Interestingly, researchers found the diagnosing urologist accounted for more than double the rate of variation seen in treatment versus observation decisions compared to individual patient characteristics such as age, comorbidities and PSA level.
Patients diagnosed by urologists who treated low-risk prostate cancer were more likely to receive treatment, and when treated, more likely to receive a therapy their diagnosing urologist used. Hoffman said these findings suggest that physicians not only influence decision making, but the type of treatment selected.
For example, the research found that patients diagnosed by urologists who billed for external beam radiation therapy were more likely to receive it, bringing financial considerations into the fold. The study could not determine those physicians with ownership interests in radiation equipment, but the finding that was also referenced in earlier reports underscores a possible rationale behind some of the disparity.
The authors note public reporting of physician's cancer management profiles would enable primary care providers and patients to make more informed decisions when selecting a physician to diagnose and treat their prostate cancer.
"Primary care physicians play a key role because they refer patients to urologists for elevated PSA levels and prostate biopsies. Increasing transparency could lead to selecting physicians more open to surveillance," Hoffman said.
The authors note several limitations to the study. Those included shifting practice patterns that may influence treatment decisions and the inability to measure certain factors that may impact treatment choice, such as family history and patient anxiety.
Follow-up work in this area will e
|Contact: William Fitzgerald|
University of Texas M. D. Anderson Cancer Center