Background: Given the importance of physician attitudes about different treatments and the quality of life (QOL) in prostate cancer, we performed a national survey of specialists to assess treatment recommendations and perceptions of treatment-related survival and QOL.
Methods: We mailed a self-administered survey instrument to a random sample of 1366 specialists in the US. Respondents were asked for treatment recommendations and survival that varied by PSA levels and Gleason scores and estimate QOL outcomes. Pearson's chi-square and multivariable regression models were used to test for differences in each outcome.
Results: Response rates were similar for radiation oncologists (52.6%) and urologists (52.3%; P=0.92). Across all risk strata, urologists were more likely to recommend surgery than were radiation oncologists, for conditions ranging from PSA >20 and Gleason score 8-10 (35.2 vs 0.2%; P< 0.001) to PSA 4-10 and Gleason score 7 (87.5 vs 20.9%; P< 0.001). Radiation oncologists were also more likely to recommend radiation therapy relative to urologists (all P< 0.001). From low- to high-risk prostate cancer, radiation oncologists and urologists perceived their treatment as being better for improving survival (all P< 0.001). Each specialty also viewed their treatment as having less urinary incontinence (all P< 0.001).
Conclusions: Radiation oncologists and urologists both prefer the treatment modalities they offer, perceive them to be more effective and to lead to a better QOL. Patients may be receiving biased information, and a truly informed consent process with shared decision-making may be possible only if they are evaluated by both specialties before deciding upon a treatment course.
Written by:
Kim SP, Gross CP, Nguyen PY, Smaldone MC, Thompson RH, Shah ND, Kutikov A, Han LC, Karnes RJ, Ziegenfuss JY, Tilburt JC. Are you the author?
Department of Urology, Yale University, New Haven, CT, USA; Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale University, New Haven, CT, USA; Department of Internal Medicine, Yale University, New Haven, CT, USA; Division of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA; Department of Urology, Mayo Clinic, Rochester, MN, USA; Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; HealthPartners Institute for Education and Research, Minneapolis, MN, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of General Medicine, Mayo Clinic, Rochester, MN, USA; Biomedical Ethics Research Unit, Mayo Clinic, Rochester, MN, USA.
Reference: Prostate Cancer Prostatic Dis. 2014 Feb 25. Epub ahead of print.
doi: 10.1038/pcan.2014.3
PubMed Abstract
PMID: 24566445
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