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Med Care. 2014 Jul;52(7):579-85. doi: 10.1097/MLR.0000000000000155.

Perceptions of Active Surveillance and Treatment Recommendations for Low-risk Prostate Cancer: Results from a National Survey of Radiation Oncologists and Urologists.

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1
Departments of *Urology †Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center Yale University, New Haven, CT ‡Department of Radiation Oncology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA §Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA ∥Division of Health Care Policy & Research, Knowledge and Evaluation Research Unit ¶Department of Urology, Mayo Clinic, Rochester #Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN **Department of Radiation Oncology, Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER), Yale University, New Haven, CT ††Division of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA ‡‡HealthPartners Institute for Education and Research, Minneapolis, MN §§Cancer Prognostics and Health Outcomes, University of Montreal Health Center, Montreal, QC, Canada ∥∥Bioethics Research Unit, Knowledge and Evaluation Research Unit, Division of General Medicine, Mayo Clinic, Rochester, MN.

Abstract

BACKGROUND:

With the growing concerns about overtreatment in prostate cancer, the extent to which radiation oncologists and urologists perceive active surveillance (AS) as effective and recommend it to patients are unknown.

OBJECTIVE:

To assess opinions of radiation oncologists and urologists about their perceptions of AS and treatment recommendations for low-risk prostate cancer.

RESEARCH DESIGN:

National survey of specialists.

PARTICIPANTS:

Radiation oncologists and urologists practicing in the United States.

MEASURES:

A total of 1366 respondents were asked whether AS was effective and whether it was underused nationally, whether their patients were interested in AS, and treatment recommendations for low-risk prostate cancer. Pearson's χ test and multivariate logistic regression were used to test for differences in physician perceptions on AS and treatment recommendations.

RESULTS:

Overall, 717 (52.5%) of physicians completed the survey with minimal differences between specialties (P=0.92). Although most physicians reported that AS is effective (71.9%) and underused in the United States (80.0%), 71.0% stated that their patients were not interested in AS. For low-risk prostate cancer, more physicians recommended radical prostatectomy (44.9%) or brachytherapy (35.4%); fewer endorsed AS (22.1%). On multivariable analysis, urologists were more likely to recommend surgery [odds ratio (OR): 4.19; P<0.001] and AS (OR: 2.55; P<0.001), but less likely to recommend brachytherapy (OR: 0.13; P<0.001) and external beam radiation therapy (OR: 0.11; P<0.001) compared with radiation oncologists.

CONCLUSIONS AND RELEVANCE:

Most prostate cancer specialists in the United States believe AS effective and underused for low-risk prostate cancer, yet continue to recommend the primary treatments their specialties deliver.

PMID:
24926704
DOI:
10.1097/MLR.0000000000000155
[Indexed for MEDLINE]
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