Nav: Home

Racial differences in outcomes, costs of care in older men with prostate cancer

October 22, 2015

Older black men with localized prostate cancer were more likely to have poorer quality care, incur higher costs and have worse postoperative outcomes than white men but that did not translate to worse overall or cancer-specific survival, according to an article published online by JAMA Oncology.

Prostate cancer is a frequently diagnosed cancer among men in the United States with an estimated 233,000 new cases in 2014. The treatment of prostate cancer is driven, in part, by the severity of disease at presentation. Definitive therapy for localized prostate cancer with the intention of curing it is radical prostatectomy (RP, removal of the prostate gland), radiotherapy or a combination thereof.

Quoc-Dien Trinh, M.D., of Brigham and Women's Hospital, Harvard Medical School, Boston, and coauthors looked at the effect of race on quality of care and survival of men receiving RP for localized prostate cancer. They used data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database for 26,482 men 65 or older with localized prostate cancer who underwent radical prostatectomy: 2,020 black men (7.6 percent) and 24,462 non-Hispanic white men (92.4 percent).

While the authors found no difference in cancer-specific or overall death between black and white men with localized prostate cancer, the authors note several other findings:
  • 59.4 percent of black men underwent RP within 90 days vs. 69.5 percent of white men.

  • Black men had a seven-day treatment delay compared with white men in the top 50 percent of patients.

  • Black men were less likely to undergo lymph node dissection.

  • Black men were more likely to have postoperative visits to the emergency department or be readmitted to the hospital compared with white men.

  • The top 50 percent of black patients had higher incremental annual costs for surgery, spending $1,185 more compared to white patients.

Limitations to the study include that it was comprised only of Medicare enrollees 65 or older and the authors acknowledge that most men being treated with RP are younger and have private health insurance, so the findings may not be generalizable to the general population of men having RP.

"We provide robust evidence for the existence of a substantial difference in the quality of surgical care of PCa (localized prostate cancer) in blacks. Because the unfavorable quality of care did not translate into worse overall and cancer-specific survival in our sample, the commonly perceived detrimental survival in black patients with PCa may be the sequelae of barriers and selection bias in definitive treatment. Public and professional awareness needs to be raised to address these concerning issues and identify their underlying causes," the authors conclude.

(JAMA Oncol. Published online October 22, 2015. doi:10.1001/jamaoncol.2015.3384. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Authors made conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Commentary: The Meaning of Race in Prostate Cancer Treatment

In a related commentary, Otis W. Brawley, M.D., M.A.C.P., of the American Cancer Society and Emory University, Atlanta, writes: "The black patients in this study have insurance and access to care and were deemed healthy enough for surgery, but there was still a disparity in quality of that care. ... This study documents clear evidence that quality of care differs by race. ... Race is an important sociopolitical categorization as quality of care differs. The reason is debatable. Is it racism on the part of physicians? I personally doubt it. My hypothesis is that a higher proportion of black men have physicians who do not routinely perform radical prostatectomies and a higher proportion of blacks are treated at hospitals that have a low volume of prostate surgery. It is widely established that physicians and hospitals that have high volumes of radical prostatectomy have better outcomes. ... It is my belief that quality health care is a basic human right. While many blacks get superb health care, being black in America means one is less likely to receive quality care and more likely to have a bad outcome. Schmid and colleagues show this in localized prostate cancer, and it is likely true for other diseases."

(JAMA Oncol. Published online October 22, 2015. doi:10.1001/jamaoncol.2015.3615. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
-end-
Media Advisory: To contact corresponding author Quoc-Dien Trinh, M.D., call Johanna Younghans at 617-525-6373 or email jyounghans@partners.org. To contact commentary author Otis W. Brawley, M.D., M.A.C.P., call David Sampson at 213-407-9950 or email david.sampson@cancer.org.

To place an electronic embedded link in your story: Links will be live at the embargo time: http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2015.3384;http://oncology.jamanetwork.com/article.aspx?doi=10.1001/jamaoncol.2015.3615

The JAMA Network Journals

Related Prostate Cancer Articles:

ESMO 2020: Breast cancer drug set to transform prostate cancer treatment
A drug used to treat breast and ovarian cancer can extend the lives of some men with prostate cancer and should become a new standard treatment for the disease, concludes a major trial which is set to change clinical practice.
Major trial shows breast cancer drug can hit prostate cancer Achilles heel
A drug already licensed for the treatment of breast and ovarian cancers is more effective than targeted hormone therapy at keeping cancer in check in some men with advanced prostate cancer, a major clinical trial reports.
The Lancet: Prostate cancer study finds molecular imaging could transform management of patients with aggressive cancer
Results from a randomised controlled trial involving 300 prostate cancer patients find that a molecular imaging technique is more accurate than conventional medical imaging and recommends the scans be introduced into routine clinical practice.
Common genetic defect in prostate cancer inspires path to new anti-cancer drugs
Researchers found that, in prostate cancer, a mutation leading to the loss of one allele of a tumor suppressor gene known as PPP2R2A is enough to worsen a tumor caused by other mutations.
First prostate cancer therapy to target genes delays cancer progression
For the first time, prostate cancer has been treated based on the genetic makeup of the cancer, resulting in delayed disease progression, delayed time to pain progression, and potentially extending lives in patients with advanced, metastatic prostate cancer, reports a large phase 3 trial.
Men taking medications for enlarged prostate face delays in prostate cancer diagnosis
University of California San Diego School of Medicine researchers report that men treated with medications for benign prostatic hyperplasia (enlarged prostate) experienced a two-year delay in diagnosis of their prostate cancer and were twice as likely to have advanced disease upon diagnosis.
CNIO researchers confirm links between aggressive prostate cancer and hereditary breast cancer
The study has potential implications for families with members suffering from these types of tumours who are at an increased risk of developing cancer.
Distinguishing fatal prostate cancer from 'manageable' cancer now possible
Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer, which could reduce unnecessary surgeries and radiotherapy.
Researchers find prostate cancer drug byproduct can fuel cancer cells
A genetic anomaly in certain men with prostate cancer may impact their response to common drugs used to treat the disease, according to new research at Cleveland Clinic.
ASCO and Cancer Care Ontario update guideline on radiation therapy for prostate cancer
The American Society of Clinical Oncology (ASCO) and Cancer Care Ontario today issued a joint clinical practice guideline update on brachytherapy (internal radiation) for patients with prostate cancer.
More Prostate Cancer News and Prostate Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.