When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment

Archana Radhakrishnan; David Grande; Michelle Ross; Nandita Mitra; Justin Bekelman; Christian Stillson; Craig Evan Pollack

doi:10.3122/jabfm.2017.03.160359

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Figure 1.
Adjusted odds ratio (OR) and 95% confidence interval of receipt of definitive treatment associated with receiving help from the primary care physician among various patient cohorts. All models adjusted for age, race, education, insurance, employment, marital status, and life expectancy, with models for older men and limited life expectancy additionally adjusted for Gleason score and clinical stage. NCCN = National comprehensive Cancer Network.

Tables

Figures

View popup

Table 1.

Demographic and Clinical Characteristics of Patients

Characteristic
Age (years)
Mean (SD)	65.4 (8.3)
<60	567 (24.7)
60–64	459 (20.0)
65–69	570 (24.9)
70–74	363 (15.8)
≥75	318 (13.9)
Missing	17 (0.7)
Race/ethnicity
Non-Hispanic white	1804 (78.6)
Non-Hispanic black	351 (15.3)
Hispanic	41 (1.8)
Non-Hispanic other	26 (1.1)
Missing	72 (3.1)
Education
Less than high school	157 (6.8)
High school graduate	529 (23.1)
Some college	463 (20.2)
College graduate	349 (15.2)
More than college	620 (27.0)
Missing	176 (7.7)
Insurance
Private	1271 (55.4)
Medicaid	67 (2.9)
Medicare	921 (40.1)
None	10 (0.4)
Missing	25 (1.1)
Employment
Unemployed/other	242 (10.6)
Employed	902 (39.3)
Retired	972 (42.4)
Missing	178 (7.8)
Marital status
Single	425 (18.5)
Married	1836 (80.0)
Missing	33 (1.4)
10-Year risk of mortality
<25%	622 (27.1)
25- 50%	747 (32.6)
50–75%	548 (23.9)
≥75%	225 (9.8)
Missing	152 (6.6)
Gleason score	6.8 (0.89)
<7	909 (39.6)
7	920 (40.1)
>7	400 (17.4)
Missing	65 (2.8)
Clinical tumor stage
1	1642 (71.6)
2	558 (24.3)
3	51 (2.2)
Missing	43 (1.9)
Definitive treatment
Yes	1825 (79.6)
No	364 (15.8)
Missing	105 (4.6)
Treatment
Surgery	1175 (51.2)
Radiation therapy	680 (29.6)
Hormone therapy	309 (13.5)

Data are n (%) of patients unless otherwise indicated.
SD, standard deviation.

View popup

Table 2.

Bivariate and Multivariable Analyses of Patient Characteristics Associated with Receiving Help from the Primary Care Physician Regarding Treatment

