Disproportionate Presentation of High Risk Prostate Cancer in a Safety Net Health System

Abstract

Purpose: Most prostate cancer research is based on relatively homogenous cohorts of men, often with comparatively high socioeconomic status. We describe prostate cancer characteristics in men treated in a public health system and hypothesize a disproportionate burden of high risk disease in this population. Materials and Methods:We created a clinical registry from a review of the medical records of 377 men diagnosed with prostate cancer in the San Francisco General Hospital system, which provides care to underserved, uninsured populations. We compared sociodemographic data and cancer characteristics with those in 2 large prostate cancer databases from a community (CaPSURE™) and an academic (University of California-San Francisco tumor registry) setting to assess differences in risk distribution using the D'Amico and Cancer of the Prostate Risk Assessment scoring systems. Results: Compared to men in CaPSURE or the University of California-San Francisco tumor registry those in the San Francisco General Hospital cohort were nonwhite (76%), insured under Medicaid (31%) or uninsured (8%) and had adverse clinical characteristics, including median prostate specific antigen greater than 10 ng/ml at diagnosis and higher Gleason grade. In addition, the majority of patients (67%) had intermediate or high risk disease based on the D'Amico classification and a higher mean Cancer of the Prostate Risk Assessment score. Using ANOVA for continuous variables and the chi-square test for categorical variables, all comparisons were statistically significant (p Ͻ0.001). Conclusions: Men in the San Francisco General Hospital public health system bear a substantially higher burden of high risk disease that those in an academic or a community setting. Populations such as this would benefit most from targeted efforts for early detection and treatment to decrease prostate cancer morbidity and mortality.

Effect of hospital safety net designation on treatment use and survival in hepatocellular carcinoma

“…Potential HCC knowledge gaps among providers may include misconceptions about screening and treatment guidelines for HCC . At the patient level, individuals at SNHs often undergo less preventive care, have advanced medical comorbidity, and have notable nonmedical social barriers to care . Previous studies have also suggested differential levels of knowledge about HCC between SNHs and non‐SNHs .…”

“…[26][27][28][29] At the patient level, individuals at SNHs often undergo less preventive care, have advanced medical comorbidity, and have notable nonmedical social barriers to care. 10,30,31 Previous studies have also suggested differential levels of knowledge about HCC between SNHs and non-SNHs. 32,33 Although we did not find differences in treatment and overall survival by safety net designation in a conditional landmark analysis accounting for patient comorbidity and liver function, these findings highlight the importance of large multicenter studies using clinically granular data to explore reasons for differences in treatment and outcomes between SNHs and non-SNHs.…”

The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004–2013)

“…Previous studies have documented disparities in the presentation of advance or mPCa based on presentation to a government-funded vs. private hospital [7], low income and lack of insurance [5,6], and nonwhite race [5,8]. Given the large scale of the NCDB, we were able to simultaneously account for SES, race, and insurance in our cohort which revealed that each variable independently affected the odds of presenting with mPCa.…”

Effect of race and socioeconomic status on surgical margins and biochemical outcomes in an equal‐access health care setting

“…19 Furthermore, analyses of different disadvantaged patient cohorts in the US showed disproportionately high CaP severity relative to the rest of the US population. 20, 21 In the current study, we attempted to distinguish between disease biology and surgical technique by adjusting for aggressive disease characteristics, including pathologic Gleason sum, ECE, and SVI, in our multivariate models. While we still found lower SES patients to have higher odds of PSM, suggesting technique explained at least some of the excess PSM among men with lower SES, ultimately, whether the higher risk of PSM is due to surgeon-level or disease-specific factors remains to be determined.…”