Association of Sociodemographic and Health-Related Factors With Receipt of Nondefinitive Therapy Among Younger Men With High-Risk Prostate Cancer

Bagley, Alexander F.; Anscher, Mitchell S.; Choi, Seungtaek; Frank, Steven J.; Hoffman, Karen E.; Kuban, Deborah A.; McGuire, Sean E.; Nguyen, Quynh Nhu; Chapin, Brian F.; Aparicio, Ana; Pezzi, Todd A.; Smith, Grace L.; Smith, Benjamin D.; Hess, Kenneth C.; Tang, Chad

doi:10.1001/jamanetworkopen.2020.1255

Cited by 17 publications

(18 citation statements)

References 20 publications

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“…In high-risk prostate cancer, multiple randomized clinical trials have shown that definitive therapy improves overall survival among patients. However, a recent publication reported that many patients do not receive definitive therapy because of sociodemographic and health-related factors [25]. In an analysis of factors associated with the receipt of nondefinitive therapy and survival among patients with high-risk prostate cancer, it was found that compared with White patients, Black and Hispanic patients were more likely to receive only systemic therapy, or not be treated at all.…”

Section: Discussionmentioning

confidence: 99%

“…In an analysis of factors associated with the receipt of nondefinitive therapy and survival among patients with high-risk prostate cancer, it was found that compared with White patients, Black and Hispanic patients were more likely to receive only systemic therapy, or not be treated at all. The most significant factors associated with receiving nondefinitive therapy were insurance status, race/ethnicity, median household income, and health-and disease-related factors, including tumor stage and medical comorbidity score [25]. In an analysis of the role of sociodemographic factors in treatment decisions for non-small-cell lung cancer, however, socioeconomic factors rather than race/ethnicity appeared to influence the refusal of cancer treatment in patients with stage IV non-small-cell lung cancer [26].…”

Section: Discussionmentioning

confidence: 99%

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Race and Ethnicity Representation in Clinical Trials: Findings from a Literature Review of Phase I Oncology Trials

Camidge

Park

Smoyer³

et al. 2021

Future Oncol.

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Aim: To provide an assessment of published literature on the demographic representation in Phase I trials of biopharmaceutical oncology agents. Materials & methods: We conducted a rapid evidence assessment to identify demographic representation reported in Phase I clinical trials for biopharmaceutical oncology agents published in 2019. Results: Globally, the population was predominantly White/Caucasian (62.2%). In the USA, the distribution was heavily skewed toward White/Caucasian (84.2%), with minimal representation of Blacks/African–Americans (7.3%), Asians (3.4%), Hispanics/Latinos (2.8%) or other race/ethnicity groups. Conclusion: Our data highlight that Phase I oncology trials do not reflect the population at large, which may perpetuate health disparities. Further research is needed to understand and address barriers to participation, particularly among under-represented groups

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Race and Ethnicity Representation in Clinical Trials: Findings from a Literature Review of Phase I Oncology Trials

Camidge

Park

Smoyer³

et al. 2021

Future Oncol.

View full text Add to dashboard Cite

show abstract

“…For example, in 1 series, young and healthy Black and Hispanic patients with high-risk prostate cancer were less likely than White patients to be treated with curative intent. 24 In a series of older patients with prostate cancer, Black patients were more likely than White patients to have delayed treatment and to incur higher treatment costs and had higher odds of readmission. 25 In a state-level series, Black patients with bladder cancer were more likely to be treated at low-volume centers, although this disparity did decline over time with increasing centralization of care.…”

Section: Discussionmentioning

confidence: 99%

Demographic Factors Associated With Non-Guideline–Based Treatment of Kidney Cancer in the United States

et al. 2021

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IMPORTANCE Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied. OBJECTIVE To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021. EXPOSURES Demographic factors, including sex, race/ethnicity, and insurance status. MAIN OUTCOMES AND MEASURES Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined. RESULTS Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment.

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“…There are vast documented disparities in clinical and patient-reported outcomes (PROs) across most malignancies, with overwhelming evidence suggesting that HLs are at a critical disadvantage. Hispanics and Latinos, specifically, present with more advanced disease and have a poorer prognosis for several different cancers relative to NHWs [10][11][12][13][14][15][16] .…”

Section: Social Determinants Of Health In Hispanic and Latinos: Effecmentioning

confidence: 99%

Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors

et al. 2021

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Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared to non-Hispanic White (NHWs) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the US, representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting healthcare options. These disparities often originate from disparate social determinants of health including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health/ exercise opportunities. Even among HLs with proper access to healthcare, they experience disparate treatment options including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the US regardless of racial and/or ethnic background. This manuscript reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. The Oncologist 2021;9999:• • Implications for Practice: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared to non-Hispanic and Latino Whites and other racial/ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.

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Association of Sociodemographic and Health-Related Factors With Receipt of Nondefinitive Therapy Among Younger Men With High-Risk Prostate Cancer

Cited by 17 publications

References 20 publications

Race and Ethnicity Representation in Clinical Trials: Findings from a Literature Review of Phase I Oncology Trials

Race and Ethnicity Representation in Clinical Trials: Findings from a Literature Review of Phase I Oncology Trials

Demographic Factors Associated With Non-Guideline–Based Treatment of Kidney Cancer in the United States

Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors

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