Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer

Vahakn B. Shahinian, Yong Fang Kuo, Jean L. Freeman, Eduardo Orihuela, James Goodwin

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Purpose: We previously have reported wide variations among urologists in the use of androgen deprivation for prostate cancer. Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we examined how individual urologist characteristics influenced the use of androgen deprivation therapy. Methods: Participants included 82,375 men with prostate cancer who were diagnosed from January 1, 1992, through December 31, 2002, and the 2,080 urologists who provided care to them. Multilevel analyses were used to estimate the likelihood of androgen deprivation use within 6 months of diagnosis in the overall cohort, in a subgroup in which use would be of uncertain benefit (primary therapy for localized prostate cancer), and in a subgroup in which use would be evidence-based (adjuvant therapy with radiation for locally advanced disease). Results: In the overall cohort of patients, a multilevel model adjusted for patient characteristics, tumor characteristics, and urologist characteristics (eg, board certification, academic affiliation, patient panel size, years since medical school graduation) showed that the likelihood of androgen deprivation use was significantly greater for patients who saw urologists without an academic affiliation. This pattern also was noted when the analysis was limited to settings in which androgen deprivation would have been of uncertain benefit. Odds ratios for use in that context were 1.66 (95% CI, 1.27 to 2.16) for urologists with no academic affiliation and 1.45 (95% CI, 1.13 to 1.85) for urologists with minor versus major academic affiliations. Conclusion: Use of androgen deprivation for prostate cancer varies by the characteristics of the urologist. Patients of non-academically affiliated urologists were significantly more likely to receive primary androgen deprivation therapy for localized prostate cancer, a setting in which the benefits are uncertain.

Original languageEnglish (US)
Pages (from-to)5359-5365
Number of pages7
JournalJournal of Clinical Oncology
Volume25
Issue number34
DOIs
StatePublished - Dec 1 2007

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Androgens
Prostatic Neoplasms
Therapeutics
Urologists
Multilevel Analysis
Certification
Medicare
Medical Schools
Epidemiology
Radiotherapy
Odds Ratio
Databases
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer. / Shahinian, Vahakn B.; Kuo, Yong Fang; Freeman, Jean L.; Orihuela, Eduardo; Goodwin, James.

In: Journal of Clinical Oncology, Vol. 25, No. 34, 01.12.2007, p. 5359-5365.

Research output: Contribution to journalArticle

Shahinian, Vahakn B. ; Kuo, Yong Fang ; Freeman, Jean L. ; Orihuela, Eduardo ; Goodwin, James. / Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 34. pp. 5359-5365.
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