Objectives To determine if there are variations in the receipt of treatment based on race and disease severity. Treatment variations in men with prostate cancer among the various racial groups in the US exist, which may be a source of potential disparity in outcome. Methods Utilizing Surveillance, Epidemiology and End Results (SEER) -17, we identified 327,636 men diagnosed with prostate cancer from 2004–2011. Logistic regression analysis was performed to determine the association of receiving definitive treatment and race in the context of disease severity. Results African-American and Hispanic men were less likely to receive treatment compared to White men (OR 0.73, 95% CI 0.71,0.75; and OR 0.95, 95% CI 0.92,0.98; respectively). African-American men had significantly lower odds ratio of receiving definitive treatment within each D’Amico risk classification compared to White men, with decreasing odds of treatment for each increase in risk category (Low risk OR 0.81, 95% CI 0.78,0.85; Intermediate risk OR 0.74, 95% CI 0.71,0.77; and High risk OR 0.62, 95% CI 0.58,0.66). Hispanic men with intermediate risk (OR 0.89, 95% CI 0.84,0.94) or high risk (OR 0.79, 95% CI 0.72,0.85) disease had lower odds of receiving treatment compared to White men. Asian men had similar or greater odds of receiving treatment compared to White men within any Gleason or D’Amico classification. Conclusions There is a significant disparity in the receipt of treatment for prostate cancer among AA and Hispanic men compared to White men. The variations in receipt of treatment reveal an area of opportunity to develop risk-stratified approaches to treatment regardless of ethnic identity, which may address the poorer prostate cancer-related outcomes in these populations.

Objective African-American (AA) men have excess mortality from prostate cancer (PCa) compared to White men, which has remained unchanged over several decades. The purpose of this study is to determine if race/ethnicity is an independent predictor of receipt of any definitive treatment vs watchful waiting/active surveillance (WW/AS). Methods and Materials Men diagnosed with PCa from 2004 to 2011 were identified from the Surveillance, Epidemiology and End-Results (SEER) program. Multinomial logistic regression analysis was performed to determine the relative risk ratio (RRR) of receipt of radical prostatectomy (RP), external beam radiation therapy (RT), brachytherapy, cryotherapy, or combination therapy vs WW/AS. Results Compared to White men, AA men were significantly less likely to receive RP (RRR 0.53, p<0.001), brachytherapy (RRR 0.72, p<0.001), cryotherapy (RRR 0.84, p=0.001), and combination therapy (RRR 0.70, p<0.001), and more likely to receive RT (RRR 1.03, p=0.041) versus AS/WW. Hispanic men were significantly less likely to receive RP (RRR 0.84, p<0.001) and brachytherapy (RRR 0.77, p<0.001), and more likely to receive RT (RRR 1.08, p<0.001) and cryotherapy (RRR 1.19, p=0.005) versus AS/WW compared to White men. Conclusions The disparate risk of receiving definitive treatment among AA and Hispanic men represents a significant public health issue that requires efforts to improve physician education, increase cultural competency, and ensure equitable access.

The COVID-19 pandemic and the simultaneous increased focus on structural racism and racial/ethnic disparities across the United States have shed light on glaring inequities in U.S. health care, both in oncology and more generally. In this article, we describe how, through the lens of fundamental ethical principles, an ethical imperative exists for the oncology community to overcome these inequities in cancer care, research, and the oncology workforce. We first explain why this is an ethical imperative, centering the discussion on lessons learned during 2020. We continue by describing ongoing equity-focused efforts by ASCO and other related professional medical organizations. We end with a call to action—all members of the oncology community have an ethical responsibility to take steps to address inequities in their clinical and academic work—and with guidance to practicing oncologists looking to optimize equity in their research and clinical practice.

Background Treatment delays affect breast cancer survival and constitute poor‐quality care. Black patients experience more treatment delay, but the relationship of geography to these disparities is poorly understood. Methods We studied a population‐based, retrospective, observational cohort of patients with breast cancer in North Carolina between 2004 and 2017 from the Cancer Information and Population Health Resource, which links cancer registry and sociodemographic data to multipayer insurance claims. We included patients >18 years with Stage I–III breast cancer who received surgery or chemotherapy as their first treatment. Delay was defined as >60 days from diagnosis to first treatment. Counties were aggregated into nine Area Health Education Center regions. Race was dichotomized as Black versus non‐Black. Results Among 32,626 patients, 6190 (19.0%) were Black. Black patients were more likely to experience treatment delay >60 days (15.0% of Black vs. 8.0% of non‐Black). Using race‐stratified modified Poisson regression, age‐adjusted relative risk of delay in the highest risk region was approximately twice that in the lowest risk region among Black (relative risk, 2.1; 95% CI, 1.6–2.6) and non‐Black patients (relative risk, 1.9; 95% CI, 1.5–2.3). Adjustment for clinical and sociodemographic features only slightly attenuated interregion differences. The magnitude of the racial gap in treatment delay varied by region, from 0.0% to 9.4%. Conclusions Geographic region was significantly associated with risk of treatment delays for both Black and non‐Black patients. The magnitude of racial disparities in treatment delay varied markedly between regions. Future studies should consider both high‐risk geographic regions and high‐risk patient groups for intervention to prevent delays.

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