National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms

Modi, Parth K.; Kaufman, Samuel R.; Qi, Ji; Lane, Brian R.; Cher, Michael L.; Miller, David C.; Hollenbeck, Brent K.; Shahinian, Vahakn B.; Dupree, James M.

doi:10.1016/j.urology.2018.06.037

Cited by 26 publications

(22 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…26 Similarly, patients diagnosed during the more recent years (2014e2018) had a shorter time on AS, which likely reflects the more recent adoption of more liberal AS eligibility criteria (supplementary Appendix 2, https://www.jurology.com). 27 The study has several limitations, including the lack of data on PSA density, biopsy-based genomic biomarkers and multiparametric magnetic resonance imaging. 28 At the start of our study, these parameters were not commonly utilized, and there was more variability in the interpretation of multiparametric magnetic resonance imaging among radiologists.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

et al. 2021

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Our estimates of CM use among patients with localized prostate cancer are lower than those reported in recent investigations using SEER-Medicare data (42.1% in 2015) 1 but higher than reported in an investigation of Michigan Medicare beneficiaries (22.3% in 2014). 17 We speculate that these differences could be due to variation in study population characteristics (ours included prostate cancer patients from many regions of the US) and geographic practice patterns. [29][30][31] Multimorbidity and life expectancy are critical components of patient counseling after a localized prostate cancer diagnosis as many older men do not live long enough to benefit from treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, for other independent variables, the competing demands model was used to conceptualize factors known to affect localized prostate cancer treatment selection within clinician, patient, and practice ecosystem domains. 15,17,26 (Figure 2).…”

Section: Key Independent Variablesmentioning

confidence: 99%

See 1 more Smart Citation

Associations of multimorbidity and patient‐reported experiences of care with conservative management among elderly patients with localized prostate cancer

Fiano¹,

Merrick

Innes

et al. 2020

Cancer Medicine

View full text Add to dashboard Cite

Background Many elderly localized prostate cancer patients could benefit from conservative management (CM). This retrospective cohort study examined the associations of patient‐reported access to care and multimorbidity on CM use patterns among Medicare Fee‐for‐Service (FFS) beneficiaries with localized prostate cancer. Methods We used linked Surveillance, Epidemiology, and End Results cancer Registry, Medicare Claims, and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey files. We identified FFS Medicare Beneficiaries (age ≥ 66; continuous enrollment in Parts A & B) with incident localized prostate cancer from 2003 to 2013 and a completed MCAHPS survey measuring patient‐reported experiences of care within 24 months after diagnosis (n = 496). We used multivariable models to examine MCAHPS measures (getting needed care, timeliness of care, and doctor communication) and multimorbidity on CM use. Results Localized prostate cancer patients with multimorbidity were less likely to use CM (adjusted odds ratio (AOR)=0.42 (0.27‐ 0.66), P < .001); those with higher scores on timeliness of care (AOR = 1.21 (1.09, 1.35), P < .001), higher education attainment (3.21 = AOR (1.50,6.89), P = .003), and impaired mental health status (4.32 = AOR (1.86, 10.1) P < .001) were more likely to use CM. Conclusion(s) Patient‐reported experience with timely care was significantly and positively associated with CM use. Multimorbidity was significantly and inversely associated with CM use. Addressing specific modifiable barriers to timely care along the cancer continuum for elderly localized prostate cancer patients with limited life expectancy could reduce the adverse effects of overtreatment on health outcomes and costs.

show abstract

“…However, in prior work linking clinical registry data to Medicare claims, conservative management as we have defined it identifies patients undergoing active surveillance with high sensitivity (88.2%) and specificity (93.5%), suggesting that most of such cases represent active surveillance. 18…”

Section: Discussionmentioning

confidence: 99%

Practice-Level Adoption of Conservative Management for Prostate Cancer

Modi

Kaufman

Herrel

et al. 2019

JOP

Self Cite

View full text Add to dashboard Cite

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.

show abstract

National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms

Abstract: We describe the performance of claims-based algorithms to identify active surveillance.

Cited by 26 publications

References 25 publications

Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

Factors Associated with Time to Conversion from Active Surveillance to Treatment for Prostate Cancer in a Multi-Institutional Cohort

Associations of multimorbidity and patient‐reported experiences of care with conservative management among elderly patients with localized prostate cancer

Practice-Level Adoption of Conservative Management for Prostate Cancer

Contact Info

Product

Resources

About