Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?

Moses, Kelvin A.; Orom, Heather; Brasel, Alicia; Gaddy, Jacquelyne; Underwood, Willie

doi:10.1016/j.urology.2016.07.045

Cited by 66 publications

(57 citation statements)

References 30 publications

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“…The current study observed that race/ethnicity, neighborhood SES, and Medicaid/public insurance were significantly associated with use of orchiectomy over medical forms of ADT. These results are consistent with prior research suggesting that the choice of 2 treatments for prostate cancer that have identical efficacy may differ based on social factors such as SES, insurance, and race/ethnicity …”

Section: Discussionsupporting

confidence: 91%

Differential use of medical versus surgical androgen deprivation therapy for patients with metastatic prostate cancer

Borno

Lichtensztajn

Gomez

et al. 2018

Cancer

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Background Surgical and medical androgen deprivation therapy (ADT) strategies are comparable in their ability to suppress serum testosterone levels as treatment in patients with metastatic prostate cancer but differ with regard to cost and impact on quality of life. Medical ADT is associated with better long‐term quality of life due to the flexibility of possible therapy interruption but comes with a higher cumulative cost. In the current study, the authors examined whether surgical ADT (ie, bilateral orchiectomy) was used differentially by race/ethnicity and other social factors. Methods The authors identified patients with metastatic disease at the time of diagnosis through the California Cancer Registry. The association between race/ethnicity and receipt of surgical ADT was modeled using multivariable Firth logistic regression adjusting for age, Gleason score, prostate‐specific antigen level, clinical tumor and lymph node classification, neighborhood socioeconomic status (SES), insurance, marital status, comorbidities, initial treatment (radiotherapy, chemotherapy), location of care, rural/urban area of residence, and year of diagnosis. Results The authors examined a total of 10,675 patients with metastatic prostate cancer, 11.4% of whom were non‐Hispanic black, 8.4% of whom were Asian/Pacific Islander, 18.5% of whom were Hispanic/Latino, and 60.5% of whom were non‐Hispanic white. In the multivariable model, patients found to be more likely to receive surgical ADT were Hispanic/Latino (odds ratio [OR], 1.32; 95% confidence interval [95% CI], 1.01‐1.72), were from a low neighborhood SES (OR, 1.96; 95% CI, 1.34‐2.89) or rural area (OR, 1.49; 95% CI, 1.15‐1.92), and had Medicaid/public insurance (OR, 2.21; 95% CI, 1.58‐3.10). Patients with military/Veterans Affairs insurance were significantly less likely to receive surgical ADT compared with patients with private insurance (OR, 0.34; 95% CI, 0.13‐0.88). Conclusions Race/ethnicity, neighborhood SES, and insurance status appear to be significantly associated with receipt of surgical ADT. Future research will need to characterize other differences in initial treatments among men with advanced prostate cancer based on race/ethnicity and aim to better understand what factors drive the association between surgical ADT among men of Hispanic origin or those from areas with low neighborhood SES.

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Section: Discussionsupporting

confidence: 91%

Differential use of medical versus surgical androgen deprivation therapy for patients with metastatic prostate cancer

Borno

Lichtensztajn

Gomez

et al. 2018

Cancer

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“…At the same time, among all AA and white men who perceived their cancers to be aggressive, there were no racial differences in treatment received. Taken together, these findings suggest that the misalignment between perceived cancer aggressiveness and actual diagnosis among AA and white men may contribute to the differences in treatments described by prior studies …”

Section: Discussionmentioning

confidence: 61%

“…In a study by Moses et al using the Surveillance, Epidemiology, and End Results database of patients diagnosed with prostate cancer across the United States, AA men were less likely to receive treatment (radical prostatectomy [RP], external‐beam radiation therapy [RT], or brachytherapy) in comparison with white men. Moreover, AA men received less aggressive treatment (ie, less surgery and more radiation): 31.0% of AA patients and 38.2% of white patients underwent RP, whereas 26.8% of AAs and 22.7% of whites underwent RT . Although published studies have consistently described less treatment overall and less aggressive treatment among AA men with prostate cancer, the reasons behind this disparity are not well understood, and few studies have examined the factors influencing patients’ decisions that may contribute to this disparity …”

Section: Introductionmentioning

confidence: 99%

Factors influencing prostate cancer treatment decisions for African American and white men

Gordon

Basak

Carpenter

et al. 2019

Cancer

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Background Prostate cancer racial disparities in mortality outcomes are the largest in all of oncology, and less aggressive treatment received by African American (AA) patients versus white patients is likely a contributing factor. However, the reasons underlying the differences in treatment are unclear. Methods This study examined a prospective, population‐based cohort of 1170 men with newly diagnosed nonmetastatic prostate cancer enrolled from 2011 to 2013 before treatment throughout North Carolina. By phone survey, each participant was asked to rate the aggressiveness of his cancer, and his response was compared to the actual diagnosis based on a medical record review. Participants were also asked to rate the importance of 10 factors for their treatment decision‐making process. Results Among AA and white patients with low‐risk cancer (according to National Comprehensive Cancer Network guidelines), 78% to 80% perceived their cancers to be “not very aggressive.” However, among high‐risk patients, 54% of AA patients considered their cancers to be “not very aggressive,” whereas 24% of white patients did (P < .001). Although both AA and white patients indicated that a cure was a very important decision‐making factor, AAs were significantly more likely to consider cost, treatment time, and recovery time as very important. In a multivariable analysis, perceived cancer aggressiveness and cure as the most important factor were significantly associated with receiving any aggressive treatment and were associated with surgery (vs radiation). After adjustments for these factors and sociodemographic factors, race was not significantly associated with the treatment received. Conclusions Racial differences in perceived cancer aggressiveness and factors important in treatment decision making provide novel insights into reasons for the known racial disparities in prostate cancer as well as potential targets for interventions to reduce these disparities.

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“…Specifically, racial disparities and barriers to care among AA patients applied to the use of definitive therapy for localized PCa . This phenomenon affected the rates of RP, which were lower in AAs than in NHWs . A similar phenomenon was recorded for rates of LND at RP.…”

Section: Introductionmentioning

confidence: 76%

“…Several investigators showed racial disparities in the quality of care for localized PCa . Specifically, racial disparities and barriers to care among AA patients applied to the use of definitive therapy for localized PCa .…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in lymph node dissection at radical prostatectomy: A Surveillance, Epidemiology and End Results database analysis

et al. 2018

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Contemporary North American African American patients treated with radical prostatectomy have equal access to lymph node dissection, the same lymph node invasion rates and the same cancer-specific mortality rates as non-Hispanic whites. However, the extent of lymph node dissection is lower in African Americans. The results regarding lymph node dissection rates are encouraging. However, improvements are required regarding lymph node dissection extent in African Americans.

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Racial/Ethnic Disparity in Treatment for Prostate Cancer: Does Cancer Severity Matter?

Cited by 66 publications

References 30 publications

Differential use of medical versus surgical androgen deprivation therapy for patients with metastatic prostate cancer

Differential use of medical versus surgical androgen deprivation therapy for patients with metastatic prostate cancer

Factors influencing prostate cancer treatment decisions for African American and white men

Racial disparities in lymph node dissection at radical prostatectomy: A Surveillance, Epidemiology and End Results database analysis

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