Free access to health services found to correct racial/ethnic disparities in prostate cancer care.

Providing free care to economically disadvantaged prostate cancer patients may eliminate racial and ethnic disparities in the use of health resources related to prostate cancer, new findings suggest.

In a study of 357 men who used the program from 2001 through 2005 and who completed questionnaires after enrollment, 72% received adequate surveillance PSA testing to follow the disease course. The investigators defined “adequate” as testing at least every six months.

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Although race and ethnicity were not significantly associated with health resource use, Hispanic men were five times as likely as white men to express complete satisfaction with the care. “The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement,” the authors concluded in the Journal of Community Health (2008;33:318-335).

Men suffering from more symptoms and distress due to their cancer, and those with metastatic or recurrent cancer, were significantly less likely than others to be completely satisfied.

“The central foundation of this program, apart from providing financial support, is that we provide every patient with a case manager to help him negotiate the health care system. That is one of the things that contributes to the higher levels of satisfaction,” said investigator Mark S. Litwin, MD, MPH, professor of health services and urology at the David Geffen School of Medicine, University of California, Los Angeles. He helped create the program, which he said ends up being cost effective.

The disparity-removing approach used in this population is called IMPACT, for “Improving Access, Counseling and Treatment for Californians with Prostate Cancer.” It was set up in 2001 after evidence showed that people from lower socioeconomic strata are less likely to have their cancer identified at early stages and are more likely to have worse outcomes and overall poor experiences with the health care system.

Each person who is enrolled in the program is uninsured and has an income of less than 200% of the federal poverty level. Each is also assigned a primary cancer care provider in his community as well as a nurse clinical-care coordinator who provides the patient with case management and help in navigating the health care system.

In addition, patients are given access to counseling and interpreter services, literacy-sensitive/culturally-relevant educational materials, transportation assistance, food security and housing referrals. The cost is about $5,000-$6,000 per patient annually. (For more information on the program, go to