Alexander Putnam Cole, M.D.
Black men with prostate cancer had a higher cumulative incidence of prostate cancer-specific mortality than white men with prostate cancer, but had similar survival outcomes when managed with the same therapy. According to data from a retrospective study presented at an international conference, 2023 American Urological Association Annual Meeting. According to Alexander Putnam Cole, M.D., this suggests that racial and ethnic disparities are likely due to unequal access to care and treatment, and are addressed early in the course of the disease. It states that it may imply that it is necessary to
A study of non-Hispanic black and non-Hispanic white men with localized intermediate-risk and high-risk prostate cancer compared cancer-specific survival rates according to race and therapy: Black men were shown to have a higher cumulative incidence of prostate cancer–higher specific mortality and were less likely to undergo surgery than radiation compared to white men (adjusted odds ratio, 0.53; 95 %CI, 0.51-0.55; P. < .001). Radiation was also associated with a higher prostate cancer-specific mortality risk than surgery (adjusted HR) [aHR]2.03; 95% CI, 1.79–2.31; P. < .001).
We utilized a model that included an interaction term between race and treatment to assess whether treatment type mitigated or exacerbated racial disparities. Were there large racial differences in cancer outcomes among men who underwent radiation therapy or surgery? (aHR, 1.25; 95% CI, 0.97–1.63; 95% CI, 0.97–1.63; P. = .086) or radiation (aHR, 0.95; 95% CI, 0.82–1.11; P. = .056).
“This is consistent with other research that my team and I have done. [which suggests] Equal access to care and equal treatment create many racial differences in survival [to] Go away,” Cole is an assistant professor of surgery at Harvard Medical School, an associate surgeon in urology at Brigham and Women’s Hospital, and a junior core faculty member at the Center for Surgery and Public Health in Boston, Massachusetts. . “or [suggests that] Differences in how people access care mediate racial disparities in cancer outcomes. ”
in an interview with Onclive®Cole noted the importance of investigating racial and ethnic disparities in prostate cancer outcomes, the key data from this analysis, and how these results will improve access and quality of patient care in this disease. We discussed how we can better inform efforts to
Onclive®: Describe the rationale for investigating the magnitude of racial differences in cancer-specific survival rates for surgery and radiation therapy in prostate cancer patients.
call: This is a study using surveillance, epidemiology and end results. [SEER] cancer registry. Black men are about twice as likely to die from prostate cancer, and black and white men receive different types of treatment. [for their disease]. We also know that there is a difference in the quality of treatment for prostate cancer between black and white men.
For example, white men are more likely to be referred to high volume cancer surgeons for radiotherapy for prostate cancer and are more likely to meet certain quality criteria for radiotherapy. The question we had was whether racial differences in outcomes occurred within these two treatments, or whether these mainly occurred between or within these treatments.Moreover, is there a bigger difference [between racial outcomes] With any of these treatments? For example, you might imagine that in surgery the expertise of the surgeon and the amount of surgery are very important, whereas in the case of radiation there is a bit more standardization. Larger racial differences may be seen with surgery compared to those seen with radiotherapy.
What methods were used to conduct the analysis?
[We conducted] Unadjusted analysis, then adjusted analysis. We wanted to determine whether there are racial differences in prostate cancer-specific mortality and whether there are differences in the type of first-line treatment for high-risk localized prostate cancer.we [initially] We used two different regression models. One was for prostate cancer-specific mortality and the other was for treatment with radiotherapy or surgery.then we [used] A third regression model with an interaction term combines both race and treatment. This term tests whether a patient’s race alters the effects of different treatments.
Could you discuss the key data from this study, which was presented at the 2023 AUA conference?
When looking at prostate cancer-specific mortality odds, the hazard ratio was approximately 2. He was twice as likely as a black man to die from this type of prostate cancer. We know; it’s not really a new discovery. Regarding treatment, the odds ratio for radiotherapy was found to be approximately 1.8. This means that black men are about 80% more likely to receive first-line radiation therapy. Both its direction and magnitude indicated an increase in mortality from prostate cancer in black men and an increase in radiation therapy for black men. Their scale was quite similar. When we examined the interaction of race and treatment, we found this to be insignificant. The effect of race on surgery does not seem to have a greater effect on radiation therapy.
Interestingly, we then ran a survival model that included treatment.I don’t see it anymore [a race-based difference in prostate cancer–specific mortality] When adjusting for these treatment types, [patients received]. This is also shown in other studies by our group, such as Dr. Klinghoff’s 2019 in Prostate Cancer and Prostate Disease.
Do these findings illuminate factors that contribute to racial disparities in clinical practice? At what point in the course of the disease should these be addressed?
The ‘cheesy explanation’ is that black men are dead [at increased rates] because they are undergoing radiation therapy [they appear to have] worse result [with this modality]. I don’t think so.In most areas such a phenomenon is not seen [quality] research. That would be one potential interpretation, but I don’t think it’s entirely correct.
[These findings] do [suggest] Inequality seems to start early [specifically] in deciding on treatment. Once treatment decisions are made, racial differences in access to treatment are reduced.This refers to [the need for] Efforts focused on access to care. Disparities start early. They start at the beginning of the diagnostic and therapeutic pathway. Once on the road to treatment, from that point onwards, such disparities no longer exist. This is one of the places where the racial disparity in prostate cancer is striking. [originate].
Based on these findings, what steps is your facility taking to address the impact of racial disparities on prostate cancer outcomes?
there is something [BWH and Massachusetts General Hospital] It’s called the Prostate Cancer Outreach Clinic. I work for a very good nationally ranked hospital with access to experienced surgeons and next generation diagnostics. Many of my patients are wealthy white men with prostate cancer. [Whereas men in minoritized communities in areas around Boston aren’t necessarily getting to our clinic. We don’t know exactly why. Maybe they get diagnosed and referred to a radiation center nearby without a multidisciplinary evaluation. Maybe there are transportation barriers. There are millions of potential factors and we have grant funding from the Department of Defense and American Cancer Society to identify and intervene on these barriers.
[In] Our Prostate Cancer Outreach Clinic, [we’re] We are building an infrastructure that includes people from social workers, community outreach workers, community partners and community health centres, to pave the way for these. [patients] To access our hospitals, clinics, surgeons and radiation oncologists. This is just one part of a larger anti-racism program here at Massachusetts General Brigham, and they have been very helpful in getting this off the ground.
reference
Frego N, Labban M, Stone B, et al. MP77-17 Effect of definitive treatment type on race-based differences in prostate cancer-specific survival. J Urol. 2023;209(4):e1109. Doi: 10.1097/JU.0000000000003351.17