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Sandy Srinivas, MD
Sandy Srinivas, MD
Posted: Thursday, February 16, 2023
Race continues to be a factor in the rates at which men with prostate cancer receive definitive treatment, and insurance coverage alone does not seem to be enough to erase treatment disparities, according to Nnenaya Agochukwu-Mmonu, MD, of New York University Medical Center, and colleagues, based on their article in JCO Oncology Practice. Black men have a higher risk of prostate cancer diagnosis and mortality, but previous evidence had shown they are less likely to receive definitive treatment (described by the investigators as radical prostatectomy combined with radiation, brachytherapy, and/or cryotherapy; radical prostatectomy alone; or radiation therapy alone).
The team set out to examine the associations between urology practice organization and patient composition by race, on the one hand, and treatment patterns for Medicare beneficiaries with newly diagnosed prostate cancer on the other. Dr. Agochukwu-Mmonu and co-investigators analyzed 2010–2015 Medicare data for 54,443 such patients—87% White and 9% Black—who were treated at 4,194 urology practices nationwide. They found that Black patients did indeed have lower odds of definitive therapy (adjusted odds ratio = 0.87) and underwent less treatment than White patients in every practice context.
Overall, Black patients had lower predicted probability of treatment (66%) than White patients (69%; P < .05). Further, continued the investigators, “patients treated in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with a comorbidity score of 3 or greater), and earlier age at prostate cancer diagnosis (33.5% aged 66–69; P < .01).”
The study results demonstrate “the downstream effects of structural racism,” declared the authors. Providers’ participation in interventions that target “communication, culturally sensitive care, mitigating conscious and unconscious bias, and [creating] partnerships with community health-care workers may be key” in countering these effects. Patients will likely also benefit from social services that include community outreach, which can improve health literacy, utilization, and outcomes, the investigators concluded.
Disclosure: The study authors’ disclosure information can be found at ascopubs.org.
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