Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007.
Changes in initial treatment for prostate cancer among Medicare beneficiaries, 1999-2007.
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DOI：
10.1016/j.ijrobp.2011.11.024
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发表时间：
2012-04-01
影响因子：
7
通讯作者：
Schulman, Kevin A.
中科院分区：
文献类型：
--
作者：
Dinan, Michaela A.;Robinson, Timothy J.;Zagar, Timothy M.;Scales, Charles D., Jr.;Curtis, Lesley H.;Reed, Shelby D.;Lee, W. Robert;Schulman, Kevin A.
关键词：
在缺乏大型临床试验证据的情况下，局限性前列腺癌的最佳治疗方法仍不清楚;然而，治疗模式不断变化。我们研究了医疗保险人群中前列腺癌患者管理的变化。我们进行了一项基于索赔的回顾性分析，在诊断前列腺癌后12个月内使用放射治疗，手术和雄激素剥夺治疗，在全国代表性的5%医疗保险索赔样本中。患者为67岁或以上的医疗保险受益人，在1999年至2007年期间诊断出前列腺癌。1999年至2007年期间，有20，918例前列腺癌病例。接受雄激素阻断治疗的患者比例从55%下降到36%，未接受积极治疗的患者比例从16%上升到23%。调强放射治疗取代三维适形放射治疗成为最常见的放射治疗方法，到2007年占外照射放射治疗的77%。微创根治性直肠癌切除术开始取代开放性手术方法，到2007年，49%的根治性直肠癌切除术使用了微创根治性直肠癌切除术。在2002年至2007年期间，雄激素剥夺治疗的使用减少，开放性手术方法在很大程度上被微创根治性直肠癌切除术所取代，调强放射治疗取代三维适形放射治疗，成为医疗保险人群中放射治疗的主要方法。人口老龄化和越来越多地使用更新，更高成本的技术治疗前列腺癌患者可能对全国范围内的医疗保健成本产生重要影响。
In the absence of evidence from large clinical trials, optimal therapy for localized prostate cancer remains unclear; however, treatment patterns continue to change. We examined changes in the management of patients with prostate cancer in the Medicare population. We conducted a retrospective claims-based analysis of the use of radiation therapy, surgery, and androgen deprivation therapy in the 12 months after diagnosis of prostate cancer in a nationally representative 5% sample of Medicare claims. Patients were Medicare beneficiaries 67 years or older with incident prostate cancer diagnosed between 1999 and 2007. There were 20,918 incident cases of prostate cancer between 1999 and 2007. The proportion of patients receiving androgen deprivation therapy decreased from 55% to 36%, and the proportion of patients receiving no active therapy increased from 16% to 23%. Intensity-modulated radiation therapy replaced 3-dimensional conformal radiation therapy as the most common method of radiation therapy, accounting for 77% of external beam radiotherapy by 2007. Minimally invasive radical prostatectomy began to replace open surgical approaches, being used in 49% of radical prostatectomies by 2007. Between 2002 and 2007, the use of androgen deprivation therapy decreased, open surgical approaches were largely replaced by minimally invasive radical prostatectomy, and intensity-modulated radiation therapy replaced 3-dimensional conformal radiation therapy as the predominant method of radiation therapy in the Medicare population. The aging of the population and the increasing use of newer, higher-cost technologies in the treatment of patients with prostate cancer may have important implications for nationwide health care costs.
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