Rural Medicare patients less likely to undergo penile prosthesis implantation following radical cystectomy.

INTRODUCTION Erectile dysfunction is common after radical cystectomy; however, research on sexual dysfunction after this procedure is relatively scarce. Our goal was to evaluate the incidence of penile prosthesis implantation after radical cystectomy, with a focus on rural/urban disparity. MATERIALS AND METHODS: We used the SEER-Medicare database to identify patients with bladder cancer diagnosed between 1991-2009 who had a radical cystectomy (ICD-9 codes 57.7, 57.71, 57.79). The outcome was placement of a penile implant (ICD-9 codes 64.95 and 64.97). Covariates extracted included rural county status, age, race, ethnicity, marital status, geographic region, socioeconomic status, Charlson comorbidity, pathologic cancer stage, and type of urinary diversion. RESULTS: A total of 95 penile implants were performed in the 11,477 cystectomy patients (0.83%). Patients who had a penile implant were mostly from urban counties (85.1%) and in the Western region of the United States (83.9%). After controlling for covariates, rural patients who underwent an ileal conduit for urinary diversion were less likely to have a penile prosthesis procedure after radical cystectomy. CONCLUSIONS: Penile prosthetic procedures are uncommon in bladder cancer patients who have undergone radical cystectomy; therefore, sexual health should be considered and discussed with patients after radical cystectomy.

30-day all-cause hospital readmission after cystectomy: no worse for rural Medicare residents.

OBJECTIVE: To evaluate rural/urban disparities in 30-day all-cause hospital admission after cystectomy. MATERIALS AND METHODS: We used the SEER-Medicare database to identify all Medicare beneficiaries who underwent radical cystectomy (ICD-9 codes 57.7, 57.71, 57.79, and 68.8) between the years 1991 and 2009, yielding a total sample size of 15,572. Our primary outcome was 30-day hospital readmission rate. Rural Urban Continuum Codes were used to designate county-level rural status based on patient residence. Location of surgery was not a variable considered in this analysis. A multivariable regression model was constructed with demographic and clinical variables as covariates. RESULTS: A total of 2,003 rural and 2,904 urban patients (31.1% vs. 31.8%, P = 0.33) were readmitted within 30 days of discharge. In the multivariable model, older age, unmarried status, lower socioeconomic status, higher Charlson comorbidity score, shorter index admission hospital stay, and discharge to a skilled nursing facility were associated with higher odds of readmission. The variables for gender, race, cancer stage, tumor grade, and type of urinary diversion were not significant. The odds ratio for readmission was not significant for patients from rural counties in the final model. CONCLUSIONS: Rural Medicare residents were not at higher risk for 30-day all-cause hospital readmission after cystectomy after accounting for various demographic and clinical variables.

Proton therapy for prostate cancer online: patient education or marketing?

INTRODUCTION: Proton therapy (PT) for prostate cancer is an expensive treatment with limited evidence of benefit over conventional radiotherapy. We sought to study whether online information on PT for prostate cancer was balanced and whether the website source influenced the content presented. MATERIALS AND METHODS: We applied a systematic search process to identify 270 weblinks associated with PT for prostate cancer, categorized the websites by source, and filtered the results to 50 websites using predetermined criteria. We then used a customized version of the DISCERN instrument, a validated tool for assessing the quality of consumer health information, to evaluate the remaining websites for balance of content and description of risks, benefits and uncertainty. RESULTS: Depending on the search engine and key word used, proton center websites (PCWs) made up 10%-47% of the first 30 encountered links. In comparison, websites from academic and nonacademic medical centers without ownership stake in proton centers appeared much less frequently as a search result (0%-3%). PCWs scored lower on DISCERN questions compared to other sources for being balanced/unbiased (p < 0.001), mentioning areas of uncertainty (p < 0.001), and describing risks of PT (p < 0.001). PCWs scored higher for describing the benefits of treatment (p = 0.003). CONCLUSIONS: Patients should be aware that online information regarding PT for prostate cancer may represent marketing by proton centers rather than comprehensive and unbiased patient education. An awareness of these results will also better prepare clinicians to address the potential biases of patients with prostate cancer who search the Internet for health information.