S P Kim1, C P Gross2, P L Nguyen, P Y Nguyen3, M C Smaldone4, R H Thompson5, N D Shah6, A Kutikov4, L C Han7, R J Karnes5, J Y Ziegenfuss8, J C Tilburt9. 1. 1] 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. 2. 1] 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. 3. Division of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. 4. Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA. 5. Department of Urology, Mayo Clinic, Rochester, MN, USA. 6. 1] Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA [2] Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. 7. Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA. 8. HealthPartners Institute for Education and Research, Minneapolis, MN, USA. 9. 1] 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.
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.
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.
Authors: Boris Gershman; Paul Maroni; Jon C Tilburt; Robert J Volk; Badrinath Konety; Charles L Bennett; Alexander Kutikov; Marc C Smaldone; Victor Chen; Simon P Kim Journal: World J Urol Date: 2019-01-22 Impact factor: 4.226
Authors: Tammy Jiang; Christian H Stillson; Craig Evan Pollack; Linda Crossette; Michelle Ross; Archana Radhakrishnan; David Grande Journal: J Am Board Fam Med Date: 2017 Mar-Apr Impact factor: 2.657
Authors: Seong Hyeon Yu; Myung Soo Kim; Ho Seok Chung; Eu Chang Hwang; Seung Il Jung; Taek Won Kang; Dongdeuk Kwon Journal: World J Urol Date: 2020-04-25 Impact factor: 4.226
Authors: David R Thurtle; David C Greenberg; Lui S Lee; Hong H Huang; Paul D Pharoah; Vincent J Gnanapragasam Journal: PLoS Med Date: 2019-03-12 Impact factor: 11.069