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Radiation Oncologist Consultations Prior to Radical Prostatectomy: Disparities and Opportunities

  • Mark T Corkum 1,
  • D Andrew Loblaw 1,
  • Gerard Morton 1,
  • Alexander V Louie 1,
  • Rachel Glicksman 1,
  • Joseph Chin 2,
  • Girish Kulkarni 3,
  • Robert E Dinniwell 4,
  • Barbara Fisher 4,
  • Refik Saskin 5,
  • Jason Pantarotto 6,
  • Andrew Warner 4,
  • George B Rodrigues 4
1 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada 2 Division of Urology, Department of Surgery, Western University, London, Ontario, Canada 3 Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada 4 Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, London, Ontario, Canada 5 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada 6 Division of Radiation Oncology, Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada

Publication: Journal of Urology, August 2021

Purpose

In 2015, men undergoing radical prostatectomy in Ontario were recommended to undergo multidisciplinary care by seeing a radiation oncologist or discussion at multidisciplinary rounds before surgery. The a priori target rate was ≥76%. We used population-based data to explore factors associated with not receiving multidisciplinary care prior to radical prostatectomy.

Materials and Methods

Men who underwent radical prostatectomy for localized prostate cancer in Ontario, Canada between 2007–2017 were identified using administrative data. Physician billings identified patients who received multidisciplinary care. Multivariable logistic regression was used to predict receipt of multidisciplinary care.

Results

31,485 men underwent radical prostatectomy between 2007–2017. 28.7% saw a radiation oncologist, 1.2% underwent multidisciplinary discussion, and 1.9% had both before surgery. Multidisciplinary care receipt increased from 17.8% (2007) to 47.8% (2017), p <0.001. The odds ratio between the highest and lowest geographic regions was 7.93 (95% CI 6.17–10.18, p <0.001). Lower odds of multidisciplinary care receipt were observed for men further from the nearest cancer center (OR 0.74 per 50km, 95% CI 0.71–0.78, p <0.001) and higher odds for the highest versus lowest income quintile (OR 1.41, 95% CI 1.29–1.54, p <0.001). Of 128 urologists who performed ≥10 radical prostatectomies between 2016–2017, 29 (22.7%) met the target of having ≥76% of men seen for multidisciplinary care prior to surgery.

Conclusions

Despite increasing utilization, many men do not receive multidisciplinary care prior to radical prostatectomy. While geography and the urologist appear to be the greatest factors predicting multidisciplinary care receipt, these factors are closely intertwined.