Risk factors involved in treatment delays and differences in treatment type for patients with prostate cancer by risk category in an academic safety net hospital

Abstract

ObjectivesUnderstanding the drivers of delays from diagnosis to treatment can elucidate how to reduce the time to treatment (TTT) in patients with prostate cancer. In addition, the available treatments depending on the stage of cancer can vary widely for many reasons. This study investigated the relationship of TTT and treatment choice with sociodemographic factors in patients with prostate cancer who underwent external beam radiation therapy (RT), radical prostatectomy (RP), androgen deprivation therapy (ADT), or active surveillance (AS) at a safety-net academic medical center.Methods and materialsA retrospective review was performed on 1088 patients who were diagnosed with nonmetastatic prostate cancer between January 2005 and December 2013. Demographic data as well as data on TTT, initial treatment choice, American Joint Committee on Cancer stage, and National Comprehensive Cancer Network risk categories were collected. Analyses of variance and multivariable logistic regression models were performed to analyze the relationship of these factors with treatment choice and TTT.ResultsAge, race, and marital status were significantly related to treatment choice. Patients who were nonwhite and older than 60 years were less likely to undergo RP. Black patients were 3.8 times more likely to undergo RT compared with white patients. The median TTT was 75 days. Longer time delays were significant in patients of older age, nonwhite race/ethnicity, non-English speakers, those with noncommercial insurance, and those with non-married status. The average TTT of high-risk patients was 25 days longer than that of low-risk patients. Patients who underwent RT had an average TTT that was 34 days longer than that of RP patients.ConclusionsThe treatment choice and TTT of patients with prostate cancer are affected by demographic factors such as age, race, marital status, and insurance, as well as clinical factors including stage and risk category of disease.

Influence of sociodemographic factors on treatment’s choice for localized prostate cancer in Portugal

“…In our work, age was the only factor that individually influenced the choice of treatment, as patients over 70 years were virtually not subjected to RP (only 3.9%). The influence of age is in agreement with literature (7,(12)(13)(14)(15)(16)(17), although such a small number leaves a doubt if some patients were excluded from a valid treatment because of their age. It must be understood that an individual with a life expectancy superior to 10 years should receive the same treatment as a young patient (3).…”

“…Is the patient ready for such a hard choice? This choice may be influenced by the beliefs and knowledge of the own patient (7). Patients that choose RP believe that this represents their best chance of cure and longevity, as all tumour is removed.…”

“…It is necessary to understand that various sociodemographic factors influence the choice of treatment for localized PCa. Various demographic, economic and social factors have been described and influencing factors such as age (7,(12)(13)(14)(15)(16)(17), race (15)(16)(17)(18)(19)(20), financial status (15,16,18,19,21), health financing by private insurance (7,17,19,20), educational level (21), marriage status (7,15,17), populational density of residence area (15,16,22) or hospital where treatment is provided (12,20).…”

Outcomes of Black men with prostate cancer treated with radiation therapy in the Veterans Health Administration

“…Black men are diagnosed with prostate cancer at an earlier age and often present with higher grade and stage at diagnosis 3 . In addition, choice of treatment differs between Black and White men of similar age and clinical presentations 4 . These health care disparities are a major concern, and there is a national focus to better understand and mitigate factors that result in divergent outcomes for individuals.…”

Identifying Risk Profiles of Malignant Prostate Cancer Surgical Delay Using a Person-Centered Approach to Understand Prostate Cancer Disparities: The Constellation of Health Determinants Using Latent Class Analysis on Cancer Registry Data

“…Our study adds to the evidence on the underlying factors associated with higher mortality among Black patients with PCa. Factors at the patient level that may be driving excess mortality are mistrust, health-seeking behaviors, rurality, and clinical or system-level factors ( Kan et al, 2018 ). Although access to health care has been known to be a main driver of health disparities and is also an important predictor of treatment behavior ( Burt et al, 2018 ; Gordon et al, 2019 ; Noonan et al, 2016 ), our study shows that patients delayed treatment despite having health insurance coverage.…”