Sociodemographic factors associated with postprostatectomy radiotherapy

Abstract

Purpose: To determine if nonclinical factors affect the use of adjuvant radiation therapy after surgical resection of the prostate gland. Methods: Using the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) public use data files, we identified men with localized/ regional prostate cancer who underwent postprostatectomy radiotherapy within 4 months of surgery. We used 2000 Census information to ascribe a median education and income level to these men based on the county of residence and ethnicity. Results: Of 34 763 men who underwent surgical resection, 1549 received postprostatectomy radiotherapy. Those with higher tumor grade and from certain geographic regions (Seattle and Hawaii) had significantly higher rates of radiotherapy while being older and from other geographic regions (Detroit, Utah, and New Mexico) was protective. The use of additional radiation therapy was not affected by ethnicity, income level, or educational attainment. Conclusions: We found no socioeconomic or demographic disparities in the receipt of postprostatectomy radiotherapy. Geographic variation in postprostatectomy radiotherapy may be explained by limited evidence supporting its use in clinical practice.

A Framework to Evaluate the Cost-Effectiveness of the NADiA ProsVue Slope to Guide Adjuvant Radiotherapy among Men with High-Risk Characteristics Following Prostatectomy for Prostate Cancer

“…With standard care, we assumed that 20% and 40% of the patients in the intermediate-risk and high-risk CAPRA-S groups would receive ART, respectively. These rates are slightly higher than those reported by Williams et al [21] for Medicare beneficiaries (14% and 36% in intermediate and high D'Amico risk groups) to represent higher use of ART in younger, privately insured populations [22].…”

“…Yet, it is an important factor in determining the cost-effectiveness of ProsVue-guided therapy. Although an analysis of a large database could be performed to obtain precise estimates of the use of ART by CAPRA-S risk, practice patterns vary widely across geographic areas and physician specialties [30][31][32]. Thus, for an individual decision maker, information on local practice patterns might be more important in determining the cost-effectiveness of "Dominated" refers to a scenario in which PSA-guided therapy is expected to be more costly and produce fewer QALYs than standard care.…”

Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence

“…Males from affluent areas in the USA were more likely to receive IMRT for localized disease (149). However, rates of adjuvant RT after surgery did not vary by residential disadvantage in one USA-based (164) and one Canadian study (165).…”

Association Between Hospital and Surgeon Radical Prostatectomy Volume and Patient Outcomes: A Systematic Review

“…18 Studies that investigated provider volumes adjusted for patient age and comorbidity, 22,25,27,36 race, 18,20,21,27,34 cancer stage and grade, 18,24,34 provider location and teaching status, 20 -22,25,38,40 and clustering of patients and providers. 18 Investigators stated that the target population included patients with localized prostate cancer, 41 reported the number of participants with localized cancer, 28,19,24 adjusted for cancer stage and grade 18,20,24,34 or assumed that all patients treated primarily with RP would have localized disease. 40 The investigators adjusted for comorbidities assessed using ICD codes for major confounding diseases 21,27 or comorbidity indexes.…”