Impact of urologists’ ownership of radiation equipment in the treatment of prostate cancer

Stephen Williams, J. Huo, B. F. Chapin, B. D. Smith, K. E. Hoffman

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    BACKGROUND:Physician practices that offer ancillary medical services may refer their patients for such services, a process known as self-referral. We wanted to evaluate how utilization and cost of care differ for men diagnosed with prostate cancer in a self-referral practice (SRP) compared to a traditional urologic practice.METHODS:A total of 17 982 men aged 66 years and older diagnosed with localized prostate cancer from 2006 to 2009 were identified from the Texas Cancer Registry. A total of 13 SRPs in the state of Texas were evaluated. We used multilevel logistic regression models that evaluated the odds of receiving a specific type of treatment.RESULTS:Men diagnosed in SRPs were more likely to receive upfront treatment (vs watchful waiting/active surveillance) than men diagnosed by traditional practices (92.7% vs 89%; adjusted odds ratio (AOR) 1.61, 95% confidence interval (CI) 1.30–2.00; P<0.001) and were more likely to be treated with external beam radiation (47.4% vs 34.1%; AOR 1.59, 95% CI 1.37–1.84; P<0.001). This persisted for both favorable and unfavorable risk cancer. Median annual prostate cancer care cost was $2460 (95% CI $1663–$3368) higher for men diagnosed by SRPs. Limitations include data limited to men aged 65 years or older and geographic concentration of SRPs in Texas may not depict nationwide patterns.CONCLUSIONS:Older men diagnosed with prostate cancer in SRPs are more likely to undergo upfront treatment and to receive radiation treatment. This may increase appropriate treatment of unfavorable disease but contribute to overtreatment of favorable disease.Prostate Cancer and Prostatic Diseases advance online publication, 28 March 2017; doi:10.1038/pcan.2017.9.

    Original languageEnglish (US)
    JournalProstate Cancer and Prostatic Diseases
    DOIs
    StateAccepted/In press - Mar 28 2017

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    Ownership
    Prostatic Neoplasms
    Radiation
    Equipment and Supplies
    Confidence Intervals
    Therapeutics
    Referral and Consultation
    Logistic Models
    Odds Ratio
    Prostatic Diseases
    Watchful Waiting
    Costs and Cost Analysis
    Urologists
    Registries
    Publications
    Neoplasms
    Physicians

    ASJC Scopus subject areas

    • Oncology
    • Urology
    • Cancer Research

    Cite this

    Impact of urologists’ ownership of radiation equipment in the treatment of prostate cancer. / Williams, Stephen; Huo, J.; Chapin, B. F.; Smith, B. D.; Hoffman, K. E.

    In: Prostate Cancer and Prostatic Diseases, 28.03.2017.

    Research output: Contribution to journalArticle

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    abstract = "BACKGROUND:Physician practices that offer ancillary medical services may refer their patients for such services, a process known as self-referral. We wanted to evaluate how utilization and cost of care differ for men diagnosed with prostate cancer in a self-referral practice (SRP) compared to a traditional urologic practice.METHODS:A total of 17 982 men aged 66 years and older diagnosed with localized prostate cancer from 2006 to 2009 were identified from the Texas Cancer Registry. A total of 13 SRPs in the state of Texas were evaluated. We used multilevel logistic regression models that evaluated the odds of receiving a specific type of treatment.RESULTS:Men diagnosed in SRPs were more likely to receive upfront treatment (vs watchful waiting/active surveillance) than men diagnosed by traditional practices (92.7{\%} vs 89{\%}; adjusted odds ratio (AOR) 1.61, 95{\%} confidence interval (CI) 1.30–2.00; P<0.001) and were more likely to be treated with external beam radiation (47.4{\%} vs 34.1{\%}; AOR 1.59, 95{\%} CI 1.37–1.84; P<0.001). This persisted for both favorable and unfavorable risk cancer. Median annual prostate cancer care cost was $2460 (95{\%} CI $1663–$3368) higher for men diagnosed by SRPs. Limitations include data limited to men aged 65 years or older and geographic concentration of SRPs in Texas may not depict nationwide patterns.CONCLUSIONS:Older men diagnosed with prostate cancer in SRPs are more likely to undergo upfront treatment and to receive radiation treatment. This may increase appropriate treatment of unfavorable disease but contribute to overtreatment of favorable disease.Prostate Cancer and Prostatic Diseases advance online publication, 28 March 2017; doi:10.1038/pcan.2017.9.",
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    AU - Williams, Stephen

    AU - Huo, J.

