Quality of Care in the Treatment of Localized Intermediate and High Risk Prostate Cancer at Minority Serving Hospitals

To investigate quality of care at minority-serving hospitals (MSH) compared to other institutions for men with localized intermediate and high-risk prostate cancer (PCa).

We identified 536,539 men aged ≥40 years presenting with localized intermediate and high-risk PCa in the United States between 2004-2015 using the National Cancer Database (NCDB). Institutions were ranked according to the proportion of Black and Hispanic patients treated at a given institution, and the top decile institutions were defined as MSH. We used multivariable analyses to characterize the association between MSH and three endpoints: receipt of definitive treatment, time to definitive treatment, and receipt of androgen deprivation therapy in young (≤65 years) and healthy (no comorbidity) men treated with external beam radiation therapy.

162 and 1168 hospitals were defined as MSH and non-MSH, respectively. In multivariable analyses, MSH was associated with decreased odds of receiving definitive treatment (Adjusted Odds Ratio [AOR] 0.73 95%-CI: 0.62-0.85, p<0.001). The adjusted mean time to treatment was significantly longer in MSHs compared to non-MSHs (4.9days, standard error 2.2; p=0.024). Among young and healthy men, there was no association between treatment at MSH and receipt of androgen deprivation therapy in conjunction with external beam radiation (AOR 0.90; 95%-CI: 0.75-1.09, p=0.291).

Treatment at MSH was associated with lower odds of receiving definitive therapy and longer time to definitive therapy for localized intermediate- and high-risk PCa, despite adjustment for race. This suggests that some of the racial disparities in PCa may be explained by the sites at which racial/ethnic minorities receive care.

The Journal of urology. 2018 Nov 08 [Epub ahead of print]

Marieke J Krimphove, Sean A Fletcher, Alexander P Cole, Sebastian Berg, Maxine Sun, Stuart R Lipsitz, Brandon A Mahal, Paul L Nguyen, Toni K Choueiri, Adam S Kibel, Luis A Kluth, Joel S Weissman, Quoc-Dien Trinh

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. Electronic address: ., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA. Electronic address: ., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA. Electronic address: ., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany. Electronic address: ., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA. Electronic address: ., Division of General Internal Medicine and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA. Electronic address: ., Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. Electronic address: ., Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. Electronic address: ., Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. Electronic address: ., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA. Electronic address: ., Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany. Electronic address: ., Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ., Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA. Electronic address: .