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Clinical Research

The impact of county-level radiation oncologist density on prostate cancer mortality in the United States

Prostate Cancer and Prostatic Diseases volume 15, pages 391–396 (2012)Cite this article

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Abstract

Background:

The distribution of radiation oncologists across the United States varies significantly among geographic regions. Accompanying these variations exist geographic variations in prostate cancer mortality. Prostate cancer outcomes have been linked to variations in urologist density, however, the impact of geographic variation in the radiation oncologist workforce and prostate cancer mortality has yet to be investigated. The goal of this study was to determine the effect of increasing radiation oncologist density on regional prostate cancer mortality.

Methods:

Using county-level prostate cancer mortality data from the National Cancer Institute and Centers for Disease Control as well as physician workforce and health system data from the Area Resource File a regression model was built for prostate cancer mortality controlling for categorized radiation oncologist density, urologist density, county socioeconomic factors and pre-existing health system infrastructure.

Results:

There was statistically significant reduction in prostate cancer mortality (3.91–5.45% reduction in mortality) in counties with at least 1 radiation oncologist compared with counties lacking radiation oncologists. However, increasing the density of radiation oncologists beyond 1 per 100 000 residents did not yield statistically significant incremental reductions in prostate cancer mortality.

Conclusion:

The presence of at least one radiation oncologist is associated with significant reductions in prostate cancer mortality within that county. However, the incremental benefit of increasing radiation oncologist density exhibits a plateau effect providing marginal benefit. In order to optimize outcomes a geographically aware policy, which addresses the size and distribution of the workforce, must be in place in order prevent geographic disparities in prostate cancer mortality.

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References

  1. Siegel R, Naishadham D, Jemal A . Cancer statistics, 2012. CA Cancer J Clin 2012; 62: 10–29.

    Article  Google Scholar 

  2. Jemal A, Ward E, Wu X, Martin HJ, McLaughlin CC, Thun MJ . Geographic patterns of prostate cancer mortality and variations in access to medical care in the United States. Cancer Epidemiol Biomarkers Prev 2005; 14: 590–595.

    Article  Google Scholar 

  3. Smith BD, Haffty BG, Wilson LD, Smith GL, Patel AN, Buchholz TA . The future of radiation oncology in the United States from 2010 to 2020: will supply keep pace with demand? J Clin Oncol 2010; 28: 5160–5165.

    Article  Google Scholar 

  4. Odisho AY, Cooperberg MR, Fradet V, Ahmad AE, Carroll PR . Urologist density and county-level urologic cancer mortality. J Clin Oncol 2010; 28: 2499–2504.

    Article  Google Scholar 

  5. Odisho AY, Fradet V, Cooperberg MR, Ahmad AE, Carroll PR . Geographic distribution of urologists throughout the United States using a county level approach. J Urol 2009; 181: 760–765; discussion 5–6.

    Article  Google Scholar 

  6. Aneja S, Smith BD, Gross CP, Wilson LD, Haffty BG, Roberts K et al. Geographic analysis of the radiation oncology workforce. Int J Radiat Oncol Biol Phys 2012; 82: 1723–1729.

    Article  Google Scholar 

  7. Starfield B, Shi L, Grover A, Macinko J . The effects of specialist supply on populations’ health: assessing the evidence. Health Aff 2005; Suppl Web Exclusives:W5-97–W5-107.

  8. Phillips Jr RL, Dodoo MS, Green LA . Adding more specialists is not likely to improve population health: is anybody listening? Health Aff 2005; Suppl Web Exclusives: W5-111–W5-4.

  9. Onega T, Duell EJ, Shi X, Wang D, Demidenko E, Goodman D . Geographic access to cancer care in the U.S. Cancer 2008; 112: 909–918.

    Article  Google Scholar 

  10. Aneja S, Bordeaux JS . Association of increased dermatologist density with lower melanoma mortality. Arch Dermatol 2012; 148: 174–178.

    Article  Google Scholar 

  11. US Department of Health and Human Services, Health Resources and Services Administration: Area Resource File (ARF): National county-level health resource information database. http://www.arfsys.com.

  12. McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T . et al. Variability in reexcision following breast conservation surgery. JAMA 2012; 307: 467–475.

    Article  Google Scholar 

  13. Jang TL, Bekelman JE, Liu Y, Bach PB, Basch EM, Elkin EB et al. Physician visits prior to treatment for clinically localized prostate cancer. Arch Intern Med 2010; 170: 440–450.

    Article  Google Scholar 

  14. Gross CP, Smith BD, Wolf E, Andersen M . Racial disparities in cancer therapy: did the gap narrow between 1992 and 2002? Cancer 2008; 112: 900–908.

    Article  Google Scholar 

  15. Du XL, Lin CC, Johnson NJ, Altekruse S . Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival: findings from the National Longitudinal Mortality Study, 1979–2003. Cancer 2011; 117: 3242–3251.

    Article  Google Scholar 

  16. Krakauer H, Jacoby I, Millman M, Lukomnik JE . Physician impact on hospital admission and on mortality rates in the Medicare population. Health Serv Res 1996; 31: 191–211.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Pruthi RS, Tornehl C, Gaston K, Lee K, Moore D, Carson CC et al. Impact of race, age, income, and residence on prostate cancer knowledge, screening behavior, and health maintenance in siblings of patients with prostate cancer. Eur Urol 2006; 50: 64–69.

    Article  Google Scholar 

  18. Aneja S, Makarov D, Gross C, Roberts K, Yu JB . The influence of physician densities and patient characteristics on the decision to treat prostate cancer patients with varying clinical benefit. Int J Radiat Oncol Biol Phys 2011; 81: S553.

    Article  Google Scholar 

  19. Aneja S, Gross C, Makarov D, Roberts K, Yu JB . The influence of regional radiation oncologist and urologist capacities on treatment choice for prostate cancer. Int J Radiat Oncol Biol Phys 2011; 81: S552.

    Article  Google Scholar 

  20. Goodman DC, Fisher ES, Little GA, Stukel TA, Chang CH, Schoendorf KS . The relation between the availability of neonatal intensive care and neonatal mortality. N Engl J Med 2002; 346: 1538–1544.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Yale School of Medicine Department of Therapeutic Radiology, New Haven, CT, USA

    S Aneja & J B Yu

  2. Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, CT, USA

    J B Yu

  3. Yale Cancer Center, New Haven, CT, USA

    J B Yu

Authors
  1. S Aneja
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  2. J B Yu
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Correspondence to J B Yu.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Aneja, S., Yu, J. The impact of county-level radiation oncologist density on prostate cancer mortality in the United States. Prostate Cancer Prostatic Dis 15, 391–396 (2012). https://doi.org/10.1038/pcan.2012.28

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