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Racial Disparity in Delivering Definitive Therapy for Intermediate/High-risk Localized Prostate Cancer: The Impact of Facility Features and Socioeconomic Characteristics.

Abstract The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races.
PMID
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Authors

Mayor MeshTerms
Keywords

Health care disparities

Health care quality

Prostatic neoplasms

Journal Title european urology
Publication Year Start




PMID- 28778619
OWN - NLM
STAT- Publisher
DA  - 20170805
LR  - 20170805
IS  - 1873-7560 (Electronic)
IS  - 0302-2838 (Linking)
DP  - 2017 Aug 01
TI  - Racial Disparity in Delivering Definitive Therapy for Intermediate/High-risk
      Localized Prostate Cancer: The Impact of Facility Features and Socioeconomic
      Characteristics.
LID - S0302-2838(17)30652-8 [pii]
LID - 10.1016/j.eururo.2017.07.023 [doi]
AB  - BACKGROUND: The gap in prostate cancer (PCa) survival between Blacks and Whites
      has widened over the past decade. Investigators hypothesize that this disparity
      may be partially attributable to differences in rates of definitive therapy
      between races. OBJECTIVE: To examine facility level variation in the use of
      definitive therapy among Black and White men for localized PCa. DESIGN, SETTING, 
      AND PARTICIPANTS: Using data from the National Cancer Data Base, we identified
      223 873 White and 59 262 Black men >/=40 yr of age receiving care within the USA 
      with biopsy confirmed localized intermediate/high-risk PCa diagnosed between
      January 2004 and December 2013. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:
      Multilevel logistic regression was fitted to predict the odds of receiving
      definitive therapy for PCa. Sensitivity and subgroup analyses were performed to
      adjust for inherent patient and facility-level differences when appropriate.
      RESULTS AND LIMITATIONS: Eighty-three percent (n=185 647) of White men received
      definitive therapy compared with 74% (n=43 662) of Black men between 2004 and
      2013. Overall rates of definitive therapy during that time increased for both
      White (81% vs 83%, p<0.001) and Black (73% vs 75%, p=0.001) men. However, 39% of 
      treating facilities demonstrated significantly higher rates of definitive therapy
      in White men, compared with just 1% favoring Black men. Our study is limited by
      potential selection bias and effect modification. CONCLUSIONS: After adjusting
      for sociodemographic and clinical factors, we found that most facilities favored 
      definitive therapy in Whites. Health care providers should be aware of these
      inherit biases when counseling patients on treatment options for localized PCa.
      Our study is limited by the retrospective nature of the cohort. PATIENT SUMMARY: 
      We found significant differences in rates of radiation and surgical treatment for
      prostate cancer among White and Black men, with most facilities favoring Whites. 
      Nonclinical factors such as treatment facility type and location influenced rates
      of therapy.
CI  - Copyright (c) 2017 European Association of Urology. Published by Elsevier B.V.
      All rights reserved.
FAU - Friedlander, David F
AU  - Friedlander DF
AD  - Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical
      School, Boston, MA, USA.
FAU - Trinh, Quoc-Dien
AU  - Trinh QD
AD  - Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical
      School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and
      Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:
      [email protected]
FAU - Krasnova, Anna
AU  - Krasnova A
AD  - Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard
      Medical School, Boston, MA, USA.
FAU - Lipsitz, Stuart R
AU  - Lipsitz SR
AD  - Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard
      Medical School, Boston, MA, USA.
FAU - Sun, Maxine
AU  - Sun M
AD  - Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard
      Medical School, Boston, MA, USA.
FAU - Nguyen, Paul L
AU  - Nguyen PL
AD  - Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and
      Women's Hospital, Boston, MA, USA.
FAU - Kibel, Adam S
AU  - Kibel AS
AD  - Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical
      School, Boston, MA, USA.
FAU - Choueiri, Toni K
AU  - Choueiri TK
AD  - Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and
      Women's Hospital, Boston, MA, USA.
FAU - Weissman, Joel S
AU  - Weissman JS
AD  - Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard
      Medical School, Boston, MA, USA.
FAU - Menon, Mani
AU  - Menon M
AD  - Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
FAU - Abdollah, Firas
AU  - Abdollah F
AD  - Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
LA  - eng
PT  - Journal Article
DEP - 20170801
PL  - Switzerland
TA  - Eur Urol
JT  - European urology
JID - 7512719
OTO - NOTNLM
OT  - Health care disparities
OT  - Health care quality
OT  - Prostatic neoplasms
EDAT- 2017/08/06 06:00
MHDA- 2017/08/06 06:00
CRDT- 2017/08/06 06:00
PHST- 2016/10/30 [received]
PHST- 2017/07/20 [accepted]
AID - S0302-2838(17)30652-8 [pii]
AID - 10.1016/j.eururo.2017.07.023 [doi]
PST - aheadofprint
SO  - Eur Urol. 2017 Aug 1. pii: S0302-2838(17)30652-8. doi:
      10.1016/j.eururo.2017.07.023.