Details:

Alternative Title:
Cancer
Personal Author:
Borno, Hala T. ; Lichtensztajn, Daphne Y. ; Gomez, Scarlett L. ; Palmer, Nynikka R. ; Ryan, Charles J.
Borno, Hala T. ; Lichtensztajn, Daphne Y. ; Gomez, Scarlett L. ; Palmer, Nynikka R. ; Ryan, Charles J. Less -
Description:
Objective:

Surgical and medical androgen deprivation therapy (ADT) strategies are comparable in their ability to suppress serum testosterone levels as treatment in metastatic prostate cancer but differ in cost and impact on quality of life. Medical ADT is associated with better long-term quality of life due to the flexibility of possible therapy interruption but comes with a higher cumulative cost. We examined if surgical ADT (i.e., bilateral orchiectomy) was differentially utilized by race/ethnicity and other social factors.

Methods

We identified patients with metastatic disease at diagnosis through the California Cancer Registry. The association of race/ethnicity with receipt of surgical ADT was modeled using multivariable Firth logistic regression adjusting for age, Gleason score, prostate specific antigen, clinical tumor and lymph node stage, neighborhood socioeconomic status (nSES), insurance, marital status, comorbidities, initial treatment (radiation, chemotherapy), location of care, rural/urban area, and year of diagnosis.

Results

We examined 10,675 patients with metastatic prostate cancer: Non-Hispanic (NH) Black (11.4%), Asian/Pacific Islander (8.4%), Hispanic/Latino (18.5%), and NH White (60.4%). In the multivariable model, patients more likely to receive surgical ADT were Hispanic/Latino (OR=1.32, 95% CI 1.01–1.72), from a low nSES (OR=1.96, 95% CI 1.34–2.89) or rural area (OR=1.49, 95% CI 1.15–1.92), and had Medicaid/public insurance (OR=2.21, 95% CI 1.58–3.10). Patients with Military/Veterans Administration insurance were significantly less likely to receive surgical ADT than patients with private insurance (OR=0.34, 95% CI 0.13–0.88).

Conclusion:

Race/ethnicity, neighborhood SES, and insurance are significantly associated with receipt of surgical ADT. Future research will need to characterize other differences in initial treatments among men with advanced prostate cancer based on race/ethnicity and aim to better understand what factors drive the association between surgical ADT among men of Hispanic origin or from low nSES.


Subjects:
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Aged Androgen Antagonists Antineoplastic Agents, Hormonal Ethnic Groups Hispanic Or Latino Humans Insurance Coverage Male Middle Aged Neoplasm Metastasis Orchiectomy Practice Patterns, Physicians' Prostatic Neoplasms Quality Of Life Registries Socioeconomic Factors White People
Source:
Cancer. 125(3):453-462
Pubmed ID:
30444526
Pubmed Central ID:
PMC6340740
Document Type:
Journal Article
Funding:
HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; T32 AG000212/AG/NIA NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; ... More +
HHSN261201000140C/CA/NCI NIH HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; T32 AG000212/AG/NIA NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; U58 DP003862/DP/NCCDPHP CDC HHS/United States Less -
Place as Subject:
California
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:395bedaf92072078a65c41bda4f60bff8a0a00ccc08a19a9509f4e8d9f2a0dd2
Download URL:
https://stacks.cdc.gov/view/cdc/62372/cdc_62372_DS1.pdf
File Type:

Supporting Files

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