Emerging racial disparities among Medicare beneficiaries and Veterans with metastatic castration-sensitive prostate cancer.
Journal
Prostate cancer and prostatic diseases
ISSN: 1476-5608
Titre abrégé: Prostate Cancer Prostatic Dis
Pays: England
ID NLM: 9815755
Informations de publication
Date de publication:
02 Apr 2024
02 Apr 2024
Historique:
received:
21
06
2023
accepted:
20
02
2024
revised:
19
12
2023
medline:
3
4
2024
pubmed:
3
4
2024
entrez:
2
4
2024
Statut:
aheadofprint
Résumé
Previous studies have shown that Black men receive worse prostate cancer care than White men. This has not been explored in metastatic castration-sensitive prostate cancer (mCSPC) in the current treatment era. We evaluated treatment intensification (TI) and overall survival (OS) in Medicare (2015-2018) and Veterans Health Administration (VHA; 2015-2019) patients with mCSPC, classifying first-line mCSPC treatment as androgen deprivation therapy (ADT) + novel hormonal therapy; ADT + docetaxel; ADT + first-generation nonsteroidal antiandrogen; or ADT alone. We analyzed 2226 Black and 16,071 White Medicare, and 1020 Black and 2364 White VHA patients. TI was significantly lower for Black vs White Medicare patients overall (adjusted odds ratio [OR] 0.68; 95% confidence interval [CI] 0.58-0.81) and without Medicaid (adjusted OR 0.70; 95% CI 0.57-0.87). Medicaid patients had less TI irrespective of race. OS was worse for Black vs White Medicare patients overall (adjusted hazard ratio [HR] 1.20; 95% CI 1.09-1.31) and without Medicaid (adjusted HR 1.13; 95% CI 1.01-1.27). OS was worse in Medicaid vs without Medicaid, with no significant OS difference between races. TI was significantly lower for Black vs White VHA patients (adjusted OR 0.75; 95% CI 0.61-0.92), with no significant OS difference between races. Guideline-recommended TI was low for all patients with mCSPC, with less TI in Black patients in both Medicare and the VHA. Black race was associated with worse OS in Medicare but not the VHA. Medicaid patients had less TI and worse OS than those without Medicaid, suggesting poverty and race are associated with care and outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Previous studies have shown that Black men receive worse prostate cancer care than White men. This has not been explored in metastatic castration-sensitive prostate cancer (mCSPC) in the current treatment era.
METHODS
METHODS
We evaluated treatment intensification (TI) and overall survival (OS) in Medicare (2015-2018) and Veterans Health Administration (VHA; 2015-2019) patients with mCSPC, classifying first-line mCSPC treatment as androgen deprivation therapy (ADT) + novel hormonal therapy; ADT + docetaxel; ADT + first-generation nonsteroidal antiandrogen; or ADT alone.
RESULTS
RESULTS
We analyzed 2226 Black and 16,071 White Medicare, and 1020 Black and 2364 White VHA patients. TI was significantly lower for Black vs White Medicare patients overall (adjusted odds ratio [OR] 0.68; 95% confidence interval [CI] 0.58-0.81) and without Medicaid (adjusted OR 0.70; 95% CI 0.57-0.87). Medicaid patients had less TI irrespective of race. OS was worse for Black vs White Medicare patients overall (adjusted hazard ratio [HR] 1.20; 95% CI 1.09-1.31) and without Medicaid (adjusted HR 1.13; 95% CI 1.01-1.27). OS was worse in Medicaid vs without Medicaid, with no significant OS difference between races. TI was significantly lower for Black vs White VHA patients (adjusted OR 0.75; 95% CI 0.61-0.92), with no significant OS difference between races.
CONCLUSIONS
CONCLUSIONS
Guideline-recommended TI was low for all patients with mCSPC, with less TI in Black patients in both Medicare and the VHA. Black race was associated with worse OS in Medicare but not the VHA. Medicaid patients had less TI and worse OS than those without Medicaid, suggesting poverty and race are associated with care and outcomes.