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    AU - Smith, B. D.

    AU - Hoffman, K. E.

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    N2 - BACKGROUND:Physician practices that offer ancillary medical services may refer their patients for such services, a process known as self-referral. We wanted to evaluate how utilization and cost of care differ for men diagnosed with prostate cancer in a self-referral practice (SRP) compared to a traditional urologic practice.METHODS:A total of 17 982 men aged 66 years and older diagnosed with localized prostate cancer from 2006 to 2009 were identified from the Texas Cancer Registry. A total of 13 SRPs in the state of Texas were evaluated. We used multilevel logistic regression models that evaluated the odds of receiving a specific type of treatment.RESULTS:Men diagnosed in SRPs were more likely to receive upfront treatment (vs watchful waiting/active surveillance) than men diagnosed by traditional practices (92.7% vs 89%; adjusted odds ratio (AOR) 1.61, 95% confidence interval (CI) 1.30–2.00; P<0.001) and were more likely to be treated with external beam radiation (47.4% vs 34.1%; AOR 1.59, 95% CI 1.37–1.84; P<0.001). This persisted for both favorable and unfavorable risk cancer. Median annual prostate cancer care cost was $2460 (95% CI $1663–$3368) higher for men diagnosed by SRPs. Limitations include data limited to men aged 65 years or older and geographic concentration of SRPs in Texas may not depict nationwide patterns.CONCLUSIONS:Older men diagnosed with prostate cancer in SRPs are more likely to undergo upfront treatment and to receive radiation treatment. This may increase appropriate treatment of unfavorable disease but contribute to overtreatment of favorable disease.Prostate Cancer and Prostatic Diseases advance online publication, 28 March 2017; doi:10.1038/pcan.2017.9.

    AB - BACKGROUND:Physician practices that offer ancillary medical services may refer their patients for such services, a process known as self-referral. We wanted to evaluate how utilization and cost of care differ for men diagnosed with prostate cancer in a self-referral practice (SRP) compared to a traditional urologic practice.METHODS:A total of 17 982 men aged 66 years and older diagnosed with localized prostate cancer from 2006 to 2009 were identified from the Texas Cancer Registry. A total of 13 SRPs in the state of Texas were evaluated. We used multilevel logistic regression models that evaluated the odds of receiving a specific type of treatment.RESULTS:Men diagnosed in SRPs were more likely to receive upfront treatment (vs watchful waiting/active surveillance) than men diagnosed by traditional practices (92.7% vs 89%; adjusted odds ratio (AOR) 1.61, 95% confidence interval (CI) 1.30–2.00; P<0.001) and were more likely to be treated with external beam radiation (47.4% vs 34.1%; AOR 1.59, 95% CI 1.37–1.84; P<0.001). This persisted for both favorable and unfavorable risk cancer. Median annual prostate cancer care cost was $2460 (95% CI $1663–$3368) higher for men diagnosed by SRPs. Limitations include data limited to men aged 65 years or older and geographic concentration of SRPs in Texas may not depict nationwide patterns.CONCLUSIONS:Older men diagnosed with prostate cancer in SRPs are more likely to undergo upfront treatment and to receive radiation treatment. This may increase appropriate treatment of unfavorable disease but contribute to overtreatment of favorable disease.Prostate Cancer and Prostatic Diseases advance online publication, 28 March 2017; doi:10.1038/pcan.2017.9.

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