Impact of physician visits on bone density testing in men with prostate cancer who receive androgen deprivation therapy.

Abstract

291 Background: Clinical guidelines for men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) recommend bone mineral density (BMD) monitoring. We examined physician visit patterns following ADT initiation and the implications for follow up BMD testing. Methods: We analyzed linked Surveillance, Epidemiology, and End Results (SEER) & Medicare data for men aged 65+ with incident non-metastatic PC diagnosed during 2007-2009 and receiving ADT for at least 6 months. We examined the proportion of men who visited the following physician types after ADT initiation: urologist, medical oncologist (MO), radiation oncologist (RO), and primary care physician (PCP). Physician contact was measured during 3 time periods: 3 months pre-ADT and 3 months post-ADT (P1); 3-6 months post-ADT (P2); and 6-9 months post-ADT (P3). Multivariable logistic regression models estimated the association between physician visits and BMD testing. Results: The sample included 4,631 men (median age: 75) with non-metastatic PC who received ADT over a median duration of 12 months. During follow-up, 12% received BMD testing, and median time from ADT initiation to BMD testing was 364 days. The proportion who visited any urologist, MO, RO, and PCP during P1 was 97%, 12%, 52%, and 71%. During P2, the proportions dropped to 69%, 9%, 19%, and 53%, respectively, and remained similar in P3. Physician visits during P1 were not associated with BMD testing. During P2, the adjusted odds ratio (95% CI) for BMD testing in men who saw a MO was 1.39 (1.04-1.86). During P3, the AOR (95% CI) was 1.52 (1.15-2.01) in men who saw a MO and 1.23 (1.02-1.49) in men who saw a PCP. Conclusions: In older PC men treated with ADT, physician contact was highest during ADT initiation and decreased over time. Continued contact with physicians following ADT initiation can be beneficial.