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Wang EH, Yu JB, Abouassally R, Meropol NJ, Cooper G, Shah ND, Williams SB, Gonzalez C, Smaldone MC, Kutikov A, Zhu H, Kim SP
Disparities in Treatment of Patients with High-Risk Prostate Cancer: Results From A Population-Based Cohort
Urology (2016) 95:88-94.
Abstract
OBJECTIVE: To assess the variation in primary treatment of high risk prostate cancer (PCa) by different hospital characteristics in the United States. MATERIALS AND METHODS: We used the National Cancer Database (NCDB) to identify patients diagnosed with pretreatment high-risk PCa from 2004 and 2011. The primary outcomes were different forms of primary therapy or watchful waiting (WW) across different types of hospitals (community, comprehensive cancer community, and academic hospitals). Multivariable logistic regression analyses were used to test for differences in treatment by hospital type. RESULTS: During the study period, we identified 102,701 men diagnosed with high-risk PCa. Overall, the most common treatment was radical prostatectomy (37.0%) followed by radiation therapy (33.2%) and WW (8.5%). Compared to white men with high-risk PCa, black men had lower adjusted odds ratios for surgery at comprehensive community (OR:0.64;p<0.001) and academic (OR:0.62;p<0.001) hospitals. Similarly, black men were also more likely to be managed with WW at community (OR:1.49;p<0.001), comprehensive cancer community hospitals (OR:1.24;p<0.001) and academic (OR:1.55;p<0.001) hospitals as well as with XRT at comprehensive cancer community (OR:1.27;p<0.001) and academic hospitals (OR:1.23;p<0.001). CONCLUSIONS: Disparities in the use of WW and different primary treatments among patients with high-risk PCa persisted across different types of hospitals and over time. Our findings highlight a significant racial disparity in the use of curative therapy for high-risk PCa that should be urgently addressed in order to ensure that all men with PCa receive appropriate care, across all racial groups and cancer care facilities.
Note
Publication Date: 2016-06-15.
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