Understanding the impact of primary care providers on treatment decisions for men with localized prostate cancer.

Abstract

91 Background: Primary care providers (PCPs) play important roles for cancer patients across the care continuum and may help patients make treatment decisions in line with patients’ preferences. However, the extent of PCP involvement is poorly understood. We evaluated how frequently men with localized prostate cancer discuss treatment with their PCP and whether PCP involvement decreased use of definitive treatment, including among those eligible for surveillance according to clinical guidelines. Methods: We mailed surveys to men diagnosed with localized prostate cancer between 2012 and 2013 in the greater Philadelphia area. Patients reporting having a PCP at the time of diagnosis were asked whether their PCP helped decide how to treat their cancer. Definitive treatment was defined as having radical prostatectomy or radiation therapy. Unadjusted and multivariate logistic regression analyses were used to compare sociodemographic and clinical characteristics of patients who did and did not discuss treatment with their PCP. Similar analyses were used to determine effect of PCP involvement on definitive treatment, both overall and in subgroups of men eligible for surveillance (men > 70 years, with limited life expectancy and with low-risk prostate cancer). Results: 3743 men were mailed a survey, 1757 responded, and 1139 were eligible for analyses. Overall, 438 (38.5%) discussed treatment with their PCP. In adjusted analyses, black men were more likely than white men (Odds Ratio 1.89; 95% Confidence Interval 1.22-2.91) and men with Medicare were more likely than men with private insurance (OR 1.61; 95% CI 1.03-2.51) to discuss treatment with their PCP. However, men who had treatment discussions with their PCP were not less likely to receive definitive treatment (p = 0.11), both overall and among those eligible for surveillance. Conclusions: Though a large proportion of men engaged in treatment discussions with their PCP, these discussions were not associated with differences in the receipt of definitive treatment among men with localized prostate cancer. Understanding the content of these discussions can inform interventions that can help patients make preference concordant treatment decisions.