University Reporter

by Leigh DuPuy

How should a patient evaluate treatment options? Get a second opinion from different specialists, urges Dr. Floyd J. (Jack) Fowler in his recent study published in The Journal of American Medical Association on June 28. In their paper, "Comparison of Recommendations by Urologists and Radiation Oncologists for Treatment of Clinically Localized Prostate Cancer," Fowler and his coauthors examine physician perspectives affecting treatment decisions.

The paper surveyed a national sample of urologists and radiation oncologists on their perceptions of prostate cancer treatments. In a choice between two aggressive treatments, specialists most commonly recommended the treatment with which they had the most experience, urologists suggesting prostate surgery and radiation oncologists suggesting radiation.

"It is clear the advice patients receive will depend on whom they talk with," Fowler explains. "When there is more than one way to treat a condition, many patients will not get a balanced picture of treatment options, their harms and benefits."

The hazards of relying too much on the recommendation of one kind of specialist become obvious with prostate cancer. There is no clear evidence in clinical trials that either approach is effective or more effective in treating prostate cancer. What is clear are the risks associated with both procedures. Incontinence and impotence are common side effects many patients experience, particularly with surgery.

"These treatments offer uncertain benefits with known risks," explains Fowler. "Patients need to be aware of all medical treatments and should be heavily involved and informed about their medical choices."

The study urges patients to seek the opinions of different specialists to evaluate treatment options. Patients then can examine the risks with each option and decide which best fits their own preference. Studies have shown that patients who make their own treatment decisions fare better and feel more in control of their health.

Variation in the way physicians practice medicine is a prominent theme throughout Fowler's work. "Geography is destiny. A patient receives different treatments for the same problem in different parts of the country," Fowler points out, "I have always been fascinated in how physicians think about problems and how treatment decisions are made."

Fowler has been studying the diagnosis and treatment of prostate cancer for ten years. A Senior Research Fellow with the Center for Survey Research and a survey methodologist, Fowler was responsibly for the survey instrument design and worked with the Center to implement data collection.

Fowler collaborated with coauthors from Massachusetts General Hospital and Dartmouth Medical School, a group that included a urologist, radiation oncologist, and two primary care physicians. "One of the project's biggest challenges," Fowler comments, "was writing the paper that accurately conveyed the divergence of opinion in how to treat prostate cancer, without being critical of anyone's point of view."

The fifth author of the paper was Diana Elliot, a UMass graduate and Center employee. In her role, Diana managed data collecting, coding of data, and data analysis. Dr. Fowler notes, "She was an integral part of the project." Diana will use her experience in her next venture, pursuing a Ph.D. in sociology at the University of Maryland in September.

The paper received substantial attention in the media, drawing inquiries from the Associated Press, Wall Street Journal, New York Times, National Public Radio, Newsday, along with numerous medical websites including: webmed.com, drkoop.com, Reuters Health, and Healthscout.com.

Prostate Cancer Study Examines Treatment Decisions by Doctors

by Leigh DuPuy