The commenter raises several potential limitations of the study that we feel require
clarification. First, we share the concern regarding the association between financial
incentives and patient care decisions. This association was demonstrated previously.
1
Second, this study included all Medicare beneficiaries who were newly diagnosed with
prostate cancer and not limited to those treated by a urologist. As such, this provides
a reasonable approximation of the population of men with newly diagnosed prostate
cancer, as most such men are Medicare beneficiaries. Finally, while this data does
not consider grade and stage, there is no compelling reason to suspect that these
factors will systematically vary among practice types. Indeed, that intuition was
confirmed in Hollenbeck et al using SEER-Medicare data with cancer stage and grade
data.
1
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Reference
- Urologist practice affiliation and intensity-modulated radiation therapy for prostate cancer in the elderly.Eur Urol. 2018; 73: 491-498https://doi.org/10.1016/j.eururo.2017.08.001
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