Disparities in Prostate Cancer Treatment: Access to Novel Hormonal Therapy

What Did the Research Discover?

This study examined racial and ethnic disparities in the use of novel hormonal therapy (NHT) agents for advanced prostate cancer using Surveillance, Epidemiology, and End Results (SEER)–Medicare linked data from 2011 to 2017. The study analyzed 3,748 men with advanced prostate cancer, including Black, Hispanic, White, and other racial and ethnic groups, to assess differences in NHT initiation (medications including abiraterone, enzalutamide, apalutamide, or darolutamide).

The results showed that Black patients had significantly lower NHT utilization rates than White patients, even after accounting for disease severity and socioeconomic factors. At two years, NHT use was highest among White patients (27%), followed by Hispanic patients (25%) and other racial and ethnic groups (23%), while Black patients had the lowest rate (20%). The disparity persisted at five years, with 37% of Black patients receiving NHT compared to 44% of White patients. After adjusting for patient characteristics, disease severity, and socioeconomic status, Black patients remained significantly less likely to receive NHT (adjusted subdistribution hazard ratio, 0.76; 95% confidence interval [CI], 0.61-0.94; P = .01). However, no significant differences were observed between White, Hispanic, and other racial and ethnic groups.

The study found that factors associated with a higher likelihood of NHT initiation included younger age at diagnosis, higher prostate-specific antigen (PSA) levels, Gleason scores of 9 or 10, metastatic disease at diagnosis, lower comorbidity burden, married status, and higher socioeconomic status.

How Can I Apply This Information ?

Patients should ask their physician about all choices of medications that may be available to them if having a diagnosis of prostate cancer.  These findings highlight a significant racial disparity in the treatment of advanced prostate cancer, with Black patients being less likely to receive NHT despite its proven survival benefits. The reasons for this disparity are likely multifactorial, including barriers to care, financial constraints, implicit bias among healthcare providers, and geographic disparities in access to treatment.

Healthcare professionals should be aware of these disparities and take proactive steps to ensure treatment access for all patients. This includes patient education, shared decision-making, and advocating for systemic changes to address healthcare inequities. Medicare policies and healthcare systems should work towards improving access to NHT for Black patients, particularly since all study participants were Medicare beneficiaries.

Further research is needed to identify specific barriers to NHT use in Black patients and develop interventions to eliminate racial disparities in prostate cancer treatment. Ensuring equitable access to life-extending therapies is crucial for improving outcomes and reducing mortality among Black men with advanced prostate cancer.

Source:

Ma TM, Agarwal N, Mahal B, Barragan-Carrillo R, Spratt D, Rettig MB, Valle LF, Steinberg ML, Garraway I, Vapiwala N, Xiang M. Racial and ethnic disparities in use of novel hormonal therapy agents in patients with prostate cancer. JAMA network open. 2023 Dec 1;6(12):e2345906-. https://pmc.ncbi.nlm.nih.gov/articles/PMC10692845/