Borza Tudor, Kaufman Samuel R, Shahinian Vahakn B, Yan Phyllis, Miller David C, Skolarus Ted A, Hollenbeck Brent K
Tudor Borza (
Samuel R. Kaufman is a research analyst in the Dow Health Services Research Division, Department of Urology, University of Michigan Health System.
Health Aff (Millwood). 2017 Jan 1;36(1):108-115. doi: 10.1377/hlthaff.2016.0739.
The indolent nature of many prostate cancers has heightened concerns that harms from treatment may outweigh those from the disease and has resulted in a growing consensus in favor of less aggressive screening and treatment. We sought to understand the population-level impact of this consensus on the treatment of prostate cancer. Using national Medicare data for the period 2007-12, we assessed treatment rates among men with newly diagnosed prostate cancer. We identified both population-based rates (which are sensitive to changes in diagnosis and treatment patterns) and rates among diagnosed men (which are sensitive only to changes in treatment patterns). We also assessed trends in treatment among men with a high risk of noncancer mortality, who are unlikely to benefit from treatment. Population-based treatment rates declined by 42 percent, while rates among diagnosed men declined by only 8 percent. Treatment rates among men with the highest noncancer mortality risk and regional variation were unchanged. These results suggest that decreasing rates of diagnosis, changing attitudes, and guidelines calling for reduced prostate-specific antigen screening, not changes in practice patterns among specialists treating diagnosed men, drove the decline in population-based treatment rates. Compared to policies that emphasize volume, those that emphasize value in specialty care have the potential to exert stronger effects on practice patterns.
许多前列腺癌生长缓慢，这加剧了人们对于治疗所带来的危害可能超过疾病本身危害的担忧，并且已达成越来越多的共识，即倾向于采取不太积极的筛查和治疗方式。我们试图了解这一共识对前列腺癌治疗在人群层面产生的影响。利用2007年至2012年期间的全国医疗保险数据，我们评估了新诊断出前列腺癌的男性的治疗率。我们既确定了基于人群的治疗率（对诊断和治疗模式的变化敏感），也确定了已确诊男性中的治疗率（仅对治疗模式的变化敏感）。我们还评估了非癌症死亡风险高、不太可能从治疗中获益的男性的治疗趋势。基于人群的治疗率下降了42%，而在已确诊男性中的治疗率仅下降了8%。非癌症死亡风险最高的男性的治疗率以及地区差异均未改变。这些结果表明，诊断率下降、态度转变以及呼吁减少前列腺特异性抗原筛查的指南，而非治疗已确诊男性的专科医生的实践模式变化，推动了基于人群的治疗率下降。与强调治疗量的政策相比，强调专科护理价值的政策可能会对实践模式产生更强的影响。
