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Clinical Research

Variation in prostate cancer treatment associated with population density of the county of residence

Abstract

Background:

We sought to assess variation in the primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to the county and state level.

Methods:

A total 138 226 men with clinically localized prostate cancer in the Surveillance, Epidemiology and End Result (SEER) database in 2005 through 2008 were analyzed. The main association of interest was between prostate cancer treatment and population density using multilevel hierarchical logit models while accounting for the random effects of counties nested within SEER regions. To quantify the effect of county and SEER region on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients.

Results:

Men with localized prostate cancer in metropolitan counties had 23% higher odds of being treated with surgery or radiation compared with men in rural counties, controlling for number of urologists per county as well as clinical and sociodemographic characteristics. Three percent (95% confidence interval (CI): 1.2–6.2%) of the total variation in treatment was attributable to SEER site, while 6% (95% CI: 4.3–9.0%) of variation was attributable to county of residence, adjusting for clinical and sociodemographic characteristics.

Conclusions:

Variation in treatment for localized prostate cancer exists for men living in different population-dense counties of the country. These findings highlight the importance of comparative effectiveness research to improve understanding of this variation and lead to a reduction in unwarranted variation.

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References

  1. Meng MV, Grossfeld GD, Sadetsky N, Mehta SS, Lubeck DP, Carroll PR . Contemporary patterns of androgen deprivation therapy use for newly diagnosed prostate cancer. Urology 2002; 60: 7–11.

    Article  CAS  PubMed  Google Scholar 

  2. Cancer Survivorship: Resilience Across the Lifespan. Proceedings of the National Cancer Institute’s and American Cancer Society’s 2002 Cancer Survivorship Conference; 2–4 June 2002; Washington, DC, USA. Cancer, suppl, 104: 2543, 2005.

    Article  PubMed  Google Scholar 

  3. Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177: 2106–2131.

    Article  PubMed  Google Scholar 

  4. Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011; 59: 61–71.

    Article  PubMed  Google Scholar 

  5. Bechis SK, Carroll PR, Cooperberg MR . Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 2011; 29: 235–241.

    Article  PubMed  Google Scholar 

  6. Cooperberg MR, Broering JM, Carroll PR . Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 2010; 28: 1117–1123.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kane CJ, Lubeck DP, Knight SJ, Spitalny M, Downs TM, Grossfeld GD et al. Impact of patient educational level on treatment for patients with prostate cancer: data from CaPSURE. Urology 2003; 62: 1035–1039.

    Article  PubMed  Google Scholar 

  8. Chamie K, Kwan L, Connor SE, Zavala M, Labo J, Litwin MS . The impact of social networks and partnership status on treatment choice in men with localized prostate cancer. BJU Int 2011; 109: 1006–1012.

    Article  PubMed  Google Scholar 

  9. Chornokur G, Dalton K, Borysova ME, Kumar NB . Disparities at presentation, diagnosis, treatment, and survival in African American men, affected by prostate cancer. Prostate 2010; 71: 985–997.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Parsons JK, Kwan L, Connor SE, Miller DC, Litwin MS . Prostate cancer treatment for economically disadvantaged men. Cancer 2010; 116: 1378–1384.

    Article  PubMed  Google Scholar 

  11. Krupski TL, Kwan L, Afifi AA, Litwin MS . Geographic and socioeconomic variation in the treatment of prostate cancer. J Clin Oncol 2005; 23: 7881–7888.

    Article  PubMed  Google Scholar 

  12. Steenland K, Goodman M, Liff J, Diiorio C, Butler S, Roberts P et al. The effect of race and rural residence on prostate cancer treatment choice among men in Georgia. Urology 2011; 77: 581–587.

    Article  PubMed  Google Scholar 

  13. Desch CE, Penberthy L, Newschaffer CJ, Hillner BE, Whittemore M, McClish D et al. Factors that determine the treatment for local and regional prostate cancer. Med Care 1996; 34: 152–162.

    Article  CAS  PubMed  Google Scholar 

  14. Surveillance, Epidemiology, and End Results (SEER) Program Public-Use Data (1973-2008): National Cancer Institute, Surveillance Research Program, Cancer Statistics Branch, based on November 2010 submission http://www.seer.cancer.gov.

  15. 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.

  16. Snijders TAB, Bosker RJ . Multilevel Analysis. SAGE Publications Limited, London, UK, 2011.

    Google Scholar 

  17. Parikh-Patel A, Bates JH, Campleman S . Colorectal cancer stage at diagnosis by socioeconomic and urban/rural status in California, 1988-2000. Cancer 2006; 107: 1189–1195.

    Article  PubMed  Google Scholar 

  18. Hopenhayn C, King JB, Christian A, Huang B, Christian WJ . Variability of cervical cancer rates across 5 Appalachian states, 1998-2003. Cancer 2008; 113: 2974–2980.

    Article  PubMed  Google Scholar 

  19. Coory MD, Baade PD . Urban-rural differences in prostate cancer mortality, radical prostatectomy and prostate-specific antigen testing in Australia. Med J Aust 2005; 182: 112–115.

    PubMed  Google Scholar 

  20. Baade PD, Youlden DR, Coory MD, Gardiner RA, Chambers SK . Urban-rural differences in prostate cancer outcomes in Australia: what has changed? Med J Aust 2011; 194: 293–296.

    PubMed  Google Scholar 

  21. Hoffman RM, Harlan LC, Klabunde CN, Gilliland FD, Stephenson RA, Hunt WC et al. Racial differences in initial treatment for clinically localized prostate cancer. Results from the prostate cancer outcomes study. J Gen Intern Med 2003; 18: 845–853.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 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  PubMed  PubMed Central  Google Scholar 

  23. Barbash GI, Glied SA . New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 2010; 363: 701–704.

    Article  CAS  PubMed  Google Scholar 

  24. Anderson CB, Penson DF, Ni S, Makarov DV, Barocas DA . Centralization of radical prostatectomy in the United States. J Urol 2013; 189: 500–506.

    Article  PubMed  Google Scholar 

  25. Zender J, Thell C . Developing a successful robotic surgery program in a rural hospital. AORN J 2010; 92: 72–86.

    Article  PubMed  Google Scholar 

  26. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS . Determinants of androgen deprivation therapy use for prostate cancer: role of the urologist. J Natl Cancer Inst 2006; 98: 839–845.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wennberg J, Gittelsohn A . Small area variations in health care delivery. Science 1973; 182: 1102–1108.

    Article  CAS  PubMed  Google Scholar 

  28. Wennberg J, Barnes BA, Zubkoff M . Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med 1982; 16: 811–824.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to C Cary.

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

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Cary, C., Odisho, A. & Cooperberg, M. Variation in prostate cancer treatment associated with population density of the county of residence. Prostate Cancer Prostatic Dis 19, 174–179 (2016). https://doi.org/10.1038/pcan.2015.65

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