Identifiants
pubmed: 38565911
doi: 10.1038/s41391-024-00815-1
pii: 10.1038/s41391-024-00815-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Sweeney CJ, Chen Y-H, Carducci M, Liu G, Jarrard DF, Eisenberger M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015;373:737–46.
pubmed: 26244877
pmcid: 4562797
doi: 10.1056/NEJMoa1503747
Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer. N Engl J Med. 2017;377:352–60.
pubmed: 28578607
doi: 10.1056/NEJMoa1704174
Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomised, double-blind, phase 3 trial. Lancet Oncol. 2019;20:686–700.
pubmed: 30987939
doi: 10.1016/S1470-2045(19)30082-8
James ND, de Bono JS, Spears MR, Clarke NW, Mason MD, Dearnaley DP, et al. Abiraterone for prostate cancer not previously treated with hormone therapy. N Engl J Med. 2017;377:338–51.
pubmed: 28578639
pmcid: 5533216
doi: 10.1056/NEJMoa1702900
Armstrong AJ, Szmulewitz RZ, Petrylak DP, Holzbeierlein J, Villers A, Azad A, et al. ARCHES: A randomized, phase III study of androgen deprivation therapy with enzalutamide or placebo in men with metastatic hormone-sensitive prostate cancer. J Clin Oncol. 2019;37:2974–86.
pubmed: 31329516
pmcid: 6839905
doi: 10.1200/JCO.19.00799
Armstrong AJ, Azad AA, Iguchi T, Szmulewitz RZ, Petrylak DP, Holzbeierlein J, et al. Improved Survival With Enzalutamide in Patients With Metastatic Hormone-Sensitive Prostate Cancer. J Clin Oncol. 2022;40:1616–22.
pubmed: 35420921
pmcid: 9113211
doi: 10.1200/JCO.22.00193
Chi KN, Agarwal N, Bjartell A, Chung BH, Pereira de Santana Gomes AJ, Given R, et al. Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med. 2019;381:13–24.
pubmed: 31150574
doi: 10.1056/NEJMoa1903307
Chi KN, Chowdhury S, Bjartell A, Chung BH, Pereira de Santana Gomes AJ, Given R, et al. Apalutamide in patients with metastatic castration-sensitive prostate cancer: Final survival analysis of the randomized, double-blind, phase III TITAN study. J Clin Oncol. 2021;39:2294–303.
pubmed: 33914595
doi: 10.1200/JCO.20.03488
Smith MR, Hussain M, Saad F, Fizazi K, Sternberg CN, Crawford ED, et al. Darolutamide and survival in metastatic, hormone-sensitive prostate cancer. N Engl J Med. 2022;386:1132–42.
pubmed: 35179323
pmcid: 9844551
doi: 10.1056/NEJMoa2119115
Virgo KS, Rumble RB, Talcott J. Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update. J Clin Oncol. 2023;41:3652–6.
Lowrance WT, Breau RH, Chou R, Chapin BF, Crispino T, Dreicer R, et al. Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline PART I. J Urol. 2021;205:14–21.
pubmed: 32960679
doi: 10.1097/JU.0000000000001375
Lowrance W, Dreicer R, Jarrard DF, Scarpato KR, Kim SK, Kirkby E, et al. Updates to Advanced Prostate Cancer: AUA/SUO Guideline (2023). J Urol. 2023;209:1082–90.
pubmed: 37096583
doi: 10.1097/JU.0000000000003452
Mottet N, Cornford P, van den Berg RCN, Briers E, Eberli D, De Meerleer G, et al. EAU - EANM - ESTRO - ESUR - ISUP - SIOG Guidelines on Prostate Cancer. 2023. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-EANM-ESTRO-ESUR-ISUP-SIOG-Guidelines-on-Prostate-Cancer-2023_2023-03-27-131655_pdvy.pdf .
Tagawa ST, Sandin R, Sah J, Mu Q, Freedland SJ. 679P Treatment patterns of metastatic castration-sensitive prostate cancer (mCSPC): A real-world evidence study. Ann Oncol. 2020;31:S541–2.
doi: 10.1016/j.annonc.2020.08.938
Freedland SJ, Sandin R, Sah J, Emir B, Mu Q, Ratiu A, et al. Treatment patterns and survival in metastatic castration-sensitive prostate cancer in the US Veterans Health Administration. Cancer Med. 2021;10:8570–80.
pubmed: 34725947
pmcid: 8633245
doi: 10.1002/cam4.4372
Ryan CJ, Ke X, Lafeuille M-H, Romdhani H, Kinkead F, Lefebvre P, et al. Management of Patients with Metastatic Castration-Sensitive Prostate Cancer in the Real-World Setting in the United States. J Urol. 2021;206:1420–9.
pubmed: 34293915
pmcid: 8584208
doi: 10.1097/JU.0000000000002121
Swami U, Sinnott JA, Haaland B, Sayegh N, McFarland TR, Tripathi N, et al. Treatment pattern and outcomes with systemic therapy in men with metastatic prostate cancer in the real-world patients in the United States. Cancers (Basel). 2021;13:4951.
