The rate of therapy for localized prostate cancer does not increase in markets with higher penetration of robotic surgical technology and intensity-modulated radiation therapy (IMRT), according to an examination of trends using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.
Lead investigator Florian Rudolf Schroeck, MD, MS, presented the analysis in poster format at the 2013 American Society of Clinical Oncology Annual Meeting.
“The major concern with diffusion of technology is that people might shift their treatment recommendations, either consciously or subconsciously, toward treating more people than they did before they had the new technology,” said Schroeck. An expansion of the population treated would result not only in an increase in costs but also more men experiencing treatment-related morbidity.
“But we found that new technology does not spur additional therapy of prostate cancer,” he said.
His group categorized markets as low, medium, or high technological capacity based on the number of physicians who provided robotic prostatectomy and IMRT. Technology penetration was characterized separately for each hospital referral region and year. Using the SEER-Medicare linked database, they identified 59,043 patients with locoregional prostate cancer who were treated or managed expectantly from 2003 to 2007. The use of radiotherapy, radical prostatectomy, or observation was obtained from Medicare claims using Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
Multinomial logistic regression was performed to examine the association of technology penetration with receipt of prostatectomy, radiotherapy, or no local therapy.
Over time, technological capacity increased. “There was no shift in the overall number of men who got treated, but what we do see is a shift in what kind of treatment they get,” said Schroeck, a fellow in urologic oncology and health services research at the University of Michigan, Ann Arbor.
With more robotic technology, patients received more prostatectomy at the expense of radiotherapy. Among all age groups, the adjusted number of men receiving treatment per 1000 diagnosed was not significantly different in the low- and high-technology markets. Markets with high robotic prostatectomy penetration compared with low penetration had higher use of prostatectomy (175 vs 141 per 1000; P = .004) but a lower use of radiotherapy (584 vs 613 per 1000; P = .046).
“It seems like patients are moved to some extent from the radiotherapy group to prostatectomy, but we are not expanding the pool of patients that get treated,” he said. “It makes a lot of sense too, because the urologists are the ones seeing the prostate cancer patients first and they’re the ones who have access to the robot.” —WK
Schroeck FR, Kaufman SR, Jacobs BL, et al. The impact of technology diffusion on treatment for prostate cancer. J Clin Oncol. 2013;31(suppl):Abstract 5044. Presented at: 2013 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2013; Chicago, IL.