Racial variation in the pattern and quality of care for prostate cancer in the USA: mind the gap.
OBJECTIVE
To review the literature on racial variation in the pattern of care (PoC) and quality of care (QoC) for prostate cancer, as there are known racial disparities in the incidence and outcomes of prostate cancer. While there are some biological explanations for these differences, they do not completely explain the variation. Differences in the appropriateness and QoC delivered to men of different racial groups may contribute to disparities in outcome.


METHODS
We searched the USA National Library of Medicine PubMed system for articles pertaining to quality indicators in prostate cancer and racial disparities in QoC for prostate cancer.


RESULTS
While standards for appropriate treatment are not clearly defined, racial variation in the PoC has been reported in several studies, suggesting that African-American men may receive less aggressive treatment. There are validated QoC indicators in prostate cancer, and researchers have begun to evaluate racial variation in adherence to these quality indicators. Further quality comparisons, particularly in structural measures, may need to be performed to fully evaluate differences in QoC.


CONCLUSIONS
There is mounting evidence for racial variation in the PoC and QoC for prostate cancer, which may contribute to observed differences in outcome. While some of the sources of racial variation in quality and outcome have been identified through the development of evidence-based guidelines and validated quality indicators, opportunities exist to identify, study and attempt to resolve other components of the quality gap.
Barocas
Daniel A
DA
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. dan.barocas@vanderbilt.edu
Penson
David F
DF
D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy; D011787:Quality of Health Care / Q000592:standards*; D044469:Racial Groups; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology