title: Treatment of men with high-risk prostate cancer based on race, insurance coverage, and access to advanced technology.
abstract: We characterized factors related to nondefinitive management (NDM) of patients with high-risk prostate cancer and assessed impact from race, insurance status, and facility-level volume of technologically advanced prostate cancer treatments (i.e., intensity-modulated radiation therapy, robotic-assisted laparoscopic radical prostatectomy) on this outcome.
  
  
  
  We identified men with high-risk localized prostate cancer (based on D׳Amico criteria) in the National Cancer Database (2010-2012). Primary outcome was NDM (i.e., delayed/no treatment with prostatectomy/radiation therapy or androgen-deprivation monotherapy). Treating facilities were classified by quartiles of proportions of patients treated with advanced technology. Multivariable regression estimated odds of primary outcome based on race, insurance status, and facility-level technology use, and evaluated for interactions between these covariates.
  
  
  
  Among 60,300 patients, 9,265 (15.4%) received NDM. This was more common among non-White men (P<0.001), Medicaid/uninsured patients (P<0.001), and those managed at facilities in the lowest quartile of technology use (25.1% vs. 11.0% highest, P<0.001). Though NDM was common among non-White men with Medicaid/no insurance treated at low-technology centers (43% vs. 10% White, private/Medicare, high-tech facility; adjusted odds ratios = 7.18, P<0.001), this was less likely if this group was managed at a high-tech hospital (22% vs. 43% low-tech, P<0.001).
  
  
  
  Technology use at a facility correlates with high-quality prostate cancer care and is associated with diminished disparities based on insurance status and patient race. More research is required to characterize other facility-level factors explaining these findings.
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Robert Steven
authors.initials: RS
authors.lastname: Gerhard
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Dattatraya
authors.initials: D
authors.lastname: Patil
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ogan
authors.affiliation: Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Alemozaffar
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Emory University, Atlanta, GA.
authors.forename: Ashesh B
authors.initials: AB
authors.lastname: Jani
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA.
authors.forename: Omer N
authors.initials: ON
authors.lastname: Kucuk
authors.affiliation: Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA; Department of Hematology and Oncology, Emory University, Atlanta, GA; Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gillespie
authors.affiliation: Department of Urology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA; Atlanta Veterans Administration Medical Center, Decatur, GA. Electronic address: cfilson@emory.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use; D020811:Biomedical Technology / Q000706:statistics & numerical data; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D014481:United States; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000726:Androgen Antagonists
keywords: African-Americans; Disparities; Insurance coverage; Prostate cancer; Technology