingly, researchers found the diagnosing urologist accounted for more than double the rate of variation seen in treatment versus observation decisions compared to individual patient characteristics such as age, comorbidities and PSA level.

Patients diagnosed by urologists who treated low-risk prostate cancer were more likely to receive treatment, and when treated, more likely to receive a therapy their diagnosing urologist used. Hoffman said these findings suggest that physicians not only influence decision making, but the type of treatment selected.

For example, the research found that patients diagnosed by urologists who billed for external beam radiation therapy were more likely to receive it, bringing financial considerations into the fold. The study could not determine those physicians with ownership interests in radiation equipment, but the finding that was also referenced in earlier reports underscores a possible rationale behind some of the disparity.

The authors note public reporting of physician's cancer management profiles would enable primary care providers and patients to make more informed decisions when selecting a physician to diagnose and treat their prostate cancer.

"Primary care physicians play a key role because they refer patients to urologists for elevated PSA levels and prostate biopsies. Increasing transparency could lead to selecting physicians more open to surveillance," Hoffman said.

The authors note several limitations to the study. Those included shifting practice patterns that may influence treatment decisions and the inability to measure certain factors that may impact treatment choice, such as family history and patient anxiety.

Follow-up work in this area will evaluate if patient counseling in a multidisciplinary setting and patient decision aids increase active surveillance acceptance.



Source: Eurekalert
Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
News Category
What's New on Medindia
Health Benefits of Sea Buckthorn
Contraceptive Pills in Polycystic Ovary Syndrome (PCOS) Curtail Type 2 Diabetes Risk
Mushroom May Help Cut Down the Odds of Developing Depression
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Prostate Cancer Cancer and Homeopathy Trans-Urethral Resection of the Prostate Reiki and Pranic Healing Prostate Cancer Facts Cancer Facts Cancer Tattoos A Body Art Prostate Cancer: Treatment Options Prostate Specific Antigen [PSA] 

Recommended Reading
Prostate Specific Antigen [PSA]
PSA blood test is specific to prostate gland but not necessarily a cancer specific test but is ......
Prostate Cancer
This cancer affects men over the age of 50 years and screening with rectal examination and PSA can h...
Prostate Cancer: Treatment Options
Treatment options of prostate cancer includes waiting, surgery, radiation, hormone therapy, chemothe...
Tattoos A Body Art
Tattoos are a rage among college students who sport it for the ‘cool dude’ or ‘cool babe’ look...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use