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Urologist Ownership of Intensity-Modulated Radiation Therapy Services Significantly Increases Use of Treatment for Prostate Cancer

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Key Points

  • Urologist groups in private practice that self-referred for intensity-modulated radiation therapy significantly increased use from preownership to ownership periods and used the treatment significantly more than non–self-referring urologists in private practice or working at NCCN centers.
  • The increase in intensity-modulated radiation therapy use was coincident with significantly decreased use of other treatment options.

In a study reported in The New England Journal of Medicine, Jean M. Mitchell, PhD, of Georgetown University, examined patterns of use of intensity-modulated radiation therapy to treat prostate cancer among urologists in private practice who have integrated intensity-modulated radiation therapy into their practice. The study showed that ownership of intensity-modulated radiation therapy services increased use of the treatment to a dramatic degree compared with treatment use by urologists who do not own intensity-modulated radiation therapy services.

Study Details

The study used Medicare claims from 2005 to 2010 to compare patterns of intensity-modulated radiation therapy use in men with newly diagnosed nonmetastatic prostate cancer between 35 self-referring urology groups in private practice who acquired intensity-modulated radiation therapy services during this period and 35 matched non–self-referring urology groups in private practice and between 11 self-referring groups in private practice and matched non–self-referring urologists who worked at 11 National Comprehensive Cancer Network (NCCN) centers.  

Private Practice Comparison

The rate of intensity-modulated radiation therapy use by the 35 self-referring urology groups in private practice increased from 13.1% of patients in the preownership period to 32.3% of patients during the ownership period (+19.2%, P < .001) compared with an increase from 14.3% to 15.6% (+1.3%, P = .05) over the same periods by non–self-referring groups (unadjusted difference, 17.9%, P < .001; regression-adjusted difference, 16.4%, P < .001).

Between preownership and ownership periods for the self-referring urology groups, there was a significant decrease in use of brachytherapy from 18.6% to 5.6% (P < .001), prostatectomy from 17.7% to 16.6% (P = .01), and androgen deprivation therapy from 16.5% to 8.4%, P < .001), and no change in use of active surveillance (26.7% to 27.0%, P = .65). By comparison, among the non–self-referring groups, there was no change in use of brachytherapy (18.9% to 17.9%, P = .19), increased use of prostatectomy (21.9% to 23.8%, P = .02), decreased use of androgen deprivation therapy (15.6% to 11.4%, P < .001), and no change in active surveillance (26.1% to 27.4%, P = .12).

Similar Findings in NCCN Comparison

In the comparison of 11 self-referring urology groups with non–self-referring urologists employed at 11 NCCN centers, self-referring groups significantly increased use of intensity-modulated radiation therapy from 9.0% in the preownership period to 42.0% in the ownership period (P < .001) and significantly decreased use of  brachytherapy from 17.6% to 2.7% (P < .001), prostatectomy from 16.4% to 12.8% (P < .001), androgen deprivation therapy from 17.4% to 7.4% (P < .001), and active surveillance from 33.9% to 27.6% (P < .001).

By comparison, among non–self-referring urologists employed at 11 NCCN centers, there were no significant changes in use of intensity-modulated radiation therapy (7.9 to 8.3%, P = .78; regression-adjusted difference vs self-referring groups 29.3%, P < .001), brachytherapy (6.3% to 8.5%, P = .09), androgen deprivation therapy (12.0% to 9.7%, P = .14), or active surveillance (44.3% to 45.0%, P = .79).

The author concluded, “Urologists who acquired ownership of [intensity-modulated radiation therapy] services increased their use of [intensity-modulated radiation therapy] substantially more than urologists who did not own such services. Allowing urologists to self-refer for [intensity-modulated radiation therapy] may contribute to increased use of this expensive therapy.”

The study was funded by the American Society for Radiation Oncology.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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