Association between urologist characteristics and radiation oncologist consultation for patients with locoregional prostate cancer.
BACKGROUND
Physicians managing patients with prostate cancer play a critical role in subsequent specialist consultations and initial treatment choice, especially in cases for which no consensus exists regarding optimal treatment strategy. The NCCN Guidelines for Prostate Cancer recommend radiation as a therapy option for patients with locoregional prostate cancer.


OBJECTIVE
The authors examined the association of urologist characteristics with the likelihood that patients would consult radiation oncologists.


METHODS
A retrospective cohort of 39,934 patients aged 66 years or older who were diagnosed with locoregional prostate cancer between 2004 and 2007, and the 2405 urologists who performed the patient diagnostic biopsies were constructed using the SEER-Medicare linked database and the American Medical Association Physician Masterfile. Logistic multilevel regression analysis was used to evaluate the influence of urologists' characteristics on radiation oncologist consultation within 9 months of locoregional prostate cancer diagnosis.


RESULTS
Overall, 24,549 (61.5%) patients consulted a radiation oncologist. After adjusting for patient and urologist characteristics, patients diagnosed by urologists in noninstitutional settings (eg, physician office) were significantly more likely to consult a radiation oncologist (odds ratio [OR], 1.40; 95% CI, 1.17-1.67; P=.0002) compared with those diagnosed by urologists in institutional settings with a major medical school affiliation. In addition, patients diagnosed by urologists older than 57 years were significantly more likely to consult a radiation oncologist (OR, 1.21; 95% CI, 1.07-1.38, P=.003).
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Ruben G W
RG
Quek
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Kevin C
KC
Ward
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Viraj A
VA
Master
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Chun Chieh
CC
Lin
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Kenneth M
KM
Portier
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Katherine S
KS
Virgo
From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Joseph
J
Lipscomb
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D012017:Referral and Consultation; D018426:SEER Program