Treatment choice and quality of care for men with localized prostate cancer.
BACKGROUND
Variations in patterns of care and treatment outcomes suggest differences in the quality of care for men treated for localized prostate cancer.


OBJECTIVE
We sought to compare adherence with quality indicators for prostate cancer care among men treated with radical prostatectomy or external beam radiation therapy.


METHODS
We sampled 5230 men diagnosed in 2000 or 2001 with early-stage prostate cancer from 984 facilities reporting to the National Cancer Data Base. Our analytic cohort includes 2604 men (from 770 facilities) treated with radical prostatectomy or external beam radiation.


METHODS
Subject-level compliance with the RAND quality indicators for localized prostate cancer care, stratified by treatment. We applied sampling weights to obtain national estimates of quality indicator adherence.


RESULTS
The weighted samples represent 24,547 and 27,125 men treated with radical prostatectomy or external beam radiation therapy, respectively. Compliance with several quality indicators approached 100% in both treatment groups; however treatment-specific variations were noted. Men receiving radiation were less likely than those undergoing surgery to be treated in facilities with a board-certified urologist (odds ratio [OR] = 0.4, 95% confidence interval [95% CI] = 0.2-0.8). Adherence with process of care indicators was appreciably higher among radiation subjects, including documentation of clinical stage (OR = 7.5, 95% CI = 4.8-11.9), pretherapy assessment of urinary (OR = 2.8, 95% CI = 1.9-4.2) and sexual (OR = 1.6, 95% CI = 1.2-2.2) function, and discussion of treatment options (OR = 1.8, 95% CI = 1.1-2.9).


CONCLUSIONS
Documented compliance with process of care quality indicators among men with localized prostate cancer appears superior for those treated with external beam radiation compared with those treated surgically.
Miller
David C
DC
Department of Urology, University of Michigan, Ann Arbor, USA.
Spencer
Benjamin A
BA
Ritchey
Jamie
J
Stewart
Andrew K
AK
Dunn
Rodney L
RL
Sandler
Howard M
HM
Wei
John T
JT
Litwin
Mark S
MS
D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D015331:Cohort Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy / Q000592:standards / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D019984:Quality Indicators, Health Care; D011878:Radiotherapy / Q000592:standards / Q000706:statistics & numerical data; D014481:United States