In a study reported in the Journal of Oncology Practice, Modi et al found that the difference in the rates of use of conservative management of prostate cancer widened between lower-use and higher-use urology practices between 2014 and 2018.
Study Details
Use of a sample of Medicare claims permitted identification of men with incident prostate cancer between 2010 and 2014. In total, 22,178 men with newly diagnosed disease managed by 350 practices were identified. The practices consisted of 31 solo practices, 142 small single-specialty groups, 82 large single-specialty groups, 85 multispecialty groups, and 10 specialist groups. A total of 7,832 men were treated by 65 practices with intensity-modulated radiation therapy (IMRT) ownership in 2010.
“There is increasing variation among group practices in the use of conservative management for prostate cancer. This underscores the need for a better understanding of practice-level factors that influence prostate cancer management.”— Modi et al
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Key Findings
Overall, multispecialty groups had the highest crude rate of conservative management (22%), with rates remaining stable at 22.3% in 2010 and 22.4% in 2014. In contrast, solo practices, single-specialty groups, and specialist groups exhibited consistent numeric increases in conservative management from 2010 to 2014 (interaction P = .03), with use in small single-specialty groups numerically exceeding that in multispecialty groups (approximately 24%) in 2014.
Practices with the most rapid increase in the use of conservative management between 2010 and 2014 (fifth quintile) had the highest absolute rate of conservative management in 2010. Practices with the slowest adoption rate (first quintile) had the lowest rate of conservative management in 2010.
In 2010, groups with the highest rates of adoption used conservative management 21.6% more frequently than those with the lowest rates of adoption. The relative difference in use between groups with the highest vs lowest rates of adoption increased to 38.1% in 2014.
IMRT-owning practices used conservative management numerically less often than practices not owning IMRT in each year from 2010 to 2014, with the rates of conservative management in both groups increasing numerically each year; there was no significant difference between the two groups in the rate of adoption of conservative management over time (interaction P = .74).
The investigators concluded, “There is increasing variation among group practices in the use of conservative management for prostate cancer. This underscores the need for a better understanding of practice-level factors that influence prostate cancer management.”
Vahakn B. Shahinian, MD, MS, of the Department of Internal Medicine, University of Michigan, Ann Arbor, is the corresponding author of the Journal of Oncology Practice article.
Disclosure: The study was supported by grants from the Agency for Healthcare Research and Quality and the National Cancer Institute. For full disclosures of the study authors, visit jop.ascopubs.org.
