Determinants of androgen deprivation therapy use for prostate cancer: Role of the urologist
Determinants of androgen deprivation therapy use for prostate cancer: Role of the urologist
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DOI：
10.1093/jnci/djj230
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发表时间：
2006-06-21
影响因子：
10.3
通讯作者：
Goodwin, James S.
中科院分区：
文献类型：
--
作者：
Shahinian, Vahakn B.;Kuo, Yong-Fang;Goodwin, James S.
背景前列腺癌雄激素剥夺疗法的使用一直在增加，即使在疗效较弱或没有证据的情况下也是如此。这种模式表明，除了典型的患者和肿瘤特征之外，其他因素可能会推动其使用。我们在一项基于人群的回顾性队列研究中，使用监测、流行病学和最终结果-医疗保险链接数据库，评估了医生作为前列腺癌雄激素剥夺治疗使用决定因素的重要性。研究方法：参与者包括61717名男性，从1992年1月1日至1999年12月31日诊断为前列腺癌，1802名泌尿科医生在癌症诊断后一年内为他们提供护理。多水平分析用于估计和划分诊断后6个月内患者或肿瘤特征与泌尿科医生之间使用雄激素剥夺治疗的差异，以检查每个组成部分对雄激素剥夺治疗的相对贡献。结果如下：在使用雄激素剥夺治疗的总方差中，泌尿科医生的百分比始终高于肿瘤或患者特征的百分比。这种模式在1997年1月1日至1999年12月31日诊断的患者中最为明显，其中22.56%的雄激素剥夺治疗的总方差归因于泌尿科医生，9.71%归因于肿瘤特征（分期或分级），4.29%与患者特征（年龄、种族、社会经济状况、合并症、地理区域或诊断年份）有关。结论：在决定患者是否接受雄激素剥夺治疗时，患者看的泌尿科医生可能比肿瘤或患者特征更重要。
Background. The use of androgen deprivation therapy for prostate cancer has been increasing, even in settings for which there is weak or no evidence of efficacy. This pattern suggests that factors other than the typical patient and tumor characteristics may be driving its use. We assessed the importance of the physician as a determinant of the use of androgen deprivation therapy in prostate cancer in a population-based, retrospective cohort study using the Surveillance, Epidemiology and End-Results-Medicare linked database. Methods: Participants included 61717 men with incident prostate cancer diagnosed from January 1, 1992, through December 31, 1999, and 1802 urologists providing care to them within I year of cancer diagnosis. Multilevel analyses were used to estimate and partition the variance in use of androgen deprivation therapy within 6 months of diagnosis between patient or tumor characteristics and urologist to examine the relative contribution of each component to androgen deprivation therapy. Results: The percentage of the total variance in the use of androgen deprivation therapy attributable to the urologist was consistently higher than that attributable to tumor or patient characteristics. This pattern was most pronounced for patients diagnosed from January 1, 1997, through December 31, 1999, in which 22.56% of the total variance in use of androgen deprivation therapy was attributable to the urologist, 9.71% to tumor characteristics (stage or grade), and 4.29% to patient characteristics (age, ethnicity, socio-economic status, comorbidity, geographic region, or year of diagnosis). Conclusions: Which urologist a patient sees may be more important in determining whether they will receive androgen deprivation therapy than tumor or patient characteristics.