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Locoregional prostate cancer treatment pattern variation in independent cancer centers: policy effect, patient preference, or physician incentive?

Camarata AS, Nickleach DC, Jani AB, Rossi PJ - Health Serv Insights (2015)

Bottom Line: Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45-64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs).Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs.Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. ; United States Navy, Medical Corps, USA.

ABSTRACT
Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45-64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

No MeSH data available.


Related in: MedlinePlus

(A)–(D) Percentages are adjusted for age, race, and year of diagnosis; analysis clustered patients within states.Notes: LMSG/ICC Prostate Cancer Treatment Patterns by CON Policy (*P < 0.05). LMSG/ICC Prostate Cancer Treatment Patterns by State (*P < 0.05).Abbreviations: LMSG, large multi-specialty group; ICC, independent cancer center.
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f2-hsi-8-2015-001: (A)–(D) Percentages are adjusted for age, race, and year of diagnosis; analysis clustered patients within states.Notes: LMSG/ICC Prostate Cancer Treatment Patterns by CON Policy (*P < 0.05). LMSG/ICC Prostate Cancer Treatment Patterns by State (*P < 0.05).Abbreviations: LMSG, large multi-specialty group; ICC, independent cancer center.

Mentions: In addition to not finding significant differences in external beam radiotherapy rates in states with CON regulation on LINACs versus unregulated states (12.66% vs. 14.00%, P = 0.675), no differences in any of the treatment modalities were found between CON-regulated and -unregulated cohorts as detailed in Figure 1A. However, practice patterns differed between ICCs and LMSGs for all treatment modalities other than brachy as detailed in Figure 1B. All analyses revealed no difference in EBRT rates across the regulated and unregulated states in the total cohort, in LMSGs, or in ICCs (Figs. 1A and 2A and B). In ICCs, higher surgery rates were associated with unregulated states (14.17% vs. 5.35%, P < 0.001) (Fig. 2B).


Locoregional prostate cancer treatment pattern variation in independent cancer centers: policy effect, patient preference, or physician incentive?

Camarata AS, Nickleach DC, Jani AB, Rossi PJ - Health Serv Insights (2015)

(A)–(D) Percentages are adjusted for age, race, and year of diagnosis; analysis clustered patients within states.Notes: LMSG/ICC Prostate Cancer Treatment Patterns by CON Policy (*P < 0.05). LMSG/ICC Prostate Cancer Treatment Patterns by State (*P < 0.05).Abbreviations: LMSG, large multi-specialty group; ICC, independent cancer center.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4401240&req=5

f2-hsi-8-2015-001: (A)–(D) Percentages are adjusted for age, race, and year of diagnosis; analysis clustered patients within states.Notes: LMSG/ICC Prostate Cancer Treatment Patterns by CON Policy (*P < 0.05). LMSG/ICC Prostate Cancer Treatment Patterns by State (*P < 0.05).Abbreviations: LMSG, large multi-specialty group; ICC, independent cancer center.
Mentions: In addition to not finding significant differences in external beam radiotherapy rates in states with CON regulation on LINACs versus unregulated states (12.66% vs. 14.00%, P = 0.675), no differences in any of the treatment modalities were found between CON-regulated and -unregulated cohorts as detailed in Figure 1A. However, practice patterns differed between ICCs and LMSGs for all treatment modalities other than brachy as detailed in Figure 1B. All analyses revealed no difference in EBRT rates across the regulated and unregulated states in the total cohort, in LMSGs, or in ICCs (Figs. 1A and 2A and B). In ICCs, higher surgery rates were associated with unregulated states (14.17% vs. 5.35%, P < 0.001) (Fig. 2B).

Bottom Line: Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45-64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs).Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs.Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA. ; United States Navy, Medical Corps, USA.

ABSTRACT
Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45-64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

No MeSH data available.


Related in: MedlinePlus