To assess the variation in primary treatment of high risk prostate cancer (PCa) by different hospital characteristics in the United States.
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We used the National Cancer Database (NCDB) to identify patients diagnosed with pretreatment high-risk PCa from 2004 and 2011. The primary outcomes were different forms of primary therapy or watchful waiting (WW) across different types of hospitals (community, comprehensive cancer community, and academic hospitals). Multivariable logistic regression analyses were used to test for differences in treatment by hospital type.
During the study period, we identified 102,701 men diagnosed with high-risk PCa. Overall, the most common treatment was radical prostatectomy (37.0%) followed by radiation therapy (33.2%) and WW (8.5%). Compared to white men with high-risk PCa, black men had lower adjusted odds ratios for surgery at comprehensive community (OR:0.64;p<0.001) and academic (OR:0.62;p<0.001) hospitals. Similarly, black men were also more likely to be managed with WW at community (OR:1.49;p<0.001), comprehensive cancer community hospitals (OR:1.24;p<0.001) and academic (OR:1.55;p<0.001) hospitals as well as with XRT at comprehensive cancer community (OR:1.27;p<0.001) and academic hospitals (OR:1.23;p<0.001).
Disparities in the use of WW and different primary treatments among patients with high-risk PCa persisted across different types of hospitals and over time. Our findings highlight a significant racial disparity in the use of curative therapy for high-risk PCa that should be urgently addressed in order to ensure that all men with PCa receive appropriate care, across all racial groups and cancer care facilities.
Urology. 2016 Jun 15 [Epub ahead of print]
Elyn H Wang, James B Yu, Robert Abouassally, Neal J Meropol, Gregory Cooper, Nilay D Shah, Stephen B Williams, Christopher Gonzalez, Marc C Smaldone, Alexander Kutikov, Hui Zhu, Simon P Kim
School of Medicine, Yale University, New Haven, Connecticut., Department of Radiation Oncology, Yale University, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut., Urology Institute, Center of Outcomes and Health Care Quality, University Hospital Case Medical Center, Cleveland, Ohio; University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio., University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, Ohio; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio., University Hospitals Case Medical Center, Department of Gastroenterology, University Hospital, Cleveland, Ohio., Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota., MD Anderson Cancer Center, Houston., Urology Institute, Center of Outcomes and Health Care Quality, University Hospital Case Medical Center, Cleveland, Ohio., MD Anderson Cancer Center, Houston., Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Louis Stokes VA, Cleveland, Ohio., Case Western Reserve University School of Medicine, Department of Urology, University Hospital Case Western Medical Center, 11000 Euclid Avenue, Cleveland, Ohio 44106. Electronic address: .