• Proton vs. intensity-modulated radiotherapy for prostate cancer

    Last week, when I posted about this new study I didn’t have access to it. It wasn’t online and all I had to go on was a Wall Street Journal article.

    In a finding likely to add fuel to the debate over treatments for prostate cancer, proton-beam therapy provided no long-term benefit over traditional radiation despite far higher costs, according to a study of 30,000 Medicare beneficiaries published Thursday in the Journal of the National Cancer Institute. […]

    Critics long have cited proton-beam therapy as a costly new technology with no proven advantage. Medicare pays over $32,000 per patient for proton therapy, compared with under $19,000 for radiation, according to the study.

    The paper is available now. You can click through for the abstract and, if you have privileges, you can get the entire article. For reasons pertaining to my own work, the following technical details are of interest to me:

    Using insights from prior studies investigating Medicare claims for prostate cancer treatment-related toxicity (17–22), we rigorously compiled a list of potential treatment-related toxicity (Supplementary Table 1, available online), specifically excluding codes that were thought to be due to surgical complications. We searched claims for Healthcare Common Procedure Coding System or International Classification of Diseases, 9th revision diagnosis or procedure codes associated with the following categories of toxicity, which were constructed a priori: genitourinary (infection, upper urinary tract dysfunction, urethral stricture/ obstruction, incontinence, erectile dysfunction); gastrointestinal (fistula, rectal repair, stenosis, bowel resection, other); and other toxicity (local musculoskeletal damage, red blood cell transfusion, systemic derangements, infection, nerve injury, and fractures). Some codes may be indicative of preexisting conditions and be unrelated to treatment; if a patient had one of these codes after treatment but also had evidence of the code in the 9 months prior to treatment, we did not count it as a complication. Our outcome was whether a patient had a complication between 0 and 6 months or 0 and 12 months after start of treatment.

    References

    17. Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346(15):1138–1144.

    18. Bekelman JE, Mitra N, Efstathiou J, et al. Outcomes after intensity-modulated versus conformal radiotherapy in older men with nonmetastatic prostate cancer. Int J Radiat Oncol Biol Phys. 2011;81(4):e325–e334.

    19. Potosky AL, Warren JL, Riedel ER, Klabunde CN, Earle CC, Begg CB. Measuring complications of cancer treatment using the SEER-Medicare data. Med Care. 2002;40(8 Suppl):IV-62–8.

    20. Berge V, Thompson T, Blackman D. Additional surgical intervention after radical prostatectomy, radiation therapy, androgen-deprivation therapy, or watchful waiting. Eur Urol. 2007;52(4):1036–1043.

    21. Chen AB, D’Amico AV, Neville BA, Earle CC. Patient and treatment factors associated with complications after prostate brachytherapy. J Clin Oncol. 2006;24(33):5298–5304.

    22. H u JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL. Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol. 2008;26(14):2278–2284.

    @afrakt

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