Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort.
OBJECTIVE
To assess the variation in primary treatment of high-risk prostate cancer (PCa) by different hospital characteristics in the United States.


METHODS
We used the National Cancer Data Base to identify patients diagnosed with pretreatment high-risk PCa from 2004 to 2011. The primary outcomes were different forms of primary therapy or watchful waiting (WW) across different types of hospitals (community, comprehensive cancer community, and academic hospitals). Multivariable logistic regression analyses were used to test for differences in treatment by hospital type.


RESULTS
During the study period, we identified 102,701 men diagnosed with high-risk PCa. Overall, the most common treatment was radical prostatectomy (37.0%) followed by radiation therapy (33.2%) and WW (8.5%). Compared with white men with high-risk PCa, black men had lower adjusted odds ratios (OR) for surgery at comprehensive community (OR: 0.64; P <.001) and academic (OR: 0.62; P <.001) hospitals. Similarly, black men were also more likely to be managed with WW at community (OR: 1.49; P <.001), comprehensive cancer community (OR: 1.24; P <.001), and academic (OR: 1.55; P <.001) hospitals, as well as with radiation therapy at comprehensive cancer community (OR: 1.27; P <.001) and academic hospitals (OR: 1.23; P <.001).


CONCLUSIONS
Disparities in the use of WW and different primary treatments among patients with high-risk PCa persisted across different types of hospitals and over time. Our findings highlight a significant racial disparity in the use of curative therapy for high-risk PCa that should be urgently addressed to ensure that all men with PCa receive appropriate care across all racial groups and cancer care facilities.
School of Medicine, Yale University, New Haven, CT.
Elyn H
EH
Wang
Department of Radiation Oncology, Yale University, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.
James B
JB
Yu
Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Case Medical Center, Cleveland, OH; University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
Robert
R
Abouassally
University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH.
Neal J
NJ
Meropol
University Hospitals Case Medical Center, Department of Gastroenterology, University Hospital, Cleveland, OH.
Gregory
G
Cooper
Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN.
Nilay D
ND
Shah
Department of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX.
Stephen B
SB
Williams
Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Case Medical Center, Cleveland, OH.
Christopher
C
Gonzalez
Department of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX.
Marc C
MC
Smaldone
Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA.
Alexander
A
Kutikov
Louis Stokes VA, Cleveland, OH.
Hui
H
Zhu
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT; Urology Institute, Center of Outcomes and Health Care Quality, University Hospitals Case Medical Center, Cleveland, OH; University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH. Electronic address: simkim@me.com.
Simon P
SP
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D044469:Racial Groups / Q000706:statistics & numerical data*; D018570:Risk Assessment; D014481:United States