A multidimensional view of racial differences in access to prostate cancer care

Abstract

Background Racial disparities in prostate cancer treatment and outcomes are widespread and poorly understood. We sought to determine whether access to care, measured across multiple dimensions, contributed to racial differences in prostate cancer. Methods The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer in 2012–2014. Men were surveyed to assess their experiences accessing care (response rate 51.1%). We determined appointment availability at 151 urology practices using simulated patient calls and calculated travel distances using geospatial techniques. We used multivariable logistic regression models to determine the association between five different domains of access—availability, accessibility, accommodation, affordability, and acceptability—and receipt of treatment, perceived quality of care, and doctor-patient communication. Results There were 1907 non-Hispanic white and 394 black men in our cohort. Overall, 85% of men received definitive treatment with no differences by race. Black men were less likely to report high quality of care (69% vs 81%, p<0.001) and good doctor-patient communication than white men (60% vs 71%, p<0.001). In adjusted models, none of the five domains of access were associated with definitive treatment overall or with radical prostatectomy. All access domains were associated with perceived quality of care and communication, though these domains did not mediate racial disparities. Conclusions This study presents the first comprehensive assessment of prostate cancer access, treatment, and patient experience, showing that while access was related to overall perceived quality of care and better doctor-patient communication, it did not appear to explain observed racial differences.

Disparities in the Utilization of Radiation Therapy for Prostate Cancer in the United States: A Comprehensive Review

“… 25 Muralidhar et al (2017) Disparities in the Receipt of Local Treatment of Node-positive Prostate Cancer Population-based (NCDB) 9,771 Men with clinical N1M0 PCa diagnosed from 1998 to 2012 Black, lower income, older, and Medicaid beneficiary or no insurance patients are less likely to receive local treatment for node-positive PCa and are associated with reduced OS. 26 Pollack et al (2017) A multidimensional view of racial differences in access to prostate cancer care Survey-based 2,374 Men diagnosed with localized PCa between 2012 and 2014 Black men with PCa are younger and more likely to have Medicaid insurance, lower income, and a high school education or less. Black men report less availability to care and a lower level of perceived quality of care and doctor-patient communication.…”

“…Reports analyzing SES, an individual's relative societal position based on factors such as occupation, education, income, and disparities, generally concluded that lower SES is associated with a decreased likelihood of receiving RT for prostate cancer. 5 , 6 , 19 , 21 , 22 , 24 , 25 , 26 More specifically, lower income is paralleled to greater odds of not receiving dose-escalated or proton therapy. 24 However, patients with Medicare and Medicaid are more likely to receive proton therapy than those without or with private insurance.…”

“…Additionally, increasing community engagement and patient education is invaluable in decreasing barriers to care, as minority patients with prostate cancer tend to be younger, identify with a lower socioeconomic class, and are more likely to be unaware of resources available for disease prevention and management. 26 Academic faculty should be encouraged to conduct disparities research while partnering with appropriate colleagues and experts to avoid the expectation that minority faculty researchers alone will advance diversity, equity, and inclusion initiatives. In clinical practice, it is imperative that clinicians are consciously aware of their implicit and explicit biases, as practice characteristics and provider preferences directly affect outcomes and contribute to disparities.…”

Racial Disparities and Mental Health Effects Within Prostate Cancer

“…In comparison, only 5% of deaths are due to tumor-related factors. 5,25 Pollack et al found that poorer access was associated with worse perceived quality of care and physician-patient communication. 5,25 However, racial differences in treatment were found not mediated or modulated by access to care but by socioeconomic factors.…”

“…5,25 Pollack et al found that poorer access was associated with worse perceived quality of care and physician-patient communication. 5,25 However, racial differences in treatment were found not mediated or modulated by access to care but by socioeconomic factors. Black men have lower treatment availability than white men due to limited insurance coverage, travel longer distances to healthcare clinics, or have shortages of healthcare providers.…”