Differences in health care access may drive prostate cancer disparities

A study conducted by investigators at Cedars-Sinai Cancer Center in Los Angeles, California counters data suggesting that Black men respond differently than White men to systemic therapies for metastatic prostate cancer, suggesting instead that when access to quality health care is equal, outcomes are similar.^1,2

The investigators currently have other studies underway to further explore these findings.

“We believe this is the most comprehensive look at this issue to date, and our findings suggest that, under the right conditions, Black men with metastatic prostate cancer can have outcomes equivalent to those of White men,” said lead author Jun Gong, MD, medical director of Colorectal Cancer Medicine at Cedars-Sinai Cancer, in a news release on the findings.² “We want all men with advanced prostate cancer to know that, in the right environment, their outcomes can be promising.”

For the study, the investigators reviewed data from real-world registries, equal-access health care settings, and prospective clinical trials. The authors noted a particular focus on equal-access settings in analyzing the data.

Overall, the majority of recent data showed that the disparity in outcomes with systemic therapies between Black and White men has minimized when accounting for modern systemic therapies, with which Black men tended to have similar outcomes to White men. In fact, the use of some therapies, including first-line hormonal therapy and immunotherapy, even demonstrated improved outcomes for Black men. The findings also suggested that subsequent lines of therapy are likely not affecting overall survival disparities.

Gong added, “It was interesting to find that when Black and White men were provided equal access to the same therapies, given at the same dosage and monitored in the same setting, disparities in outcomes were eliminated.”²

The authors made particular note of these findings given the type of data used for analysis—prospective studies and clinical trials are settings in which care is likely to be standardized. Thus, the discordance in outcomes reported in some studies may be due to other factors, such as access to care.

The authors wrote, “Theoretically, prospective clinical trials and retrospective data from equal-access health systems such as the VA reflect populations of Black men with equivalent access to systemic therapies, while real-world registries may not reflect a study population with equal access to prostate cancer care. However, as we noted previously, even equal-access settings are not immune to undertreating Black men.”¹

In fact, some of the VA-based data suggested that Black men may experience a significantly longer time to treatment initiation compared to White men, even though data have shown they may benefit more from earlier treatment.

The investigators currently have other studies underway to further explore these findings, including one to compare VA treatment patterns among Black and White men to analyze the types of therapy used, the time from diagnosis to the start of treatment, and the effect of equalizing these parameters. Another study plans to assess treatment compliance in both populations to understand the effect on patient outcomes.

References

1. Gong J, Kim DM, Hoedt AMD, et al. Disparities with systemic therapies for Black men having advanced prostate cancer: Where do we stand? J Clin Oncol. 2023:JCO2300949. doi:10.1200/JCO.23.00949

2. An updated look at prostate cancer disparities. News release. Cedars-Sinai. October 30, 2023. Accessed October 31, 2023. https://www.newswise.com/articles/an-updated-look-at-prostate-cancer-disparities