(S051) Disparities in Access and Treatment of Patients With High-Risk Prostate Cancer: Results From a Population-Based Cohort

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OncologyOncology Vol 30 No 4_Suppl_1
Volume 30
Issue 4_Suppl_1

Our findings suggest that differential treatment access alone does not explain racial disparities and that sociodemographic forces, such as referral patterns and provider biases, may heavily influence what should be a clinical decision regarding treatment provision and receipt.

Elyn H. Wang, BS, Cary P. Gross, MD, James B. Yu, MD, MHS, Nilay D. Shah, PhD, Robert Abouassally, MD, Edward E.  Cherullo, MD, Shan Dong, Quoc-Dien Trinh, MD, Paul L.  Nguyen, MD, Maxine Sun, MPH, Simon P. Kim, MD; Yale University School of Medicine; Division of Health Care Policy and Research, Mayo Clinic; Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University; Harvard Medical School; University of Montreal

INTRODUCTION: Racial disparities in the treatment and outcomes of prostate cancer (PCa) are a well-recognized public health problem. However, whether receipt of treatment varies by race across different types of hospitals remains poorly described. Therefore, we sought to evaluate the variation in primary treatment of high-risk PCa based on different hospital characteristics in the US.

METHODS: We used the National Cancer Data Base (NCDB) to identify patients diagnosed with pretreatment high-risk PCa from 2004–2011. The primary outcomes were different forms of primary therapy received or no treatment across different types of hospitals (community, comprehensive 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, radical prostatectomy (RP) (37.0%) was the most common treatment, followed by external beam radiation therapy (EBRT) (33.2%), while 8.5% of patients received no treatment. When stratified by hospital type, black patients were less likely to undergo RP at comprehensive community hospitals (adjusted odds ratio [OR], 0.64; P < .001) and academic (adjusted OR, 0.62; P < .001) hospitals, compared with white patients. However, EBRT was used more often among black men treated at comprehensive community (adjusted OR, 1.27; P < .001) and academic (adjusted OR, 1.23; P < .001) hospitals. Furthermore, black patients were more likely not to receive treatment for high-risk PCa compared with white patients across all hospital types (P < .001).

CONCLUSIONS: Our study indicates that treatment disparities persist across various hospital types and that improving access to tertiary referral hospitals will not suffice to reduce current racial disparities in PCa treatment. Our findings suggest  that differential treatment access alone does not explain racial disparities and that sociodemographic forces, such as referral patterns and provider biases, may heavily influence what should be a clinical decision regarding treatment provision and receipt.

Proceedings of the 98th Annual Meeting of the American Radium Society -americanradiumsociety.org

Articles in this issue

(S002) A 15-Year Review of Radiation Therapy for Keloids at Two Institutions
(S003) Single-Fraction Radiation Therapy for the Treatment of Multiple Myeloma Bony Metastases Provides Pain Control and Decreases Time to Chemotherapy
(S001) Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation Therapy for Oropharyngeal Cancer
(S004) Trend in Second Malignancy Risk for Head and Neck Cancer With Increased Utilization of IMRT: Analysis of SEER Database
(S005) Comparison of Legal Needs of a Group of Patients With Cancer: Economic and Geographic Factors
(S006) Mission Improvement: Lessons From Initiating a Resident-Led Quality Improvement Project on Smoking Cessation at a County Hospital
(S007) Results of a Phase II Trial Using Cetuximab Plus Docetaxel With Low-Dose Fractionated Radiation for Recurrent Unresectable Locally Advanced Head and Neck Carcinoma
(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status
(S009) Intensity-Modulated Radiation Therapy With Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: A Report on Three-Year Toxicity
(S011) Comparative Study Between Ileal Conduit and Indiana Pouch After Cystectomy for Patients With Carcinoma of Urinary Bladder
(S010) Computed Tomography–Assessed Measures of Bone Mineral Density and Muscle Mass as Predictors of Survival in Men With Prostate Cancer
(S012) Quantitative Imaging to Evaluate the Malignant Potential of Pancreatic Cysts
(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma
(S014) The Impact of Radiation Therapy on Survival in Surgically Resected, High-Risk Patients With Ampullary Adenocarcinoma: A Population-Based Analysis
(S016) The Impact of Stereotactic Body Radiation Therapy on Overall Survival in Patients With Locally Advanced Pancreatic Cancer
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