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Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):e781-6. doi: 10.1016/j.ijrobp.2011.11.024. Epub 2012 Feb 11.

Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007.

Author information

1
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.

Abstract

PURPOSE:

In the absence of evidence from large clinical trials, optimal therapy for localized prostate cancer remains unclear; however, treatment patterns continue to change. We examined changes in the management of patients with prostate cancer in the Medicare population.

METHODS AND MATERIALS:

We conducted a retrospective claims-based analysis of the use of radiation therapy, surgery, and androgen deprivation therapy in the 12 months after diagnosis of prostate cancer in a nationally representative 5% sample of Medicare claims. Patients were Medicare beneficiaries 67 years or older with incident prostate cancer diagnosed between 1999 and 2007.

RESULTS:

There were 20,918 incident cases of prostate cancer between 1999 and 2007. The proportion of patients receiving androgen deprivation therapy decreased from 55% to 36%, and the proportion of patients receiving no active therapy increased from 16% to 23%. Intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the most common method of radiation therapy, accounting for 77% of external beam radiotherapy by 2007. Minimally invasive radical prostatectomy began to replace open surgical approaches, being used in 49% of radical prostatectomies by 2007.

CONCLUSIONS:

Between 2002 and 2007, the use of androgen deprivation therapy decreased, open surgical approaches were largely replaced by minimally invasive radical prostatectomy, and intensity-modulated radiation therapy replaced three-dimensional conformal radiation therapy as the predominant method of radiation therapy in the Medicare population. The aging of the population and the increasing use of newer, higher-cost technologies in the treatment of patients with prostate cancer may have important implications for nationwide health care costs.

PMID:
22331001
PMCID:
PMC3418871
DOI:
10.1016/j.ijrobp.2011.11.024
[Indexed for MEDLINE]
Free PMC Article

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