Mp13-17 cognitive bias against age in the treatment of patients with intermediate-risk prostate cancer

You have accessJournal of UrologyCME1 May 2022MP13-17 COGNITIVE BIAS AGAINST AGE IN THE TREATMENT OF PATIENTS WITH INTERMEDIATE-RISK PROSTATE CANCER Aaron Brant, Patrick Lewicki, Tenny Zhang, Christina Sze, Jeffrey Johnson, Anise Bowman, Ilon Weinstein, and Jonathan Shoag Aaron BrantAaron Brant More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Tenny ZhangTenny Zhang More articles by this author , Christina SzeChristina Sze More articles by this author , Jeffrey JohnsonJeffrey Johnson More articles by this author , Anise BowmanAnise Bowman More articles by this author , Ilon WeinsteinIlon Weinstein More articles by this author , and Jonathan ShoagJonathan Shoag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002542.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Left-digit bias is a phenomenon in which the leftmost digit of a continuous variable disproportionately influences decision-making. We examined left-digit bias towards age of patients undergoing treatment for intermediate-risk prostate cancer. METHODS: Men aged 65 to 74 years with clinically localized Gleason grade 7 prostate cancer were identified in Surveillance, Epidemiology, and End Results (SEER) and National Cancer Database (NCDB) from 2004 to 2018. Regression discontinuity analysis was used to determine if left digit age change from 69 to 70 was associated with unexpected change in treatment recommendations. Patients with Charlson score 0 were separately evaluated within the NCDB cohort. RESULTS: We identified 115,223 patients from SEER and 198,376 patients from NCDB. In the SEER cohort, discontinuity of -2.4% was observed from age 69 to 70 in patients recommended surgery (95% CI: -4.0 – -0.9%, p=0.02) and 2.8% in patients recommended radiation (95% CI 1.4 – 4.2%, p<0.01). Discontinuity was also observed in the NCDB cohort from age 69 to 70, with a 4.0% decrease in surgery recommendation (95% CI: -5.6 – -2.4%, p<0.01), and a 4.2% increase in radiation recommendation (95% CI: 2.7 – 5.7%, p<0.01). Significant discontinuity remained in NCDB patients with Charlson score 0 (surgery: -4.1%, 95% CI: -5.7 – -2.5%, p<0.01; radiation: 4.3%, 95% CI: 2.5% - 6.1%, p<0.01), and no significant difference in Charlson score was found for age 69 vs. 70 (mean score 0.24 vs. 0.24, p=0.44). CONCLUSIONS: Left digit age change from 69 to 70 is associated with disproportionately increased recommendation for radiation therapy and disproportionately decreased recommendation for surgery in patients with intermediate-risk prostate cancer. Physicians treating patients for prostate cancer should be aware of this cognitive bias. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e228 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Patrick Lewicki More articles by this author Tenny Zhang More articles by this author Christina Sze More articles by this author Jeffrey Johnson More articles by this author Anise Bowman More articles by this author Ilon Weinstein More articles by this author Jonathan Shoag More articles by this author Expand All Advertisement PDF downloadLoading ...