pubmed: 34638435
pmcid: 8508241
doi: 10.3390/cancers13194951
Wallis CJD, Malone S, Cagiannos I, Morgan SC, Hamilton RJ, Basappa NS, et al. Real-world use of androgen-deprivation therapy: Intensification among older canadian men with de novo metastatic prostate cancer. JNCI Cancer Spectr. 2021;5:pkab082.
pubmed: 34926988
pmcid: 8678925
doi: 10.1093/jncics/pkab082
Swami U, Hong A, El-Chaar NN, Nimke D, Ramaswamy K, Bell EJ, et al. Real-world first-line (1L) treatment patterns in patients (pts) with metastatic castration-sensitive prostate cancer (mCSPC) in a U.S. health insurance database. J Clin Oncol. 2021;39(15_suppl):5072.
doi: 10.1200/JCO.2021.39.15_suppl.5072
George DJ, Agarwal N, Rider JR, Li B, Shirali R, Sandin R, et al. Real-world treatment patterns among patients diagnosed with metastatic castration-sensitive prostate cancer (mCSPC) in community oncology settings. J Clin Oncol. 2021;39(15_suppl):5074.
doi: 10.1200/JCO.2021.39.15_suppl.5074
Yip S, Niazi T, Hotte SJ, Lavallee L, Finelli A, Kapoor A, et al. Evolving real-world patterns of practice in metastatic castration-sensitive prostate cancer (mCSPC): The genitourinary research consortium (GURC) national multicenter cohort study. J Clin Oncol. 2022;40(6_suppl):86.
doi: 10.1200/JCO.2022.40.6_suppl.086
Freedland SJ, Klaassen ZWA, Agarwal N, Sandin R, Leith A, Ribbands A, et al. Reasons for oncologist and urologist treatment choice in metastatic castration-sensitive prostate cancer (mCSPC): A physician survey linked to patient chart reviews in the United States. J Clin Oncol. 2022;40(16_suppl):5065.
doi: 10.1200/JCO.2022.40.16_suppl.5065
Mahal BA, Aizer AA, Ziehr DR, Hyatt AS, Sammon JD, Schmid M, et al. Trends in disparate treatment of African American men with localized prostate cancer across National Comprehensive Cancer Network risk groups. Urology. 2014;84:386–92.
pubmed: 24975710
doi: 10.1016/j.urology.2014.05.009
Moses KA, Orom H, Brasel A, Gaddy J, Underwood W 3rd. Racial/ethnic differences in the relative risk of receipt of specific treatment among men with prostate cancer. Urol Oncol. 2016;34:415.e7–12
pubmed: 27161898
doi: 10.1016/j.urolonc.2016.04.002
Gerhard RS, Patil D, Liu Y, Ogan K, Alemozaffar M, Jani AB, et al. Treatment of men with high-risk prostate cancer based on race, insurance coverage, and access to advanced technology. Urol Oncol. 2017;35:250–6.
pubmed: 28089387
pmcid: 5400671
doi: 10.1016/j.urolonc.2016.12.004
Khan S, Hicks V, Rancilio D, Langston M, Richardson K, Drake BF. Predictors of Follow-Up Visits Post Radical Prostatectomy. Am J Mens Health. 2018;12:760–5.
pubmed: 29540091
pmcid: 6131455
doi: 10.1177/1557988318762633
Beebe-Dimmer JL, Ruterbusch JJ, Cooney KA, Bolton A, Schwartz K, Schwartz AG, et al. Racial differences in patterns of treatment among men diagnosed with de novo advanced prostate cancer: A SEER-Medicare investigation. Cancer Med. 2019;8:3325–35.
pubmed: 31094098
pmcid: 6558501
doi: 10.1002/cam4.2092
Caram MEV, Burns J, Kumbier K, Sparks JB, Tsao PA, Chapman CH, et al. Factors influencing treatment of veterans with advanced prostate cancer. Cancer. 2021;127:2311–8.
pubmed: 33764537
doi: 10.1002/cncr.33485
Mouzannar A, Atluri VS, Mason M, Prakash NS, Kwon D, Nahar B, et al. PD34-03 Racial disparity in the utilization of new therapies for advanced prostate cancer. J Urol. 2021;206(3_suppl):e583.
doi: 10.1097/JU.0000000000002038.03
Rude T, Walter D, Ciprut S, Kelly MD, Wang C, Fagerlin A, et al. Interaction between race and prostate cancer treatment benefit in the Veterans Health Administration. Cancer. 2021;127:3985–90.
