title: Receipt of National Comprehensive Cancer Network guideline-concordant prostate cancer care among African American and Caucasian American men in North Carolina.
abstract: BACKGROUND
  African Americans have a higher incidence of prostate cancer and experience poorer outcomes compared with Caucasian Americans. Racial differences in care are well documented; however, few studies have characterized patients based on their prostate cancer risk category, which is required to differentiate appropriate from inappropriate guideline application.
  
  
  METHODS
  The medical records of a population-based sample of 777 North Carolina men with newly diagnosed prostate cancer were studied to assess the association among patient race, clinical factors, and National Comprehensive Cancer Network (NCCN) guideline-concordant prostate cancer care.
  
  
  RESULTS
  African Americans presented with significantly higher Gleason scores (P = .025) and prostate-specific antigen levels (P = .008) than did Caucasian Americans. However, when clinical T stage was considered as well, difference in overall risk category only approached statistical significance (P = .055). Across risk categories, African Americans were less likely to have surgery (58.1% versus 68.0%, P = .004) and more likely to have radiation (39.0% versus 27.4%, P = .001) compared with Caucasian Americans. However, 83.5% of men received guideline-concordant care within 1 year of diagnosis, which did not differ by race in multivariable analysis (odds ratio = 0.83; 95% confidence interval  = 0.54-1.25). Greater patient-perceived access to care was associated with greater odds of receiving guideline-concordant care (odds ratio = 1.06; 95% confidence interval = 1.01-1.12).
  
  
  CONCLUSIONS
  After controlling for NCCN risk category, there were no racial differences in receipt of guideline-concordant care. Efforts to improve prostate cancer treatment outcomes should focus on improving access to the health care system.
authors.affiliation: School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7411, USA. sdellis@email.unc.edu
authors.forename: Shellie D
authors.initials: SD
authors.lastname: Ellis
authors.forename: Bonny
authors.initials: B
authors.lastname: Blackard
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: Merle
authors.initials: M
authors.lastname: Mishel
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
authors.forename: Paul A
authors.initials: PA
authors.lastname: Godley
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.forename: Jeannette T
authors.initials: JT
authors.lastname: Bensen
mesh_terms: D001741:Black or African American; D003191:Comprehensive Health Care / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D012959:Socioeconomic Factors; D044465:White People
chemical_list: D017430:Prostate-Specific Antigen