Impact of Left-digit Age Bias in the Treatment of Localized Prostate Cancer.

Left-digit bias is a phenomenon in which the leftmost digit of a number disproportionately influences decision-making. We measured the effect of left-digit age bias on treatment recommendations for localized prostate cancer.

We included men with clinically localized prostate adenocarcinoma in Surveillance, Epidemiology, and End Results (SEER) from 2004 to 2018 and National Cancer Database (NCDB) from 2004 to 2016. Primary outcomes were recommendations for radiation therapy and radical prostatectomy. Regression discontinuity was used to assess whether age increase from 69 to 70 years was associated with disproportionate changes in treatment recommendations.

In SEER, discontinuities were found in the proportion of patients recommended for radiation among the entire cohort (effect size 2.2%, p<0.01) and among patients with Gleason 6 (1.6%, p<0.01), Gleason 7 (2.5%, p<0.01), and Gleason ≥8 (2.1%, p<0.01) cancer, while the proportion recommended for prostatectomy decreased in the entire cohort (-1.4%, p<0.01) and in patients with Gleason 7 cancer (-2.4%, p<0.01). In NCDB, discontinuity from age 69 to 70 was found in recommendations for radiation in the entire cohort (effect size: 3.1%, p<0.01) and in patients with Gleason 6 (2.2%, p<0.01), Gleason 7 (4.0%, p<0.01), and Gleason ≥8 (2.3%, p<0.02) cancer, while the proportion recommended for prostatectomy decreased at this cutoff in the entire cohort (effect size: -2.7%, p<0.01) and patients with Gleason 6 (-2.2%, p<0.01) and Gleason 7 (-3.7%, p<0.01) cancer.

In patients with localized prostate cancer, left-digit age change from 69 to 70 was associated with disproportionately increased recommendations for radiation and decreased recommendations for prostatectomy.

The Journal of urology. 2022 Jul 28 [Epub ahead of print]

Aaron Brant, Patrick Lewicki, Xian Wu, Christina Sze, Jeffrey P Johnson, Spyridon P Basourakos, Camilo Arenas-Gallo, Daniel Shoag, Christopher E Barbieri, Nicholas G Zaorsky, Jonathan E Shoag

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA., Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA., Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA., Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

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