Prostate Ca study reveals more evidence of racial disparity

Results of a recently published retrospective study investigating receipt of definitive therapy for intermediate/high-risk localized prostate cancer provide further evidence of racial disparity in prostate cancer favoring Caucasian men compared with African-American men.

The research also showed the racial difference existed at the facility level and that non-clinical factors, such as hospital type and geographic region, are driving the discrepancy.

“It is well established that prostate cancer incidence and overall outcomes remain worse for black men. Yet, the precise etiology of this discrepancy remains unclear. We felt that identifying potentially modifiable non-clinical factors contributing to this disparity, such as facility type, represented a timely topic in the setting of recent health reforms that aim to standardize clinical care, such as the Medicare Access and CHIP Reauthorization Act,” said lead author David F. Friedlander, MD, MPH, of Harvard Medical School, Boston.

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“Therefore, the subgroup analysis performed in our study is particularly noteworthy because it demonstrated that the magnitude of racial variation varied according to both clinical and non-clinical factors, demonstrating the important interplay between sociodemographic and clinical factors with regards to clinical outcomes,” he told Urology Times.

Dr. Friedlander pointed out that the findings have implications for clinicians.

“While our study does not explicitly explore the influence of patient preferences or cultural beliefs, it is reasonable to infer from our findings that potentially modifiable non-clinical factors, such as the patient-provider relationship, may at least partially explain the inferior outcomes seen among black men with prostate cancer. Consequently, urology providers should take it upon themselves to recognize these potential barriers to delivering high-quality care to black patients and devise clinical interventions aimed at overcoming these impediments,” said Dr. Friedlander, who worked on the study with Quoc-Dien Trinh, MD, and colleagues.

Next: What the authors found

The study, which was published online ahead of print in European Urology (Aug. 1, 2017), analyzed data from the National Cancer Data Base for men age ≥40 years receiving care for biopsy-confirmed localized intermediate/high-risk prostate cancer (Gleason Score ≥7) diagnosed between January 2004 and December 2013. It included 223,873 Caucasian men and 59,262 African-American men seen at 356 facilities and found that definitive therapy (radical prostatectomy, brachytherapy, or external beam radiotherapy) was received within 180 days of diagnosis by 83% of Caucasian men and 74% of African-American men.

After adjusting for sociodemographic and clinical factors, multilevel logistic regression revealed that 39% of facilities favored definitive therapy in Caucasians compared with African-Americans. Only 1% of facilities demonstrated a statistically significant rate favoring definitive therapy among African-Americans compared with Caucasians.

Analyses of the data by year showed the rate of definitive therapy increased slightly over the study period-from 81% to 83% among Caucasians and from 73% to 75% among African-Americans. The rate of increase was similar in the two groups.

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Multivariable subgroup analyses showed that the effect of race on receipt of definitive therapy varied with geographic region (U.S. census division) and facility type (community cancer program, comprehensive community cancer program, academic/research, integrated network cancer program), but not facility volume. The odds ratio favoring receipt of definitive therapy by Caucasian men was highest in the South Atlantic census division and significantly higher in seven of the eight other divisions, with the exception being the Mountain division. In the analysis of facility type, the odds ratio favoring receipt of definitive therapy by Caucasian men was highest at academic/research institutions, but the difference was also statistically significant at the other facility types.

The National Cancer Data Base is a nationwide database of information on patterns of cancer care outcomes from more than 1,500 Commission on Cancer-accredited programs in the United States and Puerto Rico, and it captures about 70% of newly diagnosed malignancies. Only facilities that treated at least 50 Caucasian and 50 African-American men throughout the study period were included in the study.

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