Cancer: Prostate cancer treatment varies at county vs. private hospitals

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Researchers have found that prostate cancer treatments varied significantly between county hospitals and private providers. Patients treated in county hospitals are more likely to undergo surgery while patients treated in private facilities tend to receive radiation or hormone therapy, based on study findings published online Jan. 25 in Cancer.

"The study examined the factors that drive treatment choices for patients with prostate cancer," said principal investigator J. Kellogg Parsons, MD, an urologic oncologist at Moores Cancer Center at the University of California, San Diego. "We found that decisions are significantly influenced by the type of healthcare facility where they receive care."

Surgery, radiation and hormone therapy are the most common treatments for localized prostate cancer, the authors found. Each is associated with different risks and benefits with no consensus as to the most effective form of treatment, though life expectancy, other illnesses, cancer severity and patient preferences may account in part for treatment choices.

Parsons and colleagues compared the types of treatments prostate cancer patients received from public and private hospitals as part of a California public assistance program. Researchers analyzed the care provided to 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT).

Between 2001 and 2006, the researchers found that 56 percent of the study participants received treatment from county hospitals and 44 percent received care from private facilities. While tumor characteristics were similar in each group, patients treated in private facilities were more likely than those treated in county hospitals to be white and less likely to undergo surgery.

Specifically, patients treated in private facilities were nearly two-and-a-half times more likely than those treated in county hospitals to receive radiation and more than four-and-a-half times more likely to initially receive hormone therapy instead of surgery, according to the authors.

While the reasons for these differences in treatment decisions are not known, the type of doctor that patients see may play a role, Parsons said. At county hospitals, patients were initially under the care of urologists, while the initial providers at private facilities represented urologists, radiation oncologists and medical oncologists.

"The fact that prostate cancer patients are treated differently based on the type of hospital has implications for health policy, quality of care and equality of care—particularly because public hospitals are funded by city and state governments to provide healthcare for underserved, poor populations," said Parsons.

After skin malignancies, prostate cancer is the most commonly diagnosed cancer, and the second leading cause of cancer death among U.S. men.