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Kim SP , Gross CP , Nguyen PL , Smaldone MC , Thompson RH , Shah ND , Kutikov A , Han LC , Karnes RJ , Ziegenfuss JY , Tilburt JC
Specialty bias in treatment recommendations and quality of life among radiation oncologists and urologists for localized prostate cancer
Prostate Cancer Prostatic Dis. 2014 Jun;17(2) :163-9
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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.
Notes
Kim, S P Gross, C P Nguyen, P L Smaldone, M C Thompson, R H Shah, N D Kutikov, A Han, L C Karnes, R J Ziegenfuss, J Y Tilburt, J C eng Research Support, Non-U.S. Gov't England Prostate Cancer Prostatic Dis. 2014 Jun;17(2):163-9. doi: 10.1038/pcan.2014.3. Epub 2014 Feb 25.