Locoregional prostate cancer treatment pattern variation in independent cancer centers: policy effect, patient preference, or physician incentive?

• Type of Material: Article
• Authors: Andrew S Camarata, Emory University; Dana C Nickleach, Emory University; Ashesh Jani, Emory University; Peter Rossi, Emory University
• Language: English
• Date: 2015
• Publisher: Libertas Academica
• Publication Version: Final Published Version
• Copyright Statement: © the authors, publisher
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.4137/HSI.S24092
• Title of Journal or Parent Work: Health Services Insights
• ISSN: 1178-6329
• Volume: 8
• Start Page: 1
• End Page: 8
• Grant/Funding Information: Authors disclose no funding sources.
• Keywords: Affordable Care Act; accountable care organizations; prostate cancer; treatment patterns; certificate of need
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Oncology

Abstract

Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45-64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.