Originally published as JCO Early Release 10.1200/JCO.2005.08.755 on October 3 2005

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Krupski, T. L. Articles by Litwin, M. S. Search for Related Content PubMed PubMed Citation Articles by Krupski, T. L. Articles by Litwin, M. S.

Geographic and Socioeconomic Variation in the Treatment of Prostate Cancer

From the Department of Urology, David Geffen School of Medicine; Departments of Health Services and Biostatistics, School of Public Health; and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA

Address reprint requests to Tracey L. Krupski, MD, MPH, Duke University Health System, Box 3707, Durham, NC 22710; e-mail: krups001E{at}mc.duke.edu

PURPOSE: Within a framework of quality assessment, primary treatment choice constitutes an indicator of quality of care. This study examines geographic and socioeconomic variation in the primary treatment of men with prostate cancer during the era of prostate-specific antigen testing.

METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results public use data files, we identified men with localized/regional prostate cancer who underwent surgery, radiation therapy, or watchful waiting. We used the year 2000 US Census information to ascribe education and income levels to these men based on their county of residence and ethnicity.

RESULTS: Among the 96,769 men with localized/regional prostate cancer (during 1995 to 1999) who had sufficient information for analysis, we observed significant geographic variation nationwide in surgical, radiation, and watchful waiting treatment rates (P <.0015). Patterns noted 10 years ago, such as higher surgical rates in western regions, persisted. Ethnicity, income, and grade were all independently associated with primary treatment, or lack thereof. Blacks and low-income patients had the lowest rates of surgery and radiation. Grade was the best predictor of aggressive treatment.

CONCLUSION: Nonclinical factors, such as ethnicity and income, were associated with the use of watchful waiting rather than surgery or radiation in men with early-stage prostate cancer. These findings have implications for quality of care.

Supported by a grant from the American Foundation for Urologic Disease/American Urological Association Research Scholar Program.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				L. W. D'Avolio, M. S. Litwin, S. O. Rogers Jr., and A. A.T. Bui Facilitating Clinical Outcomes Assessment through the Automated Identification of Quality Measures for Prostate Cancer Surgery J. Am. Med. Inform. Assoc., May 1, 2008; 15(3): 341 - 348. [Abstract] [Full Text] [PDF]

				J. J. Griggs, E. Culakova, M. E.S. Sorbero, M. van Ryn, M. S. Poniewierski, D. A. Wolff, J. Crawford, D. C. Dale, and G. H. Lyman Effect of Patient Socioeconomic Status and Body Mass Index on the Quality of Breast Cancer Adjuvant Chemotherapy J. Clin. Oncol., January 20, 2007; 25(3): 277 - 284. [Abstract] [Full Text] [PDF]