	Received Help from the PCP, n (%)		P Value^*	Adjusted Model,^{^†} Odds Ratio (95% CI)	P Value
	No	Yes	P Value^*	Adjusted Model,^{^†} Odds Ratio (95% CI)	P Value
Total	1375 (59.9)	876 (38.2)
Age (years)			.24
<60	340 (24.8)	220 (25.3)		Reference
60–64	276 (20.1)	175 (20.1)		0.96 (0.72–1.27)	.77
65–69	363 (26.4)	200 (23.0)		0.75 (0.51–1.09)	.13
70–74	220 (16.0)	141 (16.2)		0.78 (0.51–1.19)	.25
≥75	175 (12.7)	135 (15.5)		0.85 (0.55–1.35)	.50
Race/ethnicity			<.001
Non-Hispanic white	1144 (85.1)	637 (75.3)		Reference
Non-Hispanic black	167 (12.4)	177 (20.9)		1.76 (1.37–2.27)	<.001
Hispanic	20 (1.5)	20 (2.4)		1.72 (0.91–3.28)	.10
Non-Hispanic other	13 (1.0)	12 (1.4)		1.48 (0.68–3.22)	.33
Education			.04
Less than high school	75 (5.9)	73 (9.1)		Reference
High school graduate	316 (24.8)	205 (25.6)		0.86 (0.61–1.26)	.48
Some college	275 (21.6)	179 (22.3)		0.92 (0.63–1.36)	.69
College graduate	214 (16.8)	127 (15.8)		0.97 (0.64–1.46)	.87
More than college	396 (31.0)	218 (27.2)		0.91 (0.62–1.32)	.62
Insurance			.28
Private	783 (57.5)	469 (54.3)		Reference
Medicaid	34 (2.5)	31 (3.6)		0.87 (0.50–1.50)	.61
Medicare	539 (39.6)	361 (41.8)		1.04 (0.82–1.33)	.74
None	6 (0.4)	3 (0.4)		0.66 (0.16–2.70)	.56
Employment			<.001
Unemployed/other	117 (9.2)	116 (14.5)		Reference
Employed	579 (45.3)	309 (38.6)		0.75 (0.54–1.04)	.09
Retired	581 (45.5)	376 (46.9)		0.83 (0.59–1.14)	.24
Marital Status			.08
Single	241 (17.7)	179 (20.7)		Reference
Married	1122 (82.3)	688 (79.4)		1.03 (0.81–1.30)	.84
10-Year mortality risk			<.001
<25%	395 (30.3)	221 (27.3)		Reference
25–50%	486 (37.2)	250 (30.9)		1.10 (0.79–1.54)	.54
50–75%	299 (22.9)	244 (30.1)		1.62 (1.11–2.36)	.01
≥75%	125 (9.6)	95 (11.7)		1.36 (0.87–2.13)	.18
Gleason score			.73
≤6	554 (41.3)	336 (39.6)		Reference
7	549 (40.9)	359 (42.3)		1.03 (0.84–1.25)	.77
>7	238 (17.8)	153 (18.0)		1.03 (0.80–1.34)	.80
Clinical tumor stage			.92
1	984 (72.8)	627 (73.0)		Reference
2	335 (24.8)	214 (24.9)		0.99 (0.80–1.22)	.93
3	32 (2.4)	18 (2.1)		0.88 (0.48–1.62)	.68

↵* χ² Test.
↵† Imputed data, adjusted for age, race, education, insurance, employment, marital status, life expectancy, Gleason score, and clinical stage.
CI, confidence interval.

View popup

Appendix Table 1.

Demographic and Clinical Characteristics of Responders and Non-Responders

Characteristic	Responders N (%) n = 2386	Non-responders N (%) n = 2286	P-value^*
Age (years)			0.044
<60	704 (29.5)	712 (31.2)
60–64	511 (21.4)	492 (21.5)
65–69	559 (23.4)	464 (20.3)
70–74	349 (14.6)	323 (14.1)
≥75	263 (11.0)	294 (12.9)
Missing	0 (0.0)	1 (0.0)
Race/ethnicity			<0.0001
Non-Hispanic White	1850 (77.5)	1405 (61.5)
Non-Hispanic Black	391 (16.4)	691 (30.2)
Hispanic	32 (1.3)	88 (3.9)
Non-Hispanic Other	0 (0.0)	0 (0.0)
Missing	113 (4.7)	102 (4.5)
Insurance			0.058
Private	1310 (54.9)	1198 (50.9)
Medicaid	73 (3.1)	102 (4.5)
Medicare	958 (40.2)	921 (40.3)
None/Other	19 (0.8)	20 (0.9)
Missing	26 (1.1)	45 (2.0)
Gleason score			0.317
<7	944 (39.6)	901 (39.4)
7	953 (39.9)	896 (39.2)
>7	414 (17.4)	348 (15.2)
Missing	75 (3.1)	141 (6.2)
Clinical tumor stage			0.446
Stage 1	1706 (71.5)	1649 (72.1)
Stage 2	574 (24.1)	514 (22.5)
Stage 3	58 (2.4)	62 (2.7)
Missing	48 (2.0)	61 (2.7)
Treatment
Surgery	1230 (51.6)	1053 (46.1)	0.496
Missing	386 (16.2)	543 (23.8)
Radiation therapy	703 (29.5)	602 (26.3)	0.539
Missing	399 (16.7)	537 (23.5)
Hormone therapy	326 (13.7)	319 (14.0)	0.122
Missing	423 (17.7)	566 (24.8)
Active Treatment			<0.001
No	393 (16.5)	567 (24.8)
Yes	1897 (79.5)	1620 (70.9)
Missing	96 (4.0)	99 (4.3)