ABSTRACT
BACKGROUND
Practice guidelines recommend bone mineral density (BMD) monitoring for men on androgen deprivation therapy (ADT) for prostate cancer, but single center studies suggest this is underutilized.
OBJECTIVE
We examined determinants of BMD testing in men receiving ADT in a large population-based cohort of men with prostate cancer.
DESIGN
Retrospective cohort study.
PARTICIPANTS
We used the Surveillance, Epidemiology and End-Results (SEER)-Medicare database to identify 84,036 men with prostate cancer initiating ADT from 1996 through 2008.
MAIN MEASURES
Rates of BMD testing within the period 12 months prior to 3 months after initiation of ADT were assessed and compared to matched controls without cancer and to men with prostate cancer not receiving ADT. A logistic regression model was performed predicting use of BMD testing, adjusted for patient demographics, indications for ADT use, year of diagnosis and specialty of the physician involved in the care of the patient.
KEY RESULTS
Rates of BMD testing increased steadily over time in men receiving ADT, diverging from the control groups such that by 2008, 11.5 % of men were receiving BMD testing versus 4.4 % in men with prostate cancer not on ADT and 3.8 % in the non-cancer controls. In the logistic regression model, year of diagnosis, race/ethnicity, indications for ADT use and geographic region were significant predictors of BMD testing. Patients with only a urologist involved in their care were significantly less likely to receive BMD testing as compared to those with both a urologist and a primary care physician (PCP) (odds ratio 0.71, 95 % confidence interval 0.64–0.80).
CONCLUSIONS
There has been a sharp increase in rates of BMD testing among men receiving ADT for prostate cancer over time, beyond rates noted in contemporaneous controls. Absolute rates of BMD testing remain low, however, but are higher in men who have a PCP involved in their care.
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Acknowledgments
Funding
This work was supported by grants from the National Cancer Institute (CA140272) and the American Cancer Society (118244-RSGI-10-076-01-CPHPS).
The sponsors had no role in the design or conduct of the study, in the interpretation of data, or in the preparation of the manuscript.
This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
Conflict of Interest
Dr. Shahinian is a paid consultant for Amgen, Inc.
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Shahinian, V.B., Kuo, YF. Patterns of Bone Mineral Density Testing in Men Receiving Androgen Deprivation for Prostate Cancer. J GEN INTERN MED 28, 1440–1446 (2013). https://doi.org/10.1007/s11606-013-2477-2
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DOI: https://doi.org/10.1007/s11606-013-2477-2