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The current landscape of low-value care in men diagnosed with prostate cancer: what is the role of individual hospitals?
- Source :
-
Urologic Oncology . Sep2019, Vol. 37 Issue 9, p575.e9-575.e18. 1p. - Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>A considerable number of prostate cancer (PCa) patients eligible for expectant management receive definitive treatment. We aimed to investigate the hospital-level contribution to overtreatment in the United States.<bold>Methods: </bold>Using the National Cancer Database we identified two nonoverlapping cohorts: (1) men with a life expectancy <10 years harbouring low or intermediate risk PCa (2) men with life expectancy ≥10 years with low-risk PCa. Multivariable mixed models with patient characteristics as fixed and hospital-level intercept as random effect were used to assess the hospital-level risk-adjusted probability of definitive treatment in both groups. Pearson's correlation coefficient was calculated to investigate the correlation between the hospitals probabilities of treating patients of both cohorts.<bold>Results: </bold>We found 33,431 men with a life expectancy <10 years and 122,514 men with a life expectancy ≥10 years and low-risk PCa. In the latter, the probability of treatment ranged from 29.0% in the bottom to 90.0% in the top decile and from 35.0% to 88.0% for men with a life expectancy <10 years. Age and race were independent predictors of low-value treatment in both cohorts. The correlation between 1,225 hospitals treating men of both cohorts was strong (Pearson's r = 0.66, P < 0.001).<bold>Conclusion: </bold>There is wide hospital-level variability in low-value treatment of men with limited life expectancies and low-risk PCa. Hospitals more likely to treat men with limited life expectancies were more likely to treat men with low-risk PCa and vice versa. Identifying drivers and modifying practice at these hospitals may represent an effective tool for reducing overtreatment. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10781439
- Volume :
- 37
- Issue :
- 9
- Database :
- Academic Search Index
- Journal :
- Urologic Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 138100875
- Full Text :
- https://doi.org/10.1016/j.urolonc.2019.04.001