WASHINGTON, DC USA (UroToday.com) - Dr. Mark Litwin presented the Whitmore Lecture on health services research.
He showed that a comorbidity score, the Charlson score can predict mortality in men with prostate cancer. Even with the approval of Provenge, CMS will rely on the assistance of epidemiologists to determine how to utilize this new treatment.
He discussed the Urologic Diseases in America initiative funded by the NIDDK. He showed all the access, quality, cost, outcomes, technology initiatives at different institutions that seek to answer health services research questions. He gave some examples of outcomes research. Not only are the elderly less likely to get a radical cystectomy when indicated, but also the economically disadvantaged or those residing in rural areas. Another example is from Dr. Hollenbeck that evaluates who actually gets a hematuria evaluation when indicated. 24% and 7% have 3 and 9 months delay in diagnosis, respectively. There is a 24% relative risk reduction and 11% absolute risk reduction using a single post-TURBT instillation in bladder cancer patients, but only 3.2% of patients get this treatment according to research by Dr. Litwin’s fellow Dr. Karim Chamie. Many advances in urologic oncology are not disseminated and put into practice by urologists.
He also showed the overutilization of complete nephrectomy instead of partial nephrectomy for small renal masses. Regarding prostate cancer, geographic areas with higher numbers of robots correlate with increased use of radical prostatectomy compared with areas having fewer robots. Technology should be an accelerator, but not the agent of change, he said. Outcomes will be monitored and eventually go online at MAT.gov, he concluded.
Presented by Mark Litwin, MD at the Society for Basic Urologic Research (SBUR)/Society of Urologic Oncology (SUO) joint meeting during the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.
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