PURPOSE: To examine variation in use of active surveillance among Medicare-eligible men undergoing expectant management for early-stage prostate cancer.
METHODS AND MATERIALS: Using Surveillance, Epidemiology and End Results and Medicare data, we identified 49,192 men diagnosed with localized prostate cancer from 2004 through 2007. Among 7,347 patients who did not receive treatment within 12 months of diagnosis (i.e., expectant management), we assessed the prevalence of active surveillance (i.e., repeat prostate biopsy and PSA) versus watchful waiting across health care markets. We fit multivariable logistic regression models to examine associations between receipt of active surveillance and patient demographics, cancer severity, and health-care market characteristics.
RESULTS: During the study interval, use of active surveillance (versus watchful waiting) increased significantly among patients managed expectantly (9.7% in 2004 to 15.3% in 2007, p< 0.001). Active surveillance was less common among older patients, those with high-risk tumors, and more comorbidities (all p< 0.001). Patients who were white and of higher socioeconomic status were more likely to undergo active surveillance (all p< 0.05). After adjusting for patient and tumor characteristics, significant differences in the predicted probability of active surveillance persisted across health care markets (from 2.4% to 30.1%). There was no significant variation in use of active surveillance associated with specific health care market characteristics, including intensity of end-of-life care, Medicare reimbursements, and provider density.
CONCLUSIONS: Active surveillance has been relatively uncommon among Medicare beneficiaries with localized prostate cancer and its use relative to watchful waiting varies based on patient demographics, tumor severity, and geographic location.
Written by:
Filson CP, Schroeck FR, Ye Z, Wei JT, Hollenbeck BK, Miller DC. Are you the author?
Reference: J Urol. 2014 Feb 8. pii: S0022-5347(14)00230-4.
doi: 10.1016/j.juro.2014.01.105
PubMed Abstract
PMID: 24518783
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