Racial variation in the pattern and quality of care for prostate cancer in the USA: mind the gap

Abstract

This is a comment moderated paper. Please go to http://www.bjuicommentary.com for further details. OBJECTIVE To review the literature on racial variation in the pattern of care (PoC) and quality of care (QoC) for prostate cancer, as there are known racial disparities in the incidence and outcomes of prostate cancer. While there are some biological explanations for these differences, they do not completely explain the variation. Differences in the appropriateness and QoC delivered to men of different racial groups may contribute to disparities in outcome. METHODS We searched the USA National Library of Medicine PubMed system for articles pertaining to quality indicators in prostate cancer and racial disparities in QoC for prostate cancer. RESULTS While standards for appropriate treatment are not clearly defined, racial variation in the PoC has been reported in several studies, suggesting that African‐American men may receive less aggressive treatment. There are validated QoC indicators in prostate cancer, and researchers have begun to evaluate racial variation in adherence to these quality indicators. Further quality comparisons, particularly in structural measures, may need to be performed to fully evaluate differences in QoC. CONCLUSIONS There is mounting evidence for racial variation in the PoC and QoC for prostate cancer, which may contribute to observed differences in outcome. While some of the sources of racial variation in quality and outcome have been identified through the development of evidence‐based guidelines and validated quality indicators, opportunities exist to identify, study and attempt to resolve other components of the quality gap.

Immigration factors and prostate cancer survival among Hispanic men in California: Does neighborhood matter?

“…An additional limitation inherent to cancer registry analyses is residual confounding by factors for which we lack information or detailed information, including detailed treatment and comorbidities. 13,14,50 …”

Burden of Hospital Admissions and Utilization of Hospice Care in Metastatic Prostate Cancer Patients

“…In particular, black individuals with CaP have been demonstrated to receive poorer quality care from the point of diagnosis, treatment, and death due to CaP. 30 Lack of access to, or awareness of, hospice services for black patients is particularly troubling given the higher proportion of men in this population with advanced disease.…”

Racial Differences in Treatment Decision-Making for Men with Clinically Localized Prostate Cancer: a Population-Based Study

“…Prostate cancer exhibits a striking racial disparity as black men have 1.6 times higher incidence and 2.4 times higher mortality compared to white men [1]. Known genetic susceptibility accounts for only a small proportion of the racial variation [2]. The disproportionate burden of prostate cancer in black men may be related to unequal access to medical care and differences in the receipt of treatment [2].…”

“…Known genetic susceptibility accounts for only a small proportion of the racial variation [2]. The disproportionate burden of prostate cancer in black men may be related to unequal access to medical care and differences in the receipt of treatment [2]. Black men who receive prostate cancer treatment similar to that of white men experience similar outcomes [3,4].…”