The following is a summary of ”Access to definitive treatment and survival for intermediate-risk and high-risk prostate cancer at hospital systems serving health disparity populations,” published in the May 2023 issue of the Urologic Oncology by Nguyen et al.

Although socioeconomic and racial disparities in prostate cancer (CaP) have been attributed to patient- and physician-level factors, there is a growing interest in examining the role of the care facility in driving cancer disparities. The researchers aimed to investigate the receipt of guideline-concordant definitive treatment, time to treatment initiation (TTI), and overall survival (OS) among men with CaP receiving care at hospital systems serving health disparity populations (HSDPs). They analyzed the National Cancer Database (2004–2016) in retrospect. Men with intermediate- or high-risk CaP eligible for definitive treatment were identified. The primary outcomes were receiving standard therapy and TTI within 90 days of diagnosis. 

OS was the secondary outcome. HSDPs were defined as minority-serving hospitals with the highest proportion of non-Hispanic Black (NHB) or Hispanic cancer patients and high-burden safety-net hospitals with the highest proportion of uninsured patients. Using mixed-effect models with a random intercept at the facility level, they compared outcomes between HSDPs and non-HSDPs for the entire cohort and among males who received definitive treatment. They included 968 non-HSDP facilities (72.2%) and 373 HSDP facilities (27.8%). Treatment at HSDPs was associated with lower odds of definitive therapy (aOR 0.64; 95% CI 0.57–0.71; P<0.001), lower odds of TTI within 90 days of diagnosis (aOR 0.74; 95% CI 0.68–0.74; P<0.001), and worse OS (aHR 1.05; 95% CI 1.02–1.03; P =.003) when covariates were accounted for. 

However, no difference in OS among patients who received definitive therapy (aHR 1.03; 95% CI 0.99–1.01; P = 0.1). Men with NHB treated at HSDPs had worse outcomes than men with NHB treated at non-HSDPs and men with NHW treated at HSDPs. Patients treated at HSDPs were less likely to receive definitive treatment promptly and had worse OS, regardless of race. At HSDPs, NHB men have worse outcomes than NHW. Thus, NHB males with CaP are doubly disadvantaged, as they are more likely to be treated in hospitals with poorer outcomes and to experience poorer outcomes than other patients at these institutions.

Source: sciencedirect.com/science/article/abs/pii/S107814392300011X