Integrated urology-radiation oncology (URO) practices in Texas may require patients to drive nearly 1,500 additional miles over a treatment course, compared with non-URO practices, according to a study published online August 15 in International Journal of Radiation Oncology•Biology•Physics . The findings prompted the scathing editorial comment: “To do nothing to stop the UROs, given the rising tide of data, would be an injustice to the care of cancer patients.”
Proponents of UROs claim that the model improves community-based cancer care by combining urologic and radiation care in a single practice. On the other hand, critics charge the model incentivizes urologists to recommend IMRT over treatment options that cost less, including prostatectomy, brachytherapy and active surveillance. “Recent data appear to suggest that [URO] arrangements lead to overutilization and overtreatment,” wrote Louis Potters, MD, from the department of radiation medicine at North Shore-LIJ Health System in New Hyde Park, N.Y., in an editorial accompanying the study.
Pavan M. Jhaveri, MD, from the section of radiation oncology at Baylor College of Medicine in Houston, and colleagues aimed to assess the presence and impact of such practices in Texas and how they affected patient travel time.
The researchers conducted a telephone survey of 229 urology practices in Texas and found that 5 percent offered radiation oncology services, and 53 percent of the state’s population lives within 10 miles of these centers. A total of 28 percent of Texas urologists work in practices that self-refer for radiation oncology services.
The 12 URO practices employ a hub-and-spoke configuration with multiple urologic clinics and one radiation oncology treatment center. This often resulted in extended travel times because radiation therapy is not available at the same physical location as the urologic clinic where the patient was initially diagnosed, according to the researchers. The mean patient travel distance was found to be 19.7 miles (26.11 minutes) to the urology-owned center versus 5.88 miles (9.15 minutes) to the nearest radiation oncology center.
“Travel time to cancer care centers is crucial, especially for older men with advanced disease, because external radiation therapy often requires daily treatment for six to eight weeks. These patients often need to lean on friends and relatives to help them get to and from these multiple appointments. We must be judicious when proposing treatment options to our patients and appreciate the time and travel investment, including significant transportation and fuel costs, they make when choosing radiation therapy,” said Colleen Lawton, MD, president-elect of American Society for Radiation Oncology.
Jhaveri et al noted two areas for further study: the extent to which the lack of physical integration may curb benefits of the integrated model and the potential effect of increased patient driving time on the perceived convenience of the model.