African-American Prostate Cancer Patients Receive Lower-Quality Surgical Care
The disparities remained statistically significant even after controlling for year surgery was performed, patient age, comorbidities, and insurance status, according to senior author Daniel Barocas, MD, MPH, assistant professor of urologic surgery at Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
“Our findings of racial variation in the quality of surgical care for prostate cancer adds to previous studies that have shown racial differences in screening behavior, stage at presentation, and use of aggressive treatment, and may contribute to our understanding of why [African-American] men have much higher prostate cancer mortality than [Caucasian] men,” Dr. Barocas wrote.
Researchers from Vanderbilt-Ingram Cancer Center, the Tennessee Valley Veterans Administration Geriatric Research Center, and US Agency for Healthcare Research and Quality in Rockville, MD, analyzed medical records for more than 105,000 prostate cancer patients who had received radical prostatectomy at nonfederal hospitals in Florida, Maryland, and New York between 1996 and 2007.
Prostate cancer patients whose surgeons perform a high volume of prostatectomies are known to have lower rates of morbidity and mortality. African-American men had a 33% lower chance of receiving surgery performed by a high-prostatectomy-volume surgeon and a 27% lower chance of being treated at a high-prostatectomy-volume hospital, the authors found. In multivariate analyses, African-American men had lower rates of treatment at high-volume hospitals (OR=0.73, 95% confidence intervals (CI), 0.70 – 0.76, P < 0.001). African-American men also had lower rates of prostatectomy by high-volume surgeons than Caucasian men (OR=0.67, 95% CI, 0.64-0.70, P < 0.001). Inpatient mortality was higher among African-American men than Caucasian men (OR=1.73, CI, 1.02-2.92).
“Racial disparities in prostate cancer outcomes may be partially explained by differences in access to high-quality care, which in turn may reflect differences in patient resources,” Dr. Barocas reported.