pubmed: 34184271
doi: 10.1002/cncr.33643
Kelly SP, Rosenberg PS, Anderson WF, Andreotti G, Younes N, Cleary SD, et al. Trends in the Incidence of Fatal Prostate Cancer in the United States by Race. Eur Urol. 2017;71:195–201.
pubmed: 27476048
doi: 10.1016/j.eururo.2016.05.011
Tsodikov A, Gulati R, de Carvalho TM, Heijnsdijk EAM, Hunter-Merrill RA, Mariotto AB, et al. Is prostate cancer different in black men? Answers from 3 natural history models. Cancer. 2017;123:2312–9.
pubmed: 28436011
doi: 10.1002/cncr.30687
Weiner AB, Matulewicz RS, Tosoian JJ, Feinglass JM, Schaeffer EM. The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004-2013). Urol Oncol. 2018;36:91.e91–6.
doi: 10.1016/j.urolonc.2017.10.023
DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69:211–33.
pubmed: 30762872
doi: 10.3322/caac.21555
Würnschimmel C, Wenzel M, Collà Ruvolo C, Nocera L, Tian Z, Saad F, et al. Life expectancy in metastatic prostate cancer patients according to racial/ethnic groups. Int J Urol. 2021;28:862–9.
pubmed: 33993551
doi: 10.1111/iju.14595
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7–33.
pubmed: 35020204
doi: 10.3322/caac.21708
Yamoah K, Lee KM, Awasthi S, Alba PR, Perez C, Anglin-Foote TR, et al. Racial and Ethnic Disparities in Prostate Cancer Outcomes in the Veterans Affairs Health Care System. JAMA Netw Open. 2022;5:e2144027.
pubmed: 35040965
pmcid: 8767437
doi: 10.1001/jamanetworkopen.2021.44027
Elliott B, Zackery DL, Eaton VA, Jones RT, Abebe F, Ragin CC, et al. Ethnic differences in TGFβ-signaling pathway may contribute to prostate cancer health disparity. Carcinogenesis. 2018;39:546–55.
pubmed: 29474521
pmcid: 5889036
doi: 10.1093/carcin/bgy020
Zhang W, Dong Y, Sartor O, Flemington EK, Zhang K. SEER and Gene Expression Data Analysis Deciphers Racial Disparity Patterns in Prostate Cancer Mortality and the Public Health Implication. Sci Rep. 2020;10:6820.
pubmed: 32321981
pmcid: 7176737
doi: 10.1038/s41598-020-63764-4
Dess RT, Hartman HE, Mahal BA, Soni PD, Jackson WC, Cooperberg MR, et al. Association of black race with prostate cancer-specific and other-cause mortality. JAMA Oncol. 2019;5:975–83.
pubmed: 31120534
pmcid: 6547116
doi: 10.1001/jamaoncol.2019.0826
Krimphove MJ, Cole AP, Fletcher SA, Harmouch SS, Berg S, Lipsitz SR, et al. Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis. 2019;22:125–36.
pubmed: 30171227
doi: 10.1038/s41391-018-0083-4
Stern N, Ly TL, Welk B, Chin J, Ballucci D, Haan M, et al. Association of Race and Ethnicity With Prostate Cancer–Specific Mortality in Canada. JAMA Netw Open. 2021;4:e2136364.
pubmed: 34932109
pmcid: 8693210
doi: 10.1001/jamanetworkopen.2021.36364
Riviere P, Luterstein E, Kumar A, Vitzthum LK, Deka R, Sarkar RR, et al. Survival of African American and non-Hispanic white men with prostate cancer in an equal-access health care system. Cancer. 2020;126:1683–90.
pubmed: 31984482
doi: 10.1002/cncr.32666
Balakrishnan AS, Palmer NR, Fergus KB, Gaither TW, Baradaran N, Ndoye M, et al. Minority Recruitment Trends in Phase III Prostate Cancer Clinical Trials (2003 to 2014): Progress and Critical Areas for Improvement. J Urol. 2019;201:259–67.
pubmed: 30218761
doi: 10.1016/j.juro.2018.09.029
U.S. Department of Veterans Affairs. About VHA. 2022. https://www.va.gov/health/aboutvha.asp .
