Refusal of recommended first-line chemotherapy for metastatic prostate cancer occurs more often among Black than White men, investigators reported at the American Urological Association’s 2023 Annual Meeting in Chicago, Illinois.
Among 102,411 men with metastatic prostate cancer from the 2004-2020 National Cancer Database, 5.6% of non-Hispanic Black patients and their caregivers refused first-line chemotherapy compared with 2.3% of non-Hispanic White patients and their caregivers, Catherine Gu, MD, of Brigham and Women’s Hospital in Boston, Massachusetts, reported on behalf of her team. The investigators found no significant differences between racial groups in acceptance of first-line hormone therapy (1.4% vs 1.3%) or immunotherapy (3.3% vs 3.2%).
In an interview, Dr Gu suggested that the health disparity in care may be due to the logistical challenges of chemotherapy and its stigmatizing side effects.
“Chemotherapy treatment for prostate cancer, such as docetaxel, typically involves 6 cycles administered every 21 days for 18 weeks,” Dr Gu said. “The demanding schedule can present challenges for patients such as transportation difficulties, time off from work, and side effects including hair loss, fatigue, nausea, and vomiting. Chemotherapy may be a less attractive treatment option compared to hormone therapy administered as pills or injections or immunotherapy administered over a shorter period, such as sipuleucel-T.”
Dr Gu suggested that clinicians need to work to establish trust and rapport with their patients and address concerns or fears that may be driving treatment refusal. Clinicians also need to understand the cultural and social factors that may influence a patient’s decision-making process.
“This can be particularly important for Black patients who may face systemic barriers to health care access and experience mistrust towards the healthcare system,” Dr Gu said.
Dr Gu suggested that clinicians refer patients to navigators and social workers who can explain the healthcare system and schedule appointments, arrange transportation to medical appointments, and address financial barriers.
For treatment-related education and support, Dr Gu recommended resources from cancer organizations such as the American Cancer Society and Prostate Cancer Foundation.
Black men were more likely to have a low income, be uninsured, and have a higher burden of metastasis at diagnosis compared with White men. In multivariable logistic regression, the investigators accounted for age, insurance coverage, Charlson comorbidity index, census tract median income, metastatic burden, year of diagnosis, facility type, and location of care.
The findings of Dr Gu’s team coincide with the release of a new meta-analysis of 24 studies totaling 683,749 patients showing that Black patients with cancer have 71% greater odds of cardiotoxicity following chemotherapy compared with White patients. The meta-analysis, which was presented at the Advancing the Cardiovascular Care of the Oncology Patient 2023 conference sponsored by the American College of Cardiology (ACC), also found that Black patients with cancer have 92% greater odds of a congestive heart failure diagnosis.
“For clinicians, it is important to be aware of these higher odds of cardiotoxicity faced by Black patients,” the study’s lead author, Wondewossen Gebeyehu, BSc, of the University of Toronto in Canada, stated in an ACC news release. “Understanding these disparities will hopefully lead to clinicians having more conversations around reducing cardiovascular risk associated with chemotherapy and targeted efforts to cater to groups at higher risk.”
The recent removal of the race coefficient from kidney function equations may render some Black patients ineligible for specific chemotherapy when it lowers their estimated glomerular filtration rate below important thresholds.
Gu C, Labban M, Melnick KR, et al. Disparities in refusal of systematic therapy in metastatic prostate cancer. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Poster MP12-19.
Advancing the CV care of the oncology patient: Black patients found to have increased odds of cardiotoxicity following cancer treatment [news release]. ACC; April 14, 2023.