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Prostate Cancer Prostatic Dis. 2014 Jun;17(2):163-9. doi: 10.1038/pcan.2014.3. Epub 2014 Feb 25.

Specialty bias in treatment recommendations and quality of life among radiation oncologists and urologists for localized prostate cancer.

Author information

  • 11] Department of Urology, Yale University, New Haven, CT, USA [2] Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale University, New Haven, CT, USA.
  • 21] Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale University, New Haven, CT, USA [2] Department of Internal Medicine, Yale University, New Haven, CT, USA.
  • 3Division of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
  • 4Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
  • 5Department of Urology, Mayo Clinic, Rochester, MN, USA.
  • 61] Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA [2] Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
  • 7Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA.
  • 8HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
  • 91] Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA [2] Division of General Medicine, Mayo Clinic, Rochester, MN, USA [3] Biomedical Ethics Research Unit, Mayo Clinic, Rochester, MN, USA.

Erratum in

  • Prostate Cancer Prostatic Dis. 2014 Jun;17(2):212. Nguyen, P Y, [corrected to Nguyen, P L].

Abstract

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 U.S. 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.

PMID:
24566445
DOI:
10.1038/pcan.2014.3
[PubMed - indexed for MEDLINE]
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