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AS: “Physician Cancer Management Profiles"...would be a step in the right direction
From Medpage Today:
Study author Karen E. Hoffman, M.D. and her colleagues at M.D. Anderson Cancer Center state that Physician Cancer Management Profiles would “allow primary care physicians to seek out urologists who are inclined to recommend observation for low-risk prostate cancer”. Their support for the public reporting of a physician’s cancer management history comes from their study, which found that doctors who diagnosed low-risk PCa had more than twice the impact on the choice of upfront therapy as compared with disease characteristics (Note: the study involved a review of 12,000 cases from 2006 to 2009).
Some of the more interesting facts that came out of the study are as follows:
1) Rates of AS among the diagnosing urologists varied from 4.5% to 64% of patients.
2) Patients were significantly more likely to begin observation if the diagnosing urologist graduated from medical school in 1980 or after. (This supports what I was saying in an earlier post when I stated that part of the over-treatment problem was likely due to urologists being set in their old-school ways. I also spoke of the profitability of treatment as another factor and that is mentioned below).
3) They found that men with low-risk disease were significantly more likely to undergo RP if the diagnosing urologist performed that type of surgery. Similarly, 91.5% of men who met with radiation oncologists received upfront treatment.**
4) Men who saw only a urologist were significantly more likely to be observed than were men who were seen by a urologist and a radiation oncologist.
**Dr. James Mohler, chairman of the NCCN, had this to say about the findings: Primary care physicians and patients should understand that "urologists and radiation oncologists believe in their treatment modality and, hence, are biased by their beliefs and sometimes by financial considerations.” He also states that the study years “predate a national emphasis on AS for low and very low-risk prostate cancer, and the rate of recommendation of AS, hopefully, is much higher today.” (Personally, I would be surprised if it was. IMO, the old school urologists need to be replaced by more young, open-minded doctors fresh out of medical school, and I think that will take some time…I would love to be proven wrong though!)
Lastly, the full article can be found by cutting and pasting www.medpagetoday.com/Urology/ProstateCancer/46769 into your browser.
Re: AS: “Physician Cancer Management Profiles" (a Problem with the Study)
While I believe that "Physician Cancer Management Profiles" are a positive step, I see a problem with the study itself. It presupposes that primary care physicians (PCPs) are more enlightened and more open-minded than the urologists that they are referring patients to. I doubt that is the case, and I know that my PCP is certainly not. Now, Dr. Hoffman (the study author) does say that patients with low-risk PCa should take the initiative to ask whether they are candidates for observation, but that certainly does not guarantee an objective answer. If the PCP thinks like many of the urologists, then that doctor is likely to dissuade the patient from exercising that option (which is exactly what my PCP tried to do with me). So, I think the answer lies in somehow expanding the use of these profiles to include a PCPs stance on cancer treatment options in general and AS in particular. I am going to see if I can e-mail Dr. Hoffman and see what she has to say about it. If I get a reply, I will post it on the forum.
