ASCO 2022: Access to Definitive Treatment and Survival for Intermediate-Risk and High-Risk Prostate Cancer at Hospital Systems Serving Health Disparity Populations

(UroToday.com) At the 2022 American Society of Clinical Oncology Annual Meeting held in Chicago and virtually, the poster session focused on Prostate, Testicular, and Penile cancers on Monday afternoon included a presentation from Dr. Muhieddine Labban discussing disparities in prostate cancer care.

Racial and socioeconomic disparities in prostate cancer care and outcomes have been long recognized. While these were initially attributed to differences in underlying biology, it is increasingly recognized that these are often due to health systems factors and access to care. Much of this work has sought to address the contribution of patient-level and physician-level factors. However, there is growing interest in investigating the role of the facility of care in driving cancer disparities. Therefore, Dr. Labban and colleagues sought to examine receipt of guideline-concordant definitive treatment, time to treatment initiation (TTI), and survival for men with prostate cancer receiving care at hospital systems serving health disparity populations (HSDPs).

To do so, they performed a retrospective analysis of the National Cancer Database to identify men with intermediate-risk or high-risk PCa eligible for definitive treatment between 2004 and 2016. Their primary outcomes were receipt of definitive treatment and TTI within 90 days of diagnosis. The secondary outcome was survival.

In terms of exposure, they defined HSDPs as minority-serving hospitals – facilities in the highest decile of the proportion of Non-Hispanic Black or Hispanic cancer patients – and/or high-burden safety-net hospitals – facilities in the highest quartile of the proportion of underinsured patients. They then used mixed-effect models with facility-level random intercept to compare outcomes between HSDPs and non-HSDPs among the entire cohort and among men who received definitive treatment. Finally, they evaluated interactions between HSDP status and race for each of the outcomes.

In total, the authors included 821,931 men with intermediate-risk or high-risk prostate cancer who were treated at 968 non-HSDPs (72.2%) and 373 HSDPs (27.8%) facilities.

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Treatment at HSDPs was associated with lower odds of receipt of definitive treatment (aOR 0.64; 95% CI 0.57-0.71; p < 0.001), lower odds of TTI within 90 days of diagnosis (aOR 0.74; 95% CI 0.68-0.79; p < 0.001), and worse survival (aHR 1.05; 95% CI 1.02-1.09; p = 0.003). However, no difference was found in survival among patients who received definitive treatment. Notably, racial differences were seen even within facility types: Non-Hispanic Black men at HSDPs had worse outcomes than Non-Hispanic Black men treated at non-HSDPs as well as Non-Hispanic White men treated at HSDPs.

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Thus, the authors conclude that patients treated at HSDPs were less likely to receive timely definitive treatment and had worse survival. Further, even among HSDPs, Non-Hispanic Black men experience worse outcomes than Non-Hispanic white men. Thus, Non-Hispanic Black are particularly disadvantaged as they are more likely to be treated at hospitals with worse outcomes and have worse outcomes than other patients at those same institutions.


Presented by: Muhieddine Labban, MD,  Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA