title: Racial Disparities in End-of-Life Care Among Patients With Prostate Cancer: A Population-Based Study.
abstract: OBJECTIVE
  To examine racial disparities in end-of-life (EOL) care among black and white patients dying of prostate cancer (PCa).
  
  
  METHODS
  Relying on the SEER-Medicare database, 3789 patients who died of metastatic PCa between 1999 and 2009 were identified. Information was assessed regarding diagnostic care, therapeutic interventions, hospitalizations, intensive care unit (ICU) admissions, and emergency department visits in the last 12 months, 3 months, and 1 month of life. Logistic regression tested the relationship between race and the receipt of diagnostic care, therapeutic interventions, and high-intensity EOL care.
  
  
  RESULTS
  Overall, 729 patients (19.24%) were black. In the 12-months preceding death, laboratory tests (odds ratio [OR], 0.51; 95% CI, 0.36-0.72), prostate-specific antigen test (OR, 0.54; 95% CI, 0.43-0.67), cystourethroscopy (OR, 0.71; 95% CI, 0.56-0.90), imaging procedure (OR, 0.58; 95% CI, 0.41-0.81), hormonal therapy (OR, 0.53; 95% CI, 0.44-0.65), chemotherapy (OR, 0.59; 95% CI, 0.48-0.72), radiotherapy (OR, 0.74; 95% CI, 0.61-0.90), and office visit (OR, 0.38; 95% CI, 0.28-0.50) were less frequent in black versus white patients. Conversely, high-intensity EOL care, such as ICU admission (OR, 1.27; 95% CI, 1.04-1.58), inpatient admission (OR, 1.49; 95% CI, 1.09-2.05), and cardiopulmonary resuscitation (OR, 1.72; 95% CI, 1.40-2.11), was more frequent in black versus white patients. Similar trends for EOL care were observed at 3-month and 1-month end points.
  
  
  CONCLUSIONS
  Although diagnostic and therapeutic interventions are less frequent in black patients with end-stage PCa, the rate of high-intensity and aggressive EOL care is higher in these individuals. These disparities may indicate that race plays an important role in the quality of care for men with end-stage PCa.
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kaustav
authors.initials: K
authors.lastname: Majumder
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Gally
authors.initials: G
authors.lastname: Reznor
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Hevelone
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Selvaggi
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: From the Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan; Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Division of Urologic Surgery and Center for Surgery and Public Health, Department of Radiation Oncology, Department of Medical Oncology, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D003558:Cystoscopy / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000208:ethnology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D009819:Office Visits / Q000706:statistics & numerical data; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D011878:Radiotherapy / Q000706:statistics & numerical data; D018426:SEER Program; D013727:Terminal Care / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen