title: Specialty bias in treatment recommendations and quality of life among radiation oncologists and urologists for localized prostate cancer.
abstract: BACKGROUND
  Given the importance of physician attitudes about different treatments and the quality of life (QOL) in prostate cancer, we performed a national survey of specialists to assess treatment recommendations and perceptions of treatment-related survival and QOL.
  
  
  METHODS
  We mailed a self-administered survey instrument to a random sample of 1366 specialists in the U.S. Respondents were asked for treatment recommendations and survival that varied by PSA levels and Gleason scores and estimate QOL outcomes. Pearson's chi-square and multivariable regression models were used to test for differences in each outcome.
  
  
  RESULTS
  Response rates were similar for radiation oncologists (52.6%) and urologists (52.3%; P=0.92). Across all risk strata, urologists were more likely to recommend surgery than were radiation oncologists, for conditions ranging from PSA>20 and Gleason score 8-10 (35.2 vs. 0.2%; P<0.001) to PSA 4-10 and Gleason score 7 (87.5 vs. 20.9%; P<0.001). Radiation oncologists were also more likely to recommend radiation therapy relative to urologists (all P<0.001). From low- to high-risk prostate cancer, radiation oncologists and urologists perceived their treatment as being better for improving survival (all P<0.001). Each specialty also viewed their treatment as having less urinary incontinence (all P<0.001).
  
  
  CONCLUSIONS
  Radiation oncologists and urologists both prefer the treatment modalities they offer, perceive them to be more effective and to lead to a better QOL. Patients may be receiving biased information, and a truly informed consent process with shared decision-making may be possible only if they are evaluated by both specialties before deciding upon a treatment course.
authors.affiliation: 1] Department of Urology, Yale University, New Haven, CT, USA [2] Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale University, New Haven, CT, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: 1] Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale University, New Haven, CT, USA [2] Department of Internal Medicine, Yale University, New Haven, CT, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Gross
authors.forename: P L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Division of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: P Y
authors.initials: PY
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Smaldone
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Thompson
authors.affiliation: 1] Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA [2] Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Department of Surgery, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kutikov
authors.affiliation: Division of Health Care & Policy Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Han
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
authors.forename: J Y
authors.initials: JY
authors.lastname: Ziegenfuss
authors.affiliation: 1] Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA [2] Division of General Medicine, Mayo Clinic, Rochester, MN, USA [3] Biomedical Ethics Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Tilburt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011467:Prostate / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011788:Quality of Life; D018787:Radiation Oncology / Q000379:methods; D014572:Urology / Q000379:methods
chemical_list: D017430:Prostate-Specific Antigen