Prostate cancer patients treated in county hospitals are likely to undergo surgery while patients treated in private facilities tend to receive radiation or hormone therapy. Those are the findings of a new study published in Cancer. The study suggests that prostate cancer patients’ treatment decisions are influenced by the type of health care facility where they receive care.

Surgery, radiation, and hormone therapy are the most common treatments for localized prostate cancer. Each is associated with different advantages and disadvantages, and no one option has proven to be more optimal than the others. What factors, then, drive prostate cancer patients’ treatment decisions? Although life expectancy, other illnesses, cancer severity, and patient preferences may account in part for treatment choices, variables that determine treatment among patients who are comparably healthy and who have similar stages of cancer remain unclear.

To investigate, J. Kellogg Parsons, MD, MHS of the Moores Comprehensive Cancer Center at the University of California San Diego and the VA Medical Center San Diego and colleagues at the University of California Los Angeles compared the types of treatments prostate cancer patients received from public and private hospitals as part of a California public assistance program. The 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, 315 (56 percent) of the study participants received treatment from county hospitals and 244 (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 (35 percent vs 10 percent) and less likely to undergo surgery (29 percent vs 54 percent). Patients treated in private facilities were nearly two and a half times more likely than those treated in county hospitals to receive radiation and over four and a half times more likely to initially receive hormone therapy instead of surgery.

While the reasons for these differences in treatment decisions are not known, the type of doctor that patients see may play a role. At county hospitals, patients were initially under the care of urologists, while the initial providers at private facilities were a mix of urologists, radiation oncologists, and medical oncologists. Although all of the IMPACT patients were offered second opinions after diagnosis, the researchers were unable to assess how many, if any, obtained them. The authors noted that clinicians should work to ensure that prostate cancer patients receive access to more than one specialist so as to minimize treatment counseling bias.

"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 health care for underserved, poor populations," said Dr. Parsons.

Source Article:"Prostate cancer treatment for economically disadvantaged men: a comparison of county hospitals and private providers." J. Kellogg Parsons, Lorna Kwan, Sarah E. Connor, David C. Miller, and Mark S. Litwin. CANCER; Published Online: January 25, 2010 

DOI: 10.1002/cncr.24856