Androgen deprivation therapy overuse still problematic among some urologists

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Inappropriate use of a gonadotropin-releasing hormone agonist for androgen deprivation therapy of localized prostate cancer fell dramatically following implementation of reimbursement cuts mandated by the Medicare Modernization Act of 2003, but overuse remains problematic, according to research presented at the American Society of Clinical Oncology annual meeting in Chicago.

Inappropriate use of a gonadotropin-releasing hormone agonist (GnRHa) for androgen deprivation therapy (ADT) of localized prostate cancer fell dramatically following implementation of reimbursement cuts mandated by the Medicare Modernization Act of 2003 (MMA), but overuse remains problematic, according to research presented at the American Society of Clinical Oncology annual meeting in Chicago.

Overuse is more likely to be practiced by urologists who are in solo practice and those lacking a medical school affiliation and affecting older patients and those in ethnic minority groups, researchers found.

“About 25% of men with localized prostate cancer for whom ADT would not be recommended were still receiving GnRHa treatment in 2005. We were interested in trying to identify characteristics of the physicians involved as a first step toward addressing this problem,” said first author Shellie D. Ellis, MA, PhD, of the University of North Carolina, Chapel Hill.

“Clearly, limiting reimbursement did not uniformly alter practice patterns. Perhaps the reason why solo practitioners and urologists lacking any medical school affiliation were more likely to be overusers is that they are professionally isolated and possibly less likely to be involved in quality improvement activities, which are usually implemented through medical schools or various physician network or institutional groups.”

The study included information for a nationwide group of 2,138 urologists treating nearly 13,000 men with early-stage and lower-grade prostate cancer diagnosed between 2000 and 2007. Characteristics of patients were extracted from SEER-Medicare data, and physician characteristics were identified via matching to American Medical Association physician data.

The majority of urologists (69%) were “static users” who had a low level of overuse in 2000 that remained relatively unchanged throughout the study period; 18% were “decreasing users” who demonstrated the highest level of overuse initially that remained steady until 2004 when it dropped precipitously and remained low; and 13% were “increasing overusers” whose overuse of ADT rose in 2004 and reached a level exceeding the highest users at the start of the study period.

Dr. Ellis and colleagues will now be trying to determine the reasons underlying solo practitioners’ persistent ADT overuse and the best ways to reach out to them with information on ADT effectiveness and risks in order to improve quality of care.

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