Survey Reveals Referral Patterns of PCPs for Prostate Cancer Patients

SAN FRANCISCO—The role of the primary care physician (PCP) is an important facet of a multidisciplinary approach for the management of patients with prostate cancer, according to the results of a web-based survey of practicing PCPs in and around Boston, Massachusetts.

Rajitha Sunkara, MD, and colleagues conducted the survey and reported results during a poster session at the 2014 Genitourinary Cancers Symposium. The poster was titled Primary Care Physician (PCP) Referral Patterns for Prostate Cancer (PC) Patients: A Web-Based Survey.

Prostate cancer is the most common cancer and the second-most common cause of cancer-related death among men. With the rapidly evolving therapeutic options for prostate cancer patients, treatment decisions are becoming increasingly complex. There is evidence that for patients with high-risk prostate cancer, a multidisciplinary approach to disease management leads to improved outcomes.

In addition to a significant role in early detection of prostate cancer, the PCP is important as a provider of counseling, making appropriate referrals, and management of metabolic side effects of androgen deprivation therapy (ADT). To understand current referral patterns of PCPs, the researchers emailed a 10-question web-based survey to approximately 300 PCPs. Of those, 56 responded.

Responses were analyzed using independent t test for demographics and ANOVA for years of experience of the individual physician. Using all independent variables together, additional multivariate analyses were conducted.

Of those responding, 30.3% said they never feel the need to refer a newly diagnosed prostate cancer patient to a medical oncologist; 60.8% said that a urologist should refer patients to a medical oncologist. In addition, only 9% feel responsible for managing the side effects of ADT: 46.4% said a urologist would manage side effects of ADT and 44.6% said an oncologist would.

When asked about providing counseling, female PCPs seemed to be more comfortable with that part of care compared with male PCPs (P=.001).

Male physicians and graduates of US medical schools tend to refer to the medical oncologist most often compared with female physicians and graduates of non-US medical schools (p = 0.013 and p = 0.015, respectively).

In terms of ease with providing counseling and discussing newer treatment options for patients newly diagnosed with prostate cancer, graduates of US medical schools with higher years of experience reported being more comfortable (p = 0.011 and p = 0.016, respectively). Overall, 44.6% of the respondents were not aware of newer treatment options for castration-resistant prostate cancer.

In summary, the researchers commented, “In the era of expanding armamentarium of treatments for prostate cancer, our results indicate the need to increase the awareness of PCPs regarding the available treatments and emphasize the importance of multidisciplinary approach to better serve the prostate cancer patients with appropriate and timely referrals.” 

Source: Sunkara R, Lele U, Soyano A, et al. Primary care physician (PCP) referral patterns for prostate cancer (PC) patients: Web-based survey. Abstract presented at 2014 Genitourinary Cancers Symposium; San Francisco, California. January 31, 2014.