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• W2000970336 abstract "No AccessJournal of UrologyAdult Urology1 Jul 2013Effect of Practice Integration Between Urologists and Radiation Oncologists on Prostate Cancer Treatment Patterns Justin E. Bekelman, Gita Suneja, Thomas Guzzo, Craig Evan Pollack, Katrina Armstrong, and Andrew J. Epstein Justin E. BekelmanJustin E. Bekelman Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author , Gita SunejaGita Suneja Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author , Thomas GuzzoThomas Guzzo Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author , Craig Evan PollackCraig Evan Pollack Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania Department of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author , Katrina ArmstrongKatrina Armstrong Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author , and Andrew J. EpsteinAndrew J. Epstein Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.01.103AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: National attention has focused on whether urology-radiation oncology practice integration, known as integrated prostate cancer centers, contributes to the use of intensity modulated radiation therapy, a common and expensive prostate cancer treatment. Materials and Methods: We examined prostate cancer treatment patterns before and after conversion of a urology practice to an integrated prostate cancer center in July 2006. Using the SEER (Statistics, Epidemiology and End Results)-Medicare database, we identified patients 65 years old or older in 1 statewide registry diagnosed with nonmetastatic prostate cancer between 2004 and 2007. We classified patients into 3 groups, including 1—those seen by integrated prostate cancer center physicians (exposure group), 2—those living in the same hospital referral region who were not seen by integrated prostate cancer center physicians (hospital referral region control group) and 3—those living elsewhere in the state (state control group). We compared changes in treatment among the 3 groups, adjusting for patient, clinical and socioeconomic factors. Results: Compared with the 8.1 ppt increase in adjusted intensity modulated radiation therapy use in the state control group, the use of this therapy increased 20.3 ppts (95% CI 13.4, 27.1) in the integrated prostate cancer center group and 19.2 ppts (95% CI 9.6, 28.9) in the hospital referral region control group. Androgen deprivation therapy, for which Medicare reimbursement decreased sharply, similarly decreased in integrated prostate cancer center and hospital referral region controls. Prostatectomy decreased significantly in the integrated prostate cancer center group. Conclusions: Coincident with the conversion of a urology group practice to an integrated prostate cancer center, we observed an increase in intensity modulated radiation therapy and a decrease in androgen deprivation therapy in patients seen by integrated prostate cancer center physicians and those seen in the surrounding health care market that were not observed in the remainder of the state. 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Google Scholar 25 : Growth of high-cost intensity-modulated radiotherapy for prostate cancer raises concerns about overuse. Health Aff (Millwood)2012; 31: 750. Google Scholar © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTsai H, Keating N, Van Den Eeden S, Haque R, Cassidy-Bushrow A, Ulcickas Yood M, Smith M and Potosky A (2018) Risk of Diabetes among Patients Receiving Primary Androgen Deprivation Therapy for Clinically Localized Prostate CancerJournal of Urology, VOL. 193, NO. 6, (1956-1962), Online publication date: 1-Jun-2015. Volume 190Issue 1July 2013Page: 97-101 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordsradiotherapy, intensity-modulateddelivery of health care, integratedprostatic neoplasmsphysician's practice patternsprostateAcknowledgmentsThe authors acknowledge the efforts of the Applied Research Program, National Cancer Institute, Office of Research, Development and Information, Centers for Medicare & Medicaid Services, Information Management Services, Inc. and the SEER Program tumor registries in the creation of the SEER-Medicare database. Robert Sunderland assisted with programming and Alexandra Lipschultz assisted with research.MetricsAuthor Information Justin E. Bekelman Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Gita Suneja Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Thomas Guzzo Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Craig Evan Pollack Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania Department of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland More articles by this author Katrina Armstrong Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Andrew J. Epstein Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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