Statistics and Evaluation Center, Intramural Research Department, American Cancer Society and Department of Health Policy and Management, Emory University, Atlanta, Georgia.
Cancer. 2013 Oct 15;119(20):3619-28. doi: 10.1002/cncr.28258. Epub 2013 Jul 31.
Prostate cancer treatment choices have been shown to vary by physician and patient characteristics. For patients with low-risk, clinically localized prostate cancer, the authors examined the impact of their clinical, sociodemographic, and radiation oncologists' (RO) characteristics on the likelihood that the patients would receive combined external beam radiotherapy and brachytherapy, a treatment regimen that is at variance with clinical guidelines.
The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database and the American Medical Association Physician Masterfile were used in a retrospective analysis of 5531 patients with low-risk, clinically localized prostate cancer who were diagnosed between 2004 and 2007, and the 708 ROs who treated them. Hierarchical logistic regression analyses were used to evaluate the relationship between patient and RO characteristics and the use of combined therapy within 6 months of diagnosis.
Overall, 356 patients (6.4%) received combined therapy. Nonclinical factors were found to be associated with combined therapy. After adjusting for patient and RO characteristics, the odds of receiving combined therapy for patients residing in Georgia were found to be significantly greater than for all other SEER regions. Black patients were significantly less likely to receive combined therapy (odds ratio, 0.62; 95% confidence interval, 0.40-0.96 [P= .03]) compared with white patients. In addition, ROs accounted for 36.6% of the variation in patients receiving combined therapy.
Geographic and sociodemographic factors were found to be significantly associated with guideline-discordant combined therapy for patients diagnosed with low-risk, clinically localized prostate cancer. Which RO a patient consults is important in determining whether they receive combined therapy.
研究表明，医生和患者的特征会影响前列腺癌的治疗选择。对于患有低危、临床局限性前列腺癌的患者，作者研究了他们的临床、社会人口统计学和放射肿瘤学家（RO）特征对患者接受外照射放疗联合近距离放疗的可能性的影响，这种治疗方案与临床指南不符。
本研究使用监测、流行病学和最终结果（SEER）-医疗保险数据库和美国医学协会医师主文件，对 5531 例于 2004 年至 2007 年间诊断为低危、临床局限性前列腺癌且接受治疗的患者（n=5531）和 708 名治疗他们的 RO 进行回顾性分析。采用分层逻辑回归分析评估患者和 RO 特征与诊断后 6 个月内联合治疗的使用之间的关系。
共有 356 例（6.4%）患者接受了联合治疗。非临床因素与联合治疗有关。在调整了患者和 RO 特征后，发现居住在佐治亚州的患者接受联合治疗的几率明显高于其他所有 SEER 地区。与白人患者相比，黑人患者接受联合治疗的可能性显著降低（比值比，0.62；95%置信区间，0.40-0.96 [P=0.03]）。此外，RO 占患者接受联合治疗差异的 36.6%。
地理和社会人口统计学因素与低危、临床局限性前列腺癌患者接受与指南不符的联合治疗显著相关。患者咨询的 RO 对他们是否接受联合治疗很重要。
