National and Regional Patterns of Prostate Brachytherapy Utilization in Relation to The New York Times Brachytherapy Article

Abstract

In June of 2009, The New York Times published a front-page article, exposing the performance of sub-standard prostate brachytherapy (BT) at the Philadelphia Veterans' Administration Hospital. It is widely assumed that this article would have negatively impacted prostate BT utilization as it cast this treatment in a negative light. Our aim was to analyze national and regional patterns of prostate BT utilization in relation to the publication of this article using a large, population-based US database. Using the Surveillance, Epidemiology, and End Results (SEER) database, information was obtained for all patients diagnosed with localized adenocarcinoma of the prostate between 2008 and 2010. Trends in the utilization of prostate BT (with or without external beam radiation) were analyzed by month and year of diagnosis in relation to the date of release of The New York Times BT article at both the national and regional levels. Regional trends were analyzed by focusing on the Northeastern registries (Connecticut and New Jersey). Joinpoint regression analyses were used to determine if there were any changes in trends that were statistically significant. 136,235 patients were identified of which 23,159 (17.0%) resided in Northeastern registries. In total, 33,672 (24.7%) underwent no local treatment, 52,526 (38.6%) underwent prostatectomy, 2,385 (1.8%) underwent local tumor destruction (primarily cryotherapy) and 45,638 (33.5%) underwent radiation treatment. Included in the latter were 16,112 (11.8%) who received BT (10,374 = BT alone and 5,738 = BT with external beam radiation therapy). When analyzing the entire cohort by month and year of diagnosis, BT utilization decreased from 12.3% in June of 2009 to 10.2% in August of 2009, but then increased in September of 2009 (Figure 1). The national utilization of BT decreased 2.6% (from 14.9% to 12.3%) in the 18 months up to and including June of 2009, whereas it decreased 3.7% (from 12.3% to 8.6%) in the 18 months after June of 2009. Joinpoint regression analysis failed to identify any significant turning points in the national trends in BT utilization between 2008 and 2010. When analyzing the Northeastern regional cohort by month and year of diagnosis, BT utilization also decreased from 10.8% in June of 2009 to 7.2% in August of 2009, but then increased in September of 2009 (Figure 1). The regional utilization of BT decreased 1.9% (from 12.7% to 10.8%) in the 18 months up to and including June of 2009, whereas it decreased 4.5% (from 10.8% to 6.3%) in the 18 months after June of 2009. Joinpoint regression analysis also failed to identify any significant turning points in the regional trends in BT utilization between 2008 and 2010. Although The New York Times brachytherapy article may have resulted in a short, two-month decline in national and regional BT utilization and the decline in BT utilization was more pronounced after June of 2009 (particularly among the Northeast regional registries), we were unable to identify any significant turning points in national or regional prostate BT utilization in relation to this article. This patterns of care analysis, nonetheless, reveals that the previously noted decreasing utilization of BT continues into 2010.