Blacks Less Likely to Undergo Definitive Prostate Cancer Therapy

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Study of men with intermediate- or high-risk prostate cancer finds facility-level racial disparity in use of definitive treatment.
Study of men with intermediate- or high-risk prostate cancer finds facility-level racial disparity in use of definitive treatment.

At most US medical facilities, white men are more likely than black men to receive definitive therapy for intermediate- or high-risk prostate cancer (PCa), according to a new study.

Researchers said their findings suggest that current PCa mortality differences between white and black men may be partially the result of “within” hospital quality of care variation rather than geographic “between” hospital disparities.

Using the National Cancer Data Base, researchers identified 223,873 white men and 59,262 black men aged 40 years or older receiving care at a US facility for biopsy confirmed localized intermediate- or high-risk PCa from January 2004 to December 2013. Results showed that 83% of whites received definitive therapy compared with 74% of blacks during the study period, David F. Friedlander, MD, and Quoc-Dien Trinh, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston, and colleagues reported online ahead of print in European Urology. In addition, 39% of treating facilities showed significantly higher rates of definitive therapy among white men compared with just 1% favoring black men. After adjusting for sociodemographic and clinical factors, most facilities favored definitive therapy for white versus black patients, the investigators reported.

The effect of race on receipt of definitive therapy varied in subgroup analyses, especially by treating facility region. Compared with black men, for example, white men receive care at a facility in the South Atlantic region had 1.69-fold greater odds of receiving definitive therapy.

“These findings have major implications for ongoing efforts by federal health care agencies and national cancer organizations aimed at reducing racial disparities in both overall treatment rates and outcomes,” the investigators concluded. Ultimately, they added, such variation may partially explain the inferior survival data among black men receiving PCa care.

The researchers said their study appears to be the first to examine individual facility-level variation among white and black men.

The investigators found a number of nonclinical factors predicted receipt of definitive therapy, including income level and insurance type. “Individuals with lower income and public insurance were less likely to undergo definitive therapy.” The authors cited a study of Surveillance, Epidemiology and End Results (SEER) data, which was published in Urologic Oncology (2015;33:18e7-18), demonstrating a significant interaction effect between income level and race as evidenced by a more profound racial disparity among black men in the bottom quintile income quintile versus the top quintile. “While we attempted to control for the aforementioned interaction between race and socioeconomic status,” Dr Friedlander's team wrote, “these findings suggest that insurance status and income level likely exert some level of effect modification on race as a predictor of definitive PCa therapy.”

Reference

Friedlander DF, Trinh QD, Krasnova A, et al. Racial disparity in delivering definitive therapy for intermediate/high-risk localized prostate cancer: The impact of facility features and socioeconomic characteristics. Eur Urol 2017; published online ahead of print.

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