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
pubmed: 3558716
doi: 10.1016/0021-9681(87)90171-8
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.
pubmed: 1607900
doi: 10.1016/0895-4356(92)90133-8
Austin PC. Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. J Thorac Cardiovasc Surg. 2007;134:1128–35.
pubmed: 17976439
doi: 10.1016/j.jtcvs.2007.07.021
Austin PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med. 2008;27:2037–49.
pubmed: 18038446
doi: 10.1002/sim.3150
Normand ST, Landrum MB, Guadagnoli E, Ayanian JZ, Ryan TJ, Cleary PD, et al. Validating recommendations for coronary angiography following acute myocardial infarction in the elderly: a matched analysis using propensity scores. J Clin Epidemiol. 2001;54:387–98.
pubmed: 11297888
doi: 10.1016/S0895-4356(00)00321-8
Kaiser Family Foundation. Medicaid Income Eligibility Limits for Other Non-Disabled Adults, 2011-2023. https://www.kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-other-non-disabled-adults/ .
Lowder D, Rizwan K, McColl C, Paparella A, Ittmann M, Mitsiades N, et al. Racial disparities in prostate cancer: A complex interplay between socioeconomic inequities and genomics. Cancer Lett. 2022;531:71–82.
pubmed: 35122875
pmcid: 9701576
doi: 10.1016/j.canlet.2022.01.028
Halabi S, Dutta S, Tangen CM, Rosenthal M, Petrylak DP, Thompson IM Jr, et al. Overall survival of black and white men with metastatic castration-resistant prostate cancer treated with docetaxel. J Clin Oncol. 2019;37:403–10.
pubmed: 30576268
doi: 10.1200/JCO.18.01279
Sartor O, Armstrong AJ, Ahaghotu C, McLeod DG, Cooperberg MR, Penson DF, et al. Survival of African-American and Caucasian men after sipuleucel-T immunotherapy: outcomes from the PROCEED registry. Prostate Cancer Prostatic Dis. 2020;23:517–26.
pubmed: 32111923
pmcid: 7423504
doi: 10.1038/s41391-020-0213-7
Zhao H, Howard LE, De Hoedt A, Terris MK, Amling CL, Kane CJ, et al. Racial discrepancies in overall survival among men treated with
pubmed: 31479407
doi: 10.1097/JU.0000000000000524
Cole AP, Herzog P, Iyer HS, Marchese M, Mahal BA, Lipsitz SR, et al. Racial differences in the treatment and outcomes for prostate cancer in Massachusetts. Cancer. 2021;127:2714–23.
pubmed: 33999405
doi: 10.1002/cncr.33564
George DJ, Ramaswamy K, Huang A, Russell D, Mardekian J, Schultz NM, et al. Survival by race in men with chemotherapy-naive enzalutamide- or abiraterone-treated metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2022;25:524–30.
pubmed: 34732856
doi: 10.1038/s41391-021-00463-9
Marar M, Long Q, Mamtani R, Narayan V, Vapiwala N, Parikh RB. Outcomes Among African American and Non-Hispanic White Men With Metastatic Castration-Resistant Prostate Cancer With First-Line Abiraterone. JAMA Netw Open. 2022;5:e2142093.
pubmed: 34985518
pmcid: 8733836
doi: 10.1001/jamanetworkopen.2021.42093
Bernard B, Muralidhar V, Chen Y-H, Sridhar SS, Mitchell EP, Pettaway CA, et al. Impact of ethnicity on the outcome of men with metastatic, hormone-sensitive prostate cancer. Cancer. 2017;123:1536–44.
pubmed: 28055108
doi: 10.1002/cncr.30503
Freeman MM, Jaeger E, Zhu J, Phone A, Nussenzveig R, Caputo S, et al. Multi-institutional evaluation of the clinical outcomes and genomic correlates of African Americans with metastatic castration-sensitive prostate cancer (mCSPC). J Clin Oncol. 2021;39(6_suppl):17.
doi: 10.1200/JCO.2021.39.6_suppl.17
Smith KER, Brown JT, Wan L, Liu Y, Russler G, Yantorni L, et al. Clinical Outcomes and Racial Disparities in Metastatic Hormone-Sensitive Prostate Cancer in the Era of Novel Treatment Options. Oncologist. 2021;26:956–64.
pubmed: 34096667
pmcid: 8571757
doi: 10.1002/onco.13848
Knipper S, Preisser F, Mazzone E, Mistretta FA, Palumbo C, Tian Z, et al. Contemporary analysis of the effect of marital status on survival of prostate cancer patients across all stages: A population-based study. Urol Oncol. 2019;37:702–10.
pubmed: 31103337
doi: 10.1016/j.urolonc.2019.04.023