Specialty bias in treatment recommendations and quality of life among radiation oncologists and urologists for localized prostate cancer
Menée aux Etats-Unis par enquête adressée à 1 366 spécialistes médicaux, radio-oncologues ou urologues, cette étude américaine analyse les biais induits par leur spécialité médicale dans leurs recommandations thérapeutiques pour un cancer localisé de la prostate ainsi que dans leurs perceptions de l'efficacité du traitement en termes d'amélioration de la qualité de vie et de la survie du patient
Background: Given the importance of physician attitudes about different treatments and the quality of life (QOL) in prostate cancer, we performed a national survey of specialists to assess treatment recommendations and perceptions of treatment-related survival and QOL.
Methods: We mailed a self-administered survey instrument to a random sample of 1366 specialists in the US. Respondents were asked for treatment recommendations and survival that varied by PSA levels and Gleason scores and estimate QOL outcomes. Pearson’s chi-square and multivariable regression models were used to test for differences in each outcome.
Results: Response rates were similar for radiation oncologists (52.6%) and urologists (52.3%; P=0.92). Across all risk strata, urologists were more likely to recommend surgery than were radiation oncologists, for conditions ranging from PSA>20 and Gleason score 8–10 (35.2 vs 0.2%; P<0.001) to PSA 4–10 and Gleason score 7 (87.5 vs 20.9%; P<0.001). Radiation oncologists were also more likely to recommend radiation therapy relative to urologists (all P<0.001). From low- to high-risk prostate cancer, radiation oncologists and urologists perceived their treatment as being better for improving survival (all P<0.001). Each specialty also viewed their treatment as having less urinary incontinence (all P<0.001).
Conclusions:Radiation oncologists and urologists both prefer the treatment modalities they offer, perceive them to be more effective and to lead to a better QOL. Patients may be receiving biased information, and a truly informed consent process with shared decision-making may be possible only if they are evaluated by both specialties before deciding upon a treatment course.
Prostate Cancer Prostatic Disease , résumé, 2013