Receipt of hormone therapy is lacking among Black men with prostate cancer

Recent findings published in JAMA Network Open suggest that Black men with advanced prostate cancer are significantly less likely to receive novel hormonal therapy compared with other racial and ethnic groups.¹

Black patients continued to have a lower likelihood of receiving novel hormonal therapy agents even after adjustments were made for patient, disease, and sociodemographic factors.

“Even though we know hormonal therapies have significant clinical benefits in men with more advanced stages of prostate cancer, there is not much information available about how often people in the general population use these drugs—particularly in the context of equitable access to these medications across different race and ethnicity groups,” said co-senior author Michael H. Xiang, MD, PhD, in a news release on the findings.² Xiang is an assistant clinical professor of radiation oncology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

To this end, investigators in the study assessed data from a population-based cancer registry linked to prescription drug records among 3748 Medicare beneficiaries who were diagnosed with advanced prostate cancer from 2011 to 2017. Among those patients, 78% were White, 8% were Black, 7% were Hispanic, and 7% were from other racial and ethnic groups, defined as either Alaska Native, American Indian, Asian, Pacific Islander, or not otherwise specified and unknown.

The median patient age was 75 years. The primary outcome of interest was the receipt of a novel hormonal therapy, which included abiraterone (Zytiga), enzalutamide (Xtandi), apalutamide (Erleada), or darolutamide (Nubeqa).

Overall, 36% of patients included in the study received at least 1 administration of a novel hormonal therapy agent. Data showed that 2-year novel hormonal therapy utilization was highest among White patients at 27%. Hispanic patients demonstrated a rate of 25%, followed by other racial and ethnic groups at 23%. Black patients had the lowest rate of utilization at 20%.

Overall, Black men were shown to be 24% less likely to receive or be prescribed a novel hormonal therapy agent compared with White men. The lower rate of utilization among Black patients was consistent at 5 years, at which time 37% of Black patients had received novel hormonal therapy, compared with 44% among White patients (P = .02). There was no significant difference in hormone therapy receipt observed between White and Hispanic patients (38%; 95% CI, 32%-46%) or patients with other race and ethnicity (41%; 95% CI, 35%-49%).

Black patients continued to have a lower likelihood of receiving novel hormonal therapy agents even after adjustments were made for patient, disease, and sociodemographic factors (adjusted subdistribution hazard ratio, 0.76; 95% CI, 0.61-0.94; P = .01).

“This revelation is particularly concerning given the already disproportionate impact of prostate cancer on Black men, who are 1.5 times more likely to be diagnosed and 2.4 times more likely to die from the disease than White men in the United States,” said co-senior author Amar U. Kishan, MD, in the news release.² Kishan is a professor of radiation oncology at the David Geffen School of Medicine at UCLA and a researcher at the UCLA Health Jonsson Comprehensive Cancer Center.

The authors note that further research on these findings is needed to identify strategies to prevent the disparity in Black patients.

Xiang concluded in the news release,“Our findings raise critical questions regarding the reasons behind this inequality, suggesting possible obstacles to health care, financial burdens, and unconscious biases within the health care system.”²

References

1. Ma TM, Agarwal N, Mahal B, et al. Racial and ethnic disparities in use of novel hormonal therapy agents in patients with prostate cancer. JAMA Netw Open. 2023;6(12):e2345906. doi:10.1001/jamanetworkopen.2023.45906

2. Black men with advanced prostate cancer less likely to receive crucial treatment, study finds. News release. University of California, Los Angeles (UCLA), Health Sciences. November 29, 2023. Accessed December 4, 2023. https://www.newswise.com/articles/black-men-with-advanced-prostate-cancer-less-likely-to-receive-crucial-treatment-study-finds