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A. B. Chen 1,2, A. V. D' Amico 2,3, B. A. Neville 2, c. c. Earle 2
1 Harvard Radiation Oncology program, Boston, MA,2 Dana Farber Cancer Center, Boston,MA. 3 Brigham and Women's Hospital,Boston.MA . . ..
Purpose/Objective(s): We assessed the relationship between the provider volume and outcomes following brachytherapy in a population-based cohart of men over the age 65.
MateriaIs/Metbods: We analyzed claims of Medicare-enrolled men over age 65 living in SEER surveillance areas diagnosed with prostate cancer from 1991 -1999 who had brachotberapy as initial treatment Men with T4 or Ml disease were excluded. Recurrences and two-year complications were identified by JCD-9 diagnosis and procedure codes and CPT codes through 2001. Deaths were identified from SEER data through 2002. Brachytherapy case volume was calcu1ated for each radiation oncologist and hospital from 1991-2001. Generalized estimating equations and Cox models were used to evaluate the relationship between provider volume and outcomes following brachytherapy.
Results: We ident 5595 men treated with brachytherapy for whom both a radiation oncologist and hospital provider could be identified. The number of brachytherapy cases performed ranged from 1 to 357 cases for physicians and 1 to 725 cases for hospitals. Men who were older (p = 0.01), non-white (p < 0.01},lower income (p < 0.01), unmarried (p =0.02},living in non-urban areas (p<0.01), or had more comorbidities (p<0.01)were significantly more likly to see lower
volume physicians. After adjusting for patient and treatment covariates, higher physician volume was not associated with a decreased rate of complications (OR = 1.04 per100 cases, p=0.56). However, higher volume hospitals had a slightly lower rate of combined complication diagnoses and procedures (OR = 0.94 per 100 cases, p < 0.01). As shown in the table, men treated by higher volume physicians had lower rates of recurrence (p = 0.01) and prostate cancer death (p = 0.03), and the reduction in all deaths was borderline significant (p = 0:05). There was no significant association between hospital volume and recurrence, prostate cancer death, or any cause death.
Conclusion: Men treated with brachytherapyby higher volume radiationonocologists had a significantly lower risk of recurrence and prostate cancer death, with a borderline reduction in total deaths. We did not observe a clear relationship between provider volume and complications following treatment.
Author Disclosure: A-.B. Chen, Non,e;A.V.D'Amico, None;' B.A. Neville, None; C.C. Earle,
None.
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