Researchers who studied prostate cancer (PCa) patients receiving care in the Veterans Affairs (VA) healthcare system found no significant differences in tumor burden, treatment choice, and survival outcomes between black and white men.
“The observed lack of disparity in outcomes between African Americans and Caucasians may be due to their receipt of care in the equal-access VA healthcare system, which may eliminate or reduce major barriers in access to care for African Americans,” the investigators, led by Timothy J. Daskivich, MD, of the University of California, Los Angeles, wrote in a new online report in Prostate Cancer and Prostatic Disease.
Previous studies have shown that, compared with whites, blacks have a 48% higher incidence of PCa and a 2.5-fold higher risk of death from the cancer, Dr. Daskivich’s team pointed out. At diagnosis, blacks have been found to have higher PSA values and tumor volumes and are 3 times more likely to present with advanced disease, they noted.
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Dr. Daskivich and his colleagues sampled 1,258 men with nonmetastatic PCa diagnosed at the Greater Los Angeles and Long Beach VA medical centers from 1998 to 2004. African Americans and Caucasians had similar odds of higher tumor risk, Gleason score, and clinical stage, and similar odds of receiving aggressive treatment for low-, intermediate-, and high-risk disease. The 2 racial groups also had similar risks of cancer-specific and other-cause mortality.
“It is remarkable that we found no significant disparity for any of these outcomes despite lack of control for socioeconomic status and education, which would tend to reduce disparities if included,” the authors commented.
A plausible explanation for their findings, the investigators stated, “is that the adverse effects of low socioeconomic status, poor insurance, low education and lack of usual source of care that traditionally are associated with African-American race are diminished in the VA setting. This may lead to improved rates of screening, earlier detection of disease, more equitable provision of costly treatments and the resultant improvement in long-term outcomes.”
An alternative explanation is that Caucasians have comparatively worse disease characteristics in the VA system than in other settings, thus decreasing the apparent disparity, they noted.
Dr. Daskivich’s group pointed out that their study had limitations, such as selection bias associated with the observational study design, which may decrease the apparent magnitude of racial disparities. “Veterans with worse disease at diagnosis may not seek care at the VA, which would falsely reduce racial disparity in all of our main outcomes beyond tumor burden at diagnosis.”
