Background

Prostate cancer treatment is a significant source of morbidity and spending. Some men with prostate cancer, particularly those with significant health problems, are unlikely to benefit from treatment.

Objective

To assess relationships between financial incentives associated with urologist ownership of radiation facilities and treatment for prostate cancer.

Design, setting, and participants

A retrospective cohort of Medicare beneficiaries with prostate cancer diagnosed between 2010 and 2012. Patients were further classified by their risk of dying from noncancer causes in the 10 yr following their cancer diagnosis by using a mortality model derived from comparable patients known to be cancer-free.

Intervention

Urologists were categorized by their practice affiliation (single-specialty groups by size, multispecialty group) and ownership of a radiation facility.

Outcome measurements and analysis

Use of intensity-modulated radiation therapy (IMRT) and use of any treatment within 1 yr of diagnosis. Generalized estimating equations were used to adjust for patient differences.

Results

Among men with newly diagnosed prostate cancer, use of IMRT ranged from 24% in multispecialty groups to 37% in large urology groups (p < 0.001). Patients managed in groups with IMRT ownership (n = 5133) were more likely to receive IMRT than those managed by single-specialty groups without ownership (43% vs 30%, p < 0.001), regardless of group size. Among patients with a very high risk (> 75%) of noncancer mortality within 10 yr of diagnosis, both IMRT use (42% vs 26%, p < 0.001) and overall treatment (53% vs 44%, p < 0.001) were more likely in groups with ownership than in those without, respectively.

Conclusions

Urologists practicing in single-specialty groups with an ownership interest in radiation therapy are more likely to treat men with prostate cancer, including those with a high risk of noncancer mortality.

Patient summary

We assessed treatment for prostate cancer among urologists with varying levels of financial incentives favoring intervention. Those with stronger incentives, as determined by ownership interest in a radiation facility, were more likely to treat prostate cancer, even when treatment was unlikely to provide a survival benefit to the patient.

中文翻译：

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泌尿科医师实践联盟和强度调节放射疗法治疗老年人前列腺癌

背景

前列腺癌治疗是发病率和花费的重要来源。一些患有前列腺癌的男性，尤其是那些患有严重健康问题的男性，不太可能从治疗中受益。

客观的

评估与泌尿科医师拥有放射设施和前列腺癌治疗相关的经济诱因之间的关系。

设计，设置和参与者

在2010年至2012年之间诊断出患有前列腺癌的Medicare受益人的回顾性队列。通过根据已知为无癌症的可比患者得出的死亡率模型，对患者进行癌症诊断后10年内因非癌症原因死亡的风险进一步分类。

干涉

泌尿科医师按其执业所属类别（按大小划分的多个专科组，多个专科组）和放射设施的所有权进行分类。

成果测量和分析

在诊断后的1年内使用强度调制放射疗法（IMRT）并使用任何疗法。广义估计方程用于调整患者差异。

结果

在新诊断为前列腺癌的男性中，IMRT的使用范围从多专业组的24％到大型泌尿科的37％（p  <0.001）。与 没有所有权的单专业组管理的患者相比，拥有IMRT所有权的组（n = 5133）进行治疗的患者更有可能接受IMRT（43％vs 30％，p  <0.001），而与组大小无关。在诊断后10年内发生非癌症死亡的风险很高（> 75％）的患者中，IMRT的使用率（42％vs 26％，p  <0.001）和整体治疗（53％vs 44％，p  <0.001）均是拥有所有权的群体比没有所有权的群体更有可能。

结论

在对放射疗法有所有权的单一专科人群中从事泌尿外科的医生更倾向于治疗前列腺癌男性，包括那些非癌症死亡风险高的男性。

病人总结

我们评估了泌尿科医师对前列腺癌的治疗，并采用了不同程度的有利于干预的经济诱因。根据放射设施的所有权权益确定的，具有更强激励措施的患者更有可能治疗前列腺癌，即使这种治疗不太可能为患者带来生存益处。