Practice-Level Adoption of Conservative Management for Prostate Cancer

Abstract

Purpose: We describe the longitudinal adoption of conservative management (ie, the absence of treatment) for prostate cancer among urology group practices in the United States and identify group practice features that influence this adoption.

Methods: Using a 20% sample of Medicare claims, we identified men with incident prostate cancer from 2010 through 2014 and assigned each to his predominant urologist. We linked each urologist to a practice and characterized the practice's organization (eg, solo, single specialty, multispecialty) and ownership of intensity-modulated radiation therapy. For each group, we determined the rate of conservative management within 1 year of diagnosis. We then fit mixed-effects logistic regression models to assess relationships between practice organization and the adoption of conservative management over time, adjusted for patient characteristics.

Results: We identified 22,178 men with newly diagnosed prostate cancer managed by 350 practices. Practices that increased use the most over time also used conservative management the most in 2010, whereas those that increased use the least used conservative management the least in 2010. Thus, the difference in average use of conservative management between highest- and lowest-use practices widened between 2010 and 2014. Urology groups increased their use of conservative management more rapidly than multispecialty groups. There was no difference in the rate of increase between intensity-modulated radiation therapy owning and nonowning groups.

Conclusion: There is increasing variation among group practices in the use of conservative management for prostate cancer. This underscores the need for a better understanding of practice-level factors that influence prostate cancer management.

Fig 1.

Variation in the rate of increase in use of men undergoing conservative management from 2010 through 2014 among all urology group practices.

Fig 2.

Use of conservative management among men with incident prostate cancer among different group practice types, over time. Data derived from models adjusted for patient age, race, comorbidity, socioeconomic status, and place of residence.

Fig 3.

Use of conservative management among men with incident prostate cancer stratified by group intensity-modulated radiation therapy ownership, over time. Data derived from models adjusted for patient age, race, comorbidity, socioeconomic status, and place of residence.