Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort

Elyn H. Wang, James B. Yu, Robert Abouassally, Neal J. Meropol, Gregory Cooper, Nilay D. Shah, Stephen Williams, Christopher Gonzalez, Marc C. Smaldone, Alexander Kutikov, Hui Zhu, Simon P. Kim

    Research output: Contribution to journalArticle

    15 Citations (Scopus)

    Abstract

    Objective To assess the variation in primary treatment of high-risk prostate cancer (PCa) by different hospital characteristics in the United States. Materials and 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). Conclusion 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.

    Original languageEnglish (US)
    Pages (from-to)88-94
    Number of pages7
    JournalUrology
    Volume95
    DOIs
    StatePublished - Sep 1 2016

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    Prostatic Neoplasms
    Odds Ratio
    Watchful Waiting
    Population
    Cancer Care Facilities
    Therapeutics
    Neoplasms
    Radiotherapy
    Community Hospital
    Prostatectomy
    Logistic Models
    Regression Analysis
    Databases

    ASJC Scopus subject areas

    • Urology

    Cite this

    Wang, E. H., Yu, J. B., Abouassally, R., Meropol, N. J., Cooper, G., Shah, N. D., ... Kim, S. P. (2016). Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort. Urology, 95, 88-94. https://doi.org/10.1016/j.urology.2016.06.010

    Disparities in Treatment of Patients With High-risk Prostate Cancer : Results From a Population-based Cohort. / Wang, Elyn H.; Yu, James B.; Abouassally, Robert; Meropol, Neal J.; Cooper, Gregory; Shah, Nilay D.; Williams, Stephen; Gonzalez, Christopher; Smaldone, Marc C.; Kutikov, Alexander; Zhu, Hui; Kim, Simon P.

    In: Urology, Vol. 95, 01.09.2016, p. 88-94.

    Research output: Contribution to journalArticle

    Wang, EH, Yu, JB, Abouassally, R, Meropol, NJ, Cooper, G, Shah, ND, Williams, S, Gonzalez, C, Smaldone, MC, Kutikov, A, Zhu, H & Kim, SP 2016, 'Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort', Urology, vol. 95, pp. 88-94. https://doi.org/10.1016/j.urology.2016.06.010
    Wang, Elyn H. ; Yu, James B. ; Abouassally, Robert ; Meropol, Neal J. ; Cooper, Gregory ; Shah, Nilay D. ; Williams, Stephen ; Gonzalez, Christopher ; Smaldone, Marc C. ; Kutikov, Alexander ; Zhu, Hui ; Kim, Simon P. / Disparities in Treatment of Patients With High-risk Prostate Cancer : Results From a Population-based Cohort. In: Urology. 2016 ; Vol. 95. pp. 88-94.
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    title = "Disparities in Treatment of Patients With High-risk Prostate Cancer: Results From a Population-based Cohort",
    abstract = "Objective To assess the variation in primary treatment of high-risk prostate cancer (PCa) by different hospital characteristics in the United States. Materials and 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). Conclusion 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.",
    author = "Wang, {Elyn H.} and Yu, {James B.} and Robert Abouassally and Meropol, {Neal J.} and Gregory Cooper and Shah, {Nilay D.} and Stephen Williams and Christopher Gonzalez and Smaldone, {Marc C.} and Alexander Kutikov and Hui Zhu and Kim, {Simon P.}",
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    T1 - Disparities in Treatment of Patients With High-risk Prostate Cancer

    T2 - Results From a Population-based Cohort

    AU - Wang, Elyn H.

    AU - Yu, James B.

    AU - Abouassally, Robert

    AU - Meropol, Neal J.

    AU - Cooper, Gregory

    AU - Shah, Nilay D.

    AU - Williams, Stephen

    AU - Gonzalez, Christopher

    AU - Smaldone, Marc C.

    AU - Kutikov, Alexander

    AU - Zhu, Hui

    AU - Kim, Simon P.

    PY - 2016/9/1

    Y1 - 2016/9/1

    N2 - Objective To assess the variation in primary treatment of high-risk prostate cancer (PCa) by different hospital characteristics in the United States. Materials and 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). Conclusion 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.

    AB - Objective To assess the variation in primary treatment of high-risk prostate cancer (PCa) by different hospital characteristics in the United States. Materials and 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). Conclusion 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.

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