Prostate cancer outcomes for men aged younger than 65 years with Medicaid versus private insurance

Mahal, Amandeep R.; Mahal, Brandon A.; Nguyen, Paul L.; Yu, James B.

doi:10.1002/cncr.31106

Cited by 27 publications

(39 citation statements)

References 35 publications

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“…Studies have shown that the disparities in cancer outcomes in patients with prostate cancer (and other cancers) diminish after US patients become eligible for Medicare . Furthermore, among patients with PC, there are no apparent disparities by race noted for men with Medicaid insurance . Finally, when AA men receive care as part of randomized controlled trials, they appear to achieve outcomes that are as favorable if not better than those of their NHW counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…11,13 Furthermore, among patients with PC, there are no apparent disparities by race noted for men with Medicaid insurance. 12 Finally, when AA men receive care as part of randomized controlled trials, they appear to achieve outcomes that are as favorable if not better than those of their NHW counterparts. For example, in the Prostate Cancer Intervention Versus Observation Trial (PIVOT), there was no difference in outcome noted by race and no difference in the benefit of prostatectomy on PCSM between AA and NHW men.…”

Section: Discussionmentioning

confidence: 99%

“…It is interesting to note that the racial gap in general cancer mortality in the United States diminishes after age 65 years, most likely due to near‐universal coverage from Medicare . Similarly, reports have demonstrated no observable difference in PC outcomes between NHW and AA men with Medicaid coverage …”

Section: Introductionmentioning

confidence: 99%

“…11 Similarly, reports have demonstrated no observable difference in PC outcomes between NHW and AA men with Medicaid coverage. 12,13 For these reasons, the Veterans Affairs (VA) health care system, an equal-access system for qualifying members that treats a large, diverse, male population of all adult ages, is an important 14 setting in which to evaluate racial disparities in PCSM. The objective of the current study was to elucidate the contemporary differences in prostate cancer survival outcomes between AA and NHW patients using the VA Informatics and Computing Infrastructure (VINCI), thus benefiting from the large percentage of AA men within the VINCI registry and the availability of socioeconomic, comorbidity, and cancer data.…”

Section: Introductionmentioning

confidence: 99%

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Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Riviere

Luterstein

Kumar

et al. 2020

Cancer

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Background African American (AA) men in the general US population are more than twice as likely to die of prostate cancer (PC) compared with non‐Hispanic white (NHW) men. The authors hypothesized that receiving care through the Veterans Affairs (VA) health system, an equal‐access medical system, would attenuate this disparity. Methods A longitudinal, centralized database of >20 million veterans was used to assemble a cohort of 60,035 men (18,201 AA men [30.3%] and 41,834 NHW men [69.7%]) who were diagnosed with PC between 2000 and 2015. Results AA men were more likely to live in regions with a lower median income ($40,871 for AA men vs $48,125 for NHW men; P < .001) and lower high school graduation rates (83% for AA men vs 88% for NHW men; P < .001). At the time of diagnosis, AA men were younger (median age, 63.0 years vs 66.0 years; P < .001) and had a higher prostate‐specific antigen level (median, 6.7 ng/mL vs 6.2 ng/mL; P < .001), but were less likely to have Gleason score 8 to 10 disease (18.8% among AA men vs 19.7% among NHW men; P < .001), a clinical T classification ≥3 (2.2% vs 2.9%; P < .001), or distant metastatic disease (2.7% vs 3.1%; P = 0.01). The 10‐year PC‐specific mortality rate was slightly lower for AA men (4.4% vs 5.1%; P = .005), which was confirmed in multivariable competing‐risk analysis (subdistribution hazard ratio, 0.85; 95% CI, 0.78‐0.93; P < .001). Conclusions AA men diagnosed with PC in the VA health system do not appear to present with more advanced disease or experience worse outcomes compared with NHW men, in contrast to national trends, suggesting that access to care is an important determinant of racial equity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Riviere

Luterstein

Kumar

et al. 2020

Cancer

View full text Add to dashboard Cite

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“…Although there is evidence that Medicaid increases overall health care access for low‐income individuals, state measures such as increased out‐of‐pocket costs and restrictions on specialist care may subdue the benefits of Medicaid coverage for a financially burdensome disease such as bladder cancer . It has in fact been shown for other cost‐intensive cancers (eg, colorectal cancer and head and neck cancer) that Medicaid coverage, compared with private insurance, is associated with poorer long‐term outcomes that are similar to those of the uninsured . In addition, many of the previously documented insurance‐based health disparities have been demonstrated in screening‐detectable cancers (eg, breast cancer, prostate cancer, and colorectal cancer) .…”

Section: Discussionmentioning

confidence: 99%

The impact of underinsurance on bladder cancer diagnosis, survival, and care delivery for individuals under the age of 65 years

Fletcher

Cole

et al. 2019

Cancer

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BACKGROUND: Health insurance is a key mediator of health care disparities. Outcomes in bladder cancer, one of the costliest diseases to treat, may be especially sensitive to a patient's insurance status. METHODS: The Surveillance, Epidemiology, and End Results registry and the National Cancer Data Base were used to identify individuals younger than 65 years who were diagnosed with bladder cancer from 2007 to 2014. The associations between the insurance status (privately insured, insured by Medicaid, or uninsured) and the following outcomes were evaluated: diagnosis with advanced disease, cancer-specific survival, delay in treatment longer than 90 days, treatment in a high-volume hospital, and receipt of neoadjuvant chemotherapy (NAC). RESULTS: Compared with those with private insurance, uninsured and Medicaid-insured individuals were nearly twice as likely to receive a diagnosis of muscle-invasive bladder cancer (odds ratio [OR] for uninsured individuals, 1.90; 95% confidence interval [CI], 1.70-2.12; OR for Medicaid-insured individuals, 2.03; 95% CI, 1.87-2.20). They were also more likely to die of bladder cancer (adjusted hazard ratio [AHR] for uninsured individuals, 1.49; 95% CI, 1.31-1.71; AHR for Medicaid-insured individuals, 1.61; 95% CI, 1.46-1.79). Delays in treatment longer than 90 days were more likely for uninsured (OR, 1.36; 95% CI, 1.12-1.65) and Medicaid-insured individuals (OR, 1.22; 95% CI, 1.03-1.44) in comparison with the privately insured. Uninsured patients had lower odds of treatment at a high-volume facility, and Medicaid-insured patients had lower odds of receiving NAC (P < .001 for both). CONCLUSIONS: Compared with privately insured individuals, uninsured and Medicaid-insured individuals experience worse prognoses and poorer care quality. Expanding high-quality insurance coverage to marginalized populations may help to reduce the burden of this disease. Cancer 2020;126:496-505.

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Successful Recruitment of Black Men to Prostate Cancer Clinical Trials—A Lesson in Achievement

2021

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Over the past 5 years, multiple phase 3 clinical trials have established that addition of docetaxel, abiraterone acetate, apalutamide, or enzalutamide to androgen deprivation therapy (ADT) significantly improve survival for men with metastatic hormone-sensitive prostate cancer (mHSPC). 1 Vaishampayan and colleagues 2 report the results of a randomized (1:1) trial comparing enzalutamide plus ADT with bicalutamide plus ADT in 71 men with mHSPC. The primary end point of the trial was 7-month prostate-specific antigen (PSA) remission rate (SMPR), defined as a PSA nadir of less than 4 ng/mL after 7 months of systemic therapy. 2 The primary end point favored enzalutamide plus ADT compared with bicalutamide plus ADT, with 94% vs 65% of patients achieving SMPR. Moreover, treatment with enzalutamide also improved time to PSA progression and overall survival (OS). Their overall findings are consistent with results from the 2 recently reported phase 3 clinical trials of enzalutamide in this setting (ie, ENZAMET and ARCHES). 1 What stands out and makes this report 2 so remarkable is that it is a prospective randomized clinical trial of men with mHSPC with a novel hormonal therapy where subset analysis of outcomes in Black men was prespecified. Historically, Black patients are underrepresented in clinical trials; this was the case in the ARCHES trial, with 1.4% Black enrollment. 1 It was likely the case in the ENZAMET trial, 1 but race was not included in the baseline characteristics. In contrast, in the trial by Vaishampayan and colleagues, 2 41% of patients were Black.

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Prostate cancer outcomes for men aged younger than 65 years with Medicaid versus private insurance

Cited by 27 publications

References 35 publications

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

Survival of African American and non‐Hispanic white men with prostate cancer in an equal‐access health care system

The impact of underinsurance on bladder cancer diagnosis, survival, and care delivery for individuals under the age of 65 years

Successful Recruitment of Black Men to Prostate Cancer Clinical Trials—A Lesson in Achievement

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