Does Specialty Bias Trump Evidence in the Management of High-risk Prostate Cancer?
Does Specialty Bias Trump Evidence in the Management of High-risk Prostate Cancer?
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DOI：
10.1097/coc.0000000000000323
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发表时间：
2018-06-01
影响因子：
2.6
通讯作者：
King, Christopher R.
中科院分区：
文献类型：
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作者：
Kishan, Amar U.;Duchesne, Gillian;King, Christopher R.
目的：目的是询问专科如何影响3种临床环境中高危前列腺癌的治疗建议：前期管理、术后管理和放疗（RT）后生化复发（BCR）的管理。我们假设专业偏见将体现在所有的设置，胜过现有的evidence.Methods：执业泌尿科医生和放射肿瘤学家的调查，通过电子邮件分发。问题涉及前期管理、术后治疗和放射后BCR的局部挽救。使用多变量logistic回归评估26个选择的分类反应和专业之间的关联。培训水平/专业知识，实践设置，前列腺癌，和国籍组成的咨询案例的百分比被设置为effective modifiers.Results：一千二百五十三名医生（846放射肿瘤学家和407泌尿科医生）完成了调查。放射肿瘤学家更倾向于推荐辅助放疗，认为其未被充分利用，更倾向于在前列腺特异性抗原阈值较低时推荐补救放疗（P < 0.0001）。泌尿科医生更倾向于推荐根治性尿道切除术或冷冻消融术用于RT后的局部挽救，而放射肿瘤科医生更倾向于推荐基于RT的方式，更倾向于报告RT后局部挽救未得到充分利用（P < 0.0001）。泌尿科医生更倾向于报告前期根治性膀胱癌切除术是一种更好的确定性治疗（P < 0.0001），而放射肿瘤学家更倾向于报告相反的治疗（P = 0.005）。结论：无论现有证据如何，对前期治疗和术后和RT后BCR治疗的建议都存在专业偏见。这些数据揭示了迫切需要多学科诊所和跨专业培训作为克服专业偏见的潜在解决方案。
Objective: The objective was to query how specialty influences treatment recommendations for high-risk prostate cancer in 3 clinical settings: upfront management, postoperative management, and management of biochemical recurrences (BCRs) after radiotherapy (RT). We hypothesized that specialty bias would manifest in all settings, trumping available evidence.Methods: A survey of practicing urologists and radiation oncologists was distributed through electronic mail. Questions pertained to upfront management, postoperative treatment, and local salvage for postradiation BCRs. The associations between 26 selected categorical responses and specialty were assessed using multivariate logistic regression. Training level/expertise, practice setting, percentage of consultation caseload consisting of prostate cancer, and nationality were set as effect modifiers.Results: One thousand two hundred fifty-three physicians (846 radiation oncologists and 407 urologists) completed the survey. Radiation oncologists were more likely to recommend adjuvant RT and consider it to be underutilized, and more likely to recommend salvage RT at lower prostate-specific antigen thresholds (P < 0.0001). Urologists were more likely to recommend salvage radical prostatectomy or cryoablation for local salvage after RT, whereas radiation oncologists were more likely to recommend RT-based modalities and more likely to report that local salvage was underutilized after RT (P < 0.0001). Urologists were more likely to report that upfront radical prostatectomy was a better definitive treatment (P < 0.0001), whereas radiation oncologists were more likely to report the opposite (P = 0.005)Conclusions: Specialty biases permeate recommendations for upfront management and management in the postoperative and post-RT BCR setting, irrespective of available evidence. These data reveal the critical need for multidisciplinary clinics and cross-specialty training as potential solutions for overcoming specialty bias.