Most major cancer organizations seek to reduce sociodemographic disparities in high-risk cancers partly by increasing access to theoretically high-quality, academic-oriented cancer care. The objective of this study was to determine whether academic centers have less sociodemographic treatment disparities than community centers using high-risk prostate cancer as a test case.
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The National Cancer Data Base was used to identify 138,019 patients who were diagnosed with nonmetastatic, high-risk prostate cancer from 2004 to 2012. Multivariable logistic analysis was used to identify independent determinants of definitive therapy. The Gray test and multivariable Cox regression were used to analyze the timing of therapy. All analyses were stratified by academic versus community cancer center.
Compared with white or privately insured patients, black, Hispanic, and uninsured patients with prostate cancer were less likely to receive definitive therapy at both community centers (adjusted odds ratio: 0.60 [95% confidence interval (CI), 0.56-0.64], 0.69 [95% CI, 0.61-0.78], and 0.25 [95% CI, 0.22-0.30], respectively) and academic cancer centers (adjusted odds ratio: 0.50 [95% CI, 0.46-0.54], 0.56 [95% CI, 0.50-0.64], and 0.31 [95% CI, 0.28-0.36], respectively). Among patients who received definitive therapy, black, Hispanic, and uninsured patients were more likely to experience treatment delays at both community centers (≥15, ≥ 10, and ≥19 days, respectively; all Gray P < .001) and academic centers (≥19, ≥ 11, and ≥18 days, respectively); treatment delays were observed among the aforementioned groups even after multivariable Cox regression analysis (P < .001 for all adjusted hazard ratios).
Nationally, academic cancer centers demonstrate similarly high rates of sociodemographic disparities in cancer treatment patterns as community cancer centers. Making community centers conform to academic center standards may not necessarily reduce treatment disparities. Cancer 2016. © 2016 American Cancer Society.
Cancer. 2016 Jul 19 [Epub ahead of print]
Brandon A Mahal, Yu-Wei Chen, Vinayak Muralidhar, Amandeep R Mahal, Toni K Choueiri, Karen E Hoffman, Jim C Hu, Christopher J Sweeney, James B Yu, Felix Y Feng, Simon P Kim, Clair J Beard, Neil E Martin, Quoc-Dien Trinh, Paul L Nguyen
Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts., Harvard Medical School, Boston, Massachusetts., Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, New Haven, Connecticut., Harvard Medical School, Boston, Massachusetts., Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Department of Urology, New York-Presbyterian Hospital/Weill Cornel Medical Center, New York, New York., Harvard Medical School, Boston, Massachusetts., Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, New Haven, Connecticut., Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan., Department of Urology, University Hospitals Case Western Reserve University School of Medicine, Cleveland, Ohio., Harvard Medical School, Boston, Massachusetts., Harvard Medical School, Boston, Massachusetts., Harvard Medical School, Boston, Massachusetts., Harvard Medical School, Boston, Massachusetts.