Moderated Poster

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MP76-02: Urologist practice affiliation and intensity modulated radiation therapy for prostate cancer

Monday, May 15
9:30 AM - 11:30 AM
Location: BCEC: Room 156

Presentation Authors: Lindsey Herrel*, Brent Hollenbeck, Samuel Kaufman, Phyllis Yan, Tudor Borza, Ann Arbor, MI, Florian Schroeck, Hanover, NH, Bruce Jacobs, Pittsburgh, PA, Ted Skolarus, Vahakn Shahinian, Ann Arbor, MI

Introduction: Prostate cancer treatment is a significant source of morbidity and spending. It is widely believed that some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment. Financial incentives associated with urologist ownership of radiation facilities have the potential to spur utilization despite this understanding about disease biology.

Methods: Using a 20% sample of national Medicare claims between 2010 and 2013, prostate cancer treatment was measured according to urologist practice affiliation (i.e., single specialty groups by size, multispecialty group). Overall treatment, and intensity modulated radiation therapy (IMRT) in particular, was further assessed by urologist ownership of IMRT and patient risk of non-cancer mortality within 10 years of diagnosis. Generalized estimating equations were used to adjust for patient differences.

Results: Among the men with newly diagnosed prostate cancer, use of IMRT ranged from 23.5% in multispecialty groups to 37.4% in large urology groups (p < 0.001). In the cohort, 5,133 patients were managed in urology groups with IMRT ownership. Urologists with ownership interest were more likely to use IMRT compared with non-owners practicing in single specialty groups (42.5% vs. 29.5%, p < 0.001), regardless of group size. Among patients with a very high risk (≥ 75%) of non-cancer death within 10 years of diagnosis, both IMRT use (41.6% vs. 26.3%, p < 0.001) and overall treatment with curative intent (52.7% vs. 43.5%, p < 0.001, Figure) were more likely in urology groups with ownership compared with non-owners, respectively.

Conclusions: Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of non-cancer mortality.

Source Of Funding: This work was supported by research funding from the NCI (R01 CA168691) to BKH and VBS. FRS is supported by the Department of Veterans Affairs, Veterans Health Administration, VISN1 Career Development Award.

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