OBJECTIVES: Treating high-risk prostate cancer (CaP) with definitive therapy improves survival.
We evaluated whether having health insurance reduces racial disparities in the use of definitive therapy for high-risk CaP.
MATERIALS AND METHODS: The Surveillance, Epidemiology, and End Results Program was used to identify 70,006 men with localized high-risk CaP (prostate-specific antigen level >20ng/ml or Gleason score 8-10 or stage >cT3a) diagnosed from 2007 to 2010. We used multivariable logistic regression to analyze the 64,277 patients with complete data to determine the factors associated with receipt of definitive therapy.
RESULTS: Compared with white men, African American (AA) men were significantly less likely to receive definitive treatment (adjusted odds ratio [AOR] = 0.60; 95% CI: 0.56-0.64; P< 0.001) after adjusting for sociodemographics and known CaP prognostic factors. There was a significant interaction between race and insurance status (Pinteraction = 0.01) such that insurance coverage was associated with a reduction in racial disparity between AA and white patients regarding receipt of definitive therapy. Specifically, the AOR for definitive treatment for AA vs. white was 0.38 (95% CI: 0.27-0.54, P< 0.001) among uninsured men, whereas the AOR was 0.62 (95% CI: 0.57-0.66, P< 0.001) among insured men.
CONCLUSIONS: AA men with high-risk CaP were significantly less likely to receive potentially life-saving definitive treatment when compared with white men. Having health insurance was associated with a reduction in this racial treatment disparity, suggesting that expansion of health insurance coverage may help reduce racial disparities in the management of aggressive cancers.
Written by:
Mahal BA, Ziehr DR, Aizer AA, Hyatt AS, Sammon JD, Schmid M, Choueiri TK, Hu JC, Sweeney CJ, Beard CJ, D׳Amico AV, Martin NE, Lathan C, Kim SP, Trinh QD, Nguyen PL. Are you the author?
Harvard Medical School, Boston, MA; Harvard Radiation Oncology Program, Boston, MA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA; Vattikuti Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI; Division of Urology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA; Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA; Department of Urology, UCLA Medical Center, Los Angeles, CA; Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT.
Reference: Urol Oncol. 2014 May 17. pii: S1078-1439(14)00156-2.
doi: 10.1016/j.urolonc.2014.04.014
PubMed Abstract
PMID: 24846344
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