Access to definitive treatment and survival for intermediate-risk and high-risk prostate cancer at hospital systems serving health disparity populations

Introduction: Although socioeconomic and racial disparities in prostate cancer (CaP) have been attributed to patient-level and physician-level factors, there is growing interest in investigating the role of the facility of care in driving cancer disparities. We sought to examine the receipt of guideline-concordant definitive treatment, time to treatment initiation (TTI), and overall survival (OS) for men with CaP receiving care at hospital systems serving health disparity populations (HSDPs). Methods: We retrospective analyzed the National Cancer Database (2004-2016). We identified men with intermediate-risk or high-risk CaP eligible for definitive treatment. The primary outcomes were receipt of definitive treatment and TTI within 90 days of diagnosis. The secondary outcome was OS. We defined HSDPs as minority-serving hospitals- facilities in the highest decile of proportion of non-Hispanic Black (NHB) or Hispanic cancer patients- and/or high-burden safety-net hospitals- facilities in the highest quartile of proportion of underinsured patients. We used mixed-effect models with facility-level random intercept to compare outcomes between HSDPs and non-HSDPs among the entire cohort and among men who received definitive treatment. Results: We included 968 non-HSDPs (72.2%) and 373 HSDPs (27.8%) facilities. Treatment at HSDPs was associated with lower adjusted odds of receipt of definitive treatment (aOR 0.64; 95% CI 0.57- 0.71; P < 0.001), lower odds of TTI within 90 days of diagnosis (aOR 0.74; 95% CI 0.68- 0.79; P < 0.001), and worse OS (aHR 1.05; 95% CI 1.02- 1.09; P =.003) when accounting for covariates. However, no difference was found in OS if patients received definitive treatment (aHR 1.03; 95% CI 0.99- 1.07; P = 0.1). NHB men at HSDPs had worse outcomes than NHB men treated at non-HSDPs as well as NHW men treated at HSDPs. Conclusion: Patients treated at HSDPs were less likely to receive timely definitive treatment and had worse OS, independent of their race. NHB men have worse outcomes thanNHWat HSDPs. Thus, NHB menwith CaP are doubly disadvantaged since they aremore likely to be treated at hospitals with worse outcomes and have worse outcomes than other patients at those same institutions. (c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This study aims to investigate the role of healthcare facilities in driving socioeconomic and racial disparities in prostate cancer. The study found that men receiving care at hospital systems serving health disparity populations had lower rates of guideline-concordant treatment, delayed treatment initiation, and worse overall survival. Additionally, African American men treated at these healthcare facilities had worse outcomes.