title: Effect of urologists and medical oncologists on treatment of elderly men with Stage IV prostate cancer.
abstract: OBJECTIVE
  To examine, among elderly men with incident advanced prostate cancer (PCa), their treatment, in general, and chemotherapy, in particular, in association with a posturologist medical oncologist/hematologist (PUMOH) visit. The role of specialists in the management of advanced PCa is evolving in response to positive chemotherapy trials of PCa.
  
  
  METHODS
  Linked Surveillance, Epidemiology, and End results and Medicare data included patients with Stage IV PCa diagnosed from 1994 to 2002 who had visited a urologist after the diagnosis and received treatment. The visits and treatment were examined, comparing patients with and without PUMOH visits.
  
  
  RESULTS
  Most (77%) patients received treatment of their PCa and 85% of treated patients had a subsequent visit with a urologist, of whom 91% saw the urologist first (n = 5435). Of these, 43% saw only the urologist, 41% saw a medical oncologist/hematologist, and 32% saw a radiation oncologist. Of the 5435 patients, 16% received chemotherapy and the adjusted odds of chemotherapy receipt were 7.2 times greater (95% confidence interval 6.0-8.7, P < .001) among those with a PUMOH visit. Compared with non-Hispanic whites, black Americans were less likely (adjusted odds ratio 0.53, P < .001) to receive chemotherapy, although the likelihood of a PUMOH visit was similar (adjusted odds ratio 0.86, P = .14) among the groups.
  
  
  CONCLUSIONS
  The results of our study have shown that nearly one quarter of men with Stage IV PCa receive no PCa treatment. Although a PUMOH visit is a significant predictor of chemotherapy receipt, many men with advanced PCa received chemotherapy without a medical oncologist/hematologist visit. Black American and elderly men were less likely to receive chemotherapy for advanced PCa.
authors: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, USA. eonukwug@rx.umaryland.edu
authors: Eberechukwu
authors: E
authors: Onukwugha
authors: C Daniel
authors: CD
authors: Mullins
authors: Van Doren
authors: VD
authors: Hsu
authors: Brian
authors: B
authors: Seal
authors: Arif
authors: A
authors: Hussain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D014572:Urology / Q000592:standards*