ORLANDO, FL, USA (UroToday.com) - Treatment selection varies widely throughout the U.S. for the definitive management of prostate cancer patients.
The investigators at the Cleveland Clinic assessed patterns of use. Currently, no randomized, comparative, efficacy trial exists to provide guidance for the management of these patients. The SEER database was analyzed identifying 361 135 prostate cancer cases (1998-2008). Five treatment modalities were identified (listed in order of prevalence): radical prostatectomy (RP) 50.3%; external beam radiotherapy (EBRT) 27.5%; brachytherapy 12.4%; combination brachytherapy and external beam radiotherapy (CombRT) 6.8%; and radical prostatectomy plus external beam radiotherapy (RP+RT) 3.1%. Overall, the prostate cancer treatment choice varied greatly by region, then by year of treatment, and age of the patient; whereas, reimbursement rates during this study period did not significantly alter the treatment choice. The authors concluded regional modality choice implies an allegiance to affiliations among healthcare providers in that region.
Commentary by Jay Ciezki, MD, radiation oncologist, Cleveland Clinic Foundation
“This study was done by mining the SEER database, in which we looked in all the various SEER regions, over time, according to the treatment modality used within those regions to treat prostate cancer definitively. As background to this trial, we expected, as time went forward, that there would be various treatments that were more financially advantageous to implement in all regions of the United States over time, and we would expect a migration of patients into those modalities. With that as our working hypothesis, we embarked upon this trial. What we noticed as we started to mine this data was that if you look at all regions, there is significant variability across all regions for the definitive management of prostate cancer according to modality. Interestingly, the most obvious thing that we noticed was that there was not a migration toward the more profitable treatment modalities as time progressed. A good example, (external beam radiation) IMRT treatments over the last 10 years have become more popular, mainly because it has become more profitable. The billing codes allow a reimbursement rate, even through Medicare, at approximately twice that of prostatectomy and brachytherapy. So the expectation for IMRT to usurp all other treatment modalities was not borne out.
What we did notice, which we did not expect, was that each region was very married to specific modalities. For example, in the Atlanta area, it has a very long history of promoting a combination of external beam and brachytherapy. Within the U.S., that region has the highest utilization of CombRT. In the northwest, where permanent prostate brachytherapy had its major revival in the late 1980s and early 90s, brachytherapy still maintains a pretty large share of the market in that area. Throughout the rest of the United States, the various regions are mixed between those extremes.
In conclusion, although prostate cancer treatment use does vary (slightly) by year, and the age of the patient being treated (for example, younger patients get treated by surgery more often) and geographic region, the geographic regional variation seemed the greatest. The key take-away from this study was that this data implies affiliations amongst healthcare providers significantly impact treatment more than any other input into the decision-making process.”
Click here to view the poster from this session
Presented by Jay P. Ciezki, Chandana A. Reddy, James Ulchaker, Kenneth Angermeier, Kevin L. Stephans, Rahul D. Tendulkar, Andrew J. Stephenson, Nabil Chehade, Andrew Altman, and Eric A. Klein at the 2013 Genitourinary Cancers Symposium - February 14 - 16, 2013 - Rosen Shingle Creek - Orlando, Florida USA
Cleveland Clinic, Cleveland, OH; Center for Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland, OH; Kaiser Permanente, Cleveland, OH; Kaiser Permanente, Cleveland Heights, OH; Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
Written by Karen Roberts, medical editor for UroToday.com
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