(UroToday.com) The 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) cancers symposium held in San Francisco, CA between January 25th and 27th was host to a prostate cancer poster session. Dr. Arvip Guha presented a study of the association between patient-provider rurality and outcomes among older men with prostate cancer.
Dr. Guha noted that prostate cancer is the most commonly diagnosed cancer among males across 122 countries and remains the primary cause of cancer-related deaths in 48 countries. Among men with prostate cancer, cardiovascular disease is the primary cause of non-cancer related deaths among such men. It has been established that men in rural areas have an increased incidence of cardiovascular disease and worse age-adjusted mortality rates, compared to men from metropolitan areas in the general population. This is likely related to the increased prevalence of cardiovascular risk factors, such as hypertension and hypercholesterolemia, in rural communities. To date, the role of rurality in the development of cardiovascular disease in patients with prostate cancer remains unknown. As such, Dr. Guha and colleagues hypothesized that a rural status may be associated with a higher risk of worse outcomes, including all-cause mortality, cardiovascular disease and mortality, and prostate cancer-specific mortality.
The investigators queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database to identify males aged ≥66 years with a new primary diagnosis of prostate cancer between 2009 and 2017. Patient rurality was defined using the 2013 SEER Rural Urban Continuum Code. Conversely, provider rurality was defined by matching the provider to Core Based Statistical Area Codes with the 2013 National Center for Health Statistics Urban–Rural Classification scheme for counties.
The primary study outcome was all-cause mortality. Given an observed proportional hazards violation, adjusted extended Cox models were performed for the primary outcome. Secondary outcomes included:
- Prostate cancer-specific mortality
- Cardiovascular mortality.
Adjusted Fine-Gray modeling, accounting for the competing risk of other-cause mortality, were used to calculate the cumulative incidences of prostate cancer and cardiovascular mortalities and calculated subdistribution hazard ratios (sHR).
The study cohort included 75,291 prostate cancer patients, with a median age of 72 years, of whom 8.9% received androgen deprivation therapy (ADT). With regards to the rurality status at diagnosis and during treatment, the breakdown was as follows:
- 92% originated from and received treatment in metropolitan areas
- 7% were from urban areas but were served by metropolitan providers
- 0.8% lived in rural areas and were served by metropolitan providers
- 0.5% resided in rural areas and were served by non-metropolitan providers
They noted that patients from rural areas who had providers from non-metropolitan areas had an increased incidence of cardiovascular disease (sHR: 1.33, 95% CI: 1.08 – 1.63), cardiovascular mortality (sHR: 1.42, 95% CI: 0.96 – 2.10), and all-cause mortality (aHR: 1.44, 95% Ci: 1.15 – 1.79), compared to metropolitan patients who had providers from metropolitan areas, as well. There were no significant differences in prostate cancer mortality rates across the patient/physician rurality continuum.
Dr. Guha concluded that patients from rural areas with providers from non-metropolitan areas face a higher risk of cardiovascular disease and all-cause mortality, highlighting the role of rurality as a social determinant of health outcomes.
Presented by: Avirup Guha, MPH, MBBS, Assistant Professor, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, San Francisco, CA, January 25th – January 27th, 2024