Prostate news article, December 2005
VARIATIONS IN LOCALISED PROSTATE CANCER THERAPY BASED ON SOCIOECONOMICS AND ETHNICITY Professor Roger S Kirby Visiting Professor to St George's Hospital, London |
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It has been well documented that there is considerable variation in the approach to the treatment of localized prostate cancer based on a variety of variables, including a patient's ethnicity, socioeconomic status, cultural morays, and access to health care. This study by Krupski and colleagues sought to examine geographic, ