Race, healthcare access and physician trust among prostate cancer patients

Kyung, Young; Carpenter, William R.; Spain, Pamela; Clark, Jack A.; Hamilton, Robert J.; Galanko, Joseph A.; Jackman, Anne; Talcott, James A.; Godley, Paul A.

doi:10.1007/s10552-009-9431-y

Cited by 52 publications

(30 citation statements)

References 43 publications

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“…Specifically, given that patients with indolent prostate cancer are unlikely to die of the disease, those who are treated aggressively may unnecessarily experience the morbidities associated with surgery or radiation, 23 with little to no benefit from treatment. [7][8][9] Men of high socioeconomic status and Caucasian men with prostate cancer have greater access to healthcare and health insurance coverage compared with men of low socioeconomic status and minority men, 24,25 which may be the underlying driver of high rates of aggressive therapy for their indolent prostate cancer. Our results demonstrated that men of high socioeconomic status, Caucasian men, and married men were only slightly more likely to be insured compared with men of low socioeconomic status, non-Caucasian men, and unmarried men, respectively, indicating that differences in rates of insurance coverage probably were not a major contributor to the sociodemographic differences in receipt of aggressive therapy observed in our study.…”

Section: Discussionmentioning

confidence: 99%

Who Bears the Greatest Burden of Aggressive Treatment of Indolent Prostate Cancer?

Mahal

Cooperberg

Aizer³

et al. 2015

The American Journal of Medicine

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PURPOSE: The long-term prostate cancer-specific survival for patients initially managed with active surveillance for low-risk prostate cancer ranges from 97% to 100%. We characterized factors that are associated with aggressive treatment with radical prostatectomy or radiation for indolent prostate cancer (defined as screening-detected, low-risk disease). METHODS: The Surveillance, Epidemiology, and End Results Program was used to extract a cohort of 39,803 men diagnosed with prostate-specific antigenedetected, low-risk prostate cancer (clinical category T1c, Gleason score 6, and prostate-specific antigen <10) from 2004 to 2010. After socioeconomic profiles were generated from county-linked education and income data, multivariable logistic regression was used to determine whether there were any factors associated with high rates of aggressive treatment. RESULTS: The rate of aggressive treatment among all men with indolent prostate cancer was 64.3%. Greater rates of aggressive treatment were experienced by men with high socioeconomic status, Caucasian men, and married men (P < .001 for all cases). The increased adjusted odds for receipt of aggressive therapy were 1.25 (95% confidence interval [CI], 1.17-1.32; P < .001), 1.26 (95% CI, 1.21-1.32; P < .001), and 1.88 (95% CI, 1.80-1.97; P < .001) for men with high socioeconomic status, Caucasian men, and married men, respectively, compared with men with low socioeconomic status, non-Caucasian men, and unmarried men, respectively. CONCLUSIONS: Although men with high socioeconomic status, Caucasian men, and married men often receive the highest quality health care and have the best outcomes for many cancers, it seems that they are most at risk for the avoidable potential harms of aggressive treatment of indolent prostate cancer. Future policy should encourage more stringent guidelines for deferred treatment and culturally and sociodemographically competent counseling of active surveillance.

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Section: Discussionmentioning

confidence: 99%

Who Bears the Greatest Burden of Aggressive Treatment of Indolent Prostate Cancer?

Mahal

Cooperberg

Aizer³

et al. 2015

The American Journal of Medicine

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“…The same treatment pattern is well characterized in AA men (27, 41, 42). In AAs, etiologies for treatment differences are multifactorial and include patient mistrust of physicians (43), general negative attitudes against surgery(44), and lack of access to care(26, 45–48). Potential provider factors may include bias from known poorer outcomes in national data sets (26, 46–53) and more challenging pelvic anatomy in AAs (54, 55).…”

Section: Discussionmentioning

confidence: 99%

Are HIV-Infected Men Vulnerable to Prostate Cancer Treatment Disparities?

Bhatia

Martin

Klein

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background HIV-infected (HIV+) men face cancer treatment disparities which impact outcome. Prostate cancer (PCa) treatment and treatment appropriateness in HIV+ men are unknown. Methods We used electronic chart review to conduct a retrospective cohort study of 43 HIV+ cases with PCa and 86 age- and race-matched HIV-uninfected (HIV−) controls with PCa, aged 40–79, from 2001–2012. We defined treatment appropriateness using National Comprehensive Cancer Network (NCCN) guidelines and the Charlson Co-morbidity Index (CCI) to estimate life expectancy. Results Median age was 59.5 years at PCa diagnosis. Median CD4+ T-cell count was 459.5cells/mm3, 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy (RP) was the primary treatment for 39.5% of HIV+ and 71.0% of HIV− men (p= 0.004). Only 16.3% of HIV+ vs. 57.0% of HIV− men received open RP (p< 0.001). HIV+ men received more radiotherapy (25.6% vs. 16.3%, p= 0.13). HIV was negatively associated with open RP (OR= 0.03, p= 0.007), adjusting for insurance and CCI. No men were undertreated. Fewer HIV+ men received appropriate treatment (89.2% vs. 100%, p= 0.003), due to 4 overtreated HIV+ men. Excluding AIDS from the CCI still resulted in fewer HIV+ men receiving appropriate treatment (94.6% vs. 100%, p = 0.03). Conclusion PCa in HIV+ men is largely appropriately treated. Under-or overtreatment may occur from difficulties in life expectancy estimation. HIV+ men may receive more radiotherapy and fewer RPs, specifically open RPs. Impact Research on HIV/AIDS survival indices and etiologies and outcomes of this PCa treatment disparity in HIV+ men is needed.

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“…For example, there is some evidence from laboratory studies linking neurotransmitters associated with chronic stress to prostate cancer [29][30][31][32][33][34]. Additionally, some studies have found that lack of trust in physicians is associated with decreased PCa screening and delay in seeking PCa care, which may influence prostate cancer mortality [35,36].…”

Section: Discussionmentioning

confidence: 99%