Treatment for older prostate cancer patients: disparities in a southern state.
BACKGROUND
Black prostate cancer patients are less likely to receive aggressive therapy (AT) than Whites: reported rates for patients ≥ 65 years old are about 55% versus 65%. Little is known about treatment rates in socioeconomically deprived states with large Black populations like Alabama.


METHODS
Medicare claims and Alabama Statewide Cancer Registry records were linked for Alabamian men in Medicare fee-for-service diagnosed with loco-regional prostate cancer in 2000-2002. The association between race and likelihood of: (1) AT (prostatectomy or external beam radiation therapy [EBRT] or brachytherapy); (2) hormone therapy (primary androgen deprivation therapy [ADT] or orchiectomy); (3) <30 days of EBRT; and (4) <6 months of ADT, was investigated adjusting for age, clinical tumor stage, grade, Comorbidity Index, and census tract proportion of Black residents, of persons living below poverty and with ≤ high school.


RESULTS
Of 3561 patients, 71.2% received AT and 38.3% hormone therapy. Blacks were less likely to receive AT (64.3% vs. 73.0%, adjusted [adj.] OR: 0.80, CI: 0.67-0.96). There was no difference between Blacks and Whites in the likelihood of receiving hormone therapy (40.8% vs. 37.7%, adj. OR: 1.10, CI: 0.91-1.34), <30 days of EBRT (30.5% vs. 31.5%, adj. OR: 0.98, CI: 0.72-1.32) or <6 months of ADT (50.7% vs. 54.0%, adj. OR: 0.84, CI: 0.63-1.12).


CONCLUSIONS
In Alabama, there were racial differences in utilization of aggressive treatment for locoregional prostate cancer. Research should investigate factors associated with prostate cancer treatment among older men, such as patient behavior and access to care.
Pisu
Maria
M
Division of Preventive Medicine, University of Alabama, Birmingham, AL 35294-4410, USA. mpisu@uab.edu
Oliver
Joann S
JS
Kim
Young-Il
YI
Elder
Keith
K
Martin
Michelle
M
Richardson
Lisa C
LC
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama / Q000453:epidemiology; D001294:Attitude to Health / Q000208:ethnology*; D016001:Confidence Intervals; D015438:Health Behavior; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*