Did Medicare Reimbursement Changes Affect Prostate Cancer Treatment?

In an accompanying editorial in the journal, Dr. Gerald W. Chodak, director of the Midwest Prostate and Urology Health Center in Chicago, wrote that "changing a recommendation to a patient from an LHRH agonist to surgical castration solely for economic reasons is ethically inappropriate."

"However," he added, "asking urologists to take a financial loss while treating patients also is inappropriate."

Chodak said doctors should be totally honest with patients, making them aware of their choices in prostate cancer treatment.

Dr. Ethan Basch, an assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City, called the new study an interesting but incomplete picture.

"The trend is probably real, but I feel the study doesn't get in as deep as one would want and show what's really going on," he said. "What we don't have is information on the number of people affected."

What's also not known are the characteristics of the specific patients in the study, Basch said. "Either the treatment is more consistent with medical guidelines, or people who were being appropriately treated before are no longer getting it. We can't tell from this paper. It's very important that we have more detailed information about the patients themselves," he said.

Another report in the same issue of the journal had encouraging news. It showed increased life expectancy for people with late-stage testicular, colorectal and ovarian cancer. Treatment improvements have increased life expectancy by two years for ovarian cancer, 2.8 years for colorectal cancer, and 24 years for testicular cancer, with the testicular cancer gains largely due to an increase in the cure rate from 23 percent to 81 percent, according to the study by researchers at the U.S. National Cancer Institute.

More information

An overview of prostate cancer and its treatment is given by the American Cancer Society.

SOURCES: J. Stephen Jones, M.D., chairman of regional urology, Cleveland Clinic; Ethan Basch, M.D., assistant attending physician, Memorial Sloan-Kettering Cancer Center, New York City; May 15, 2008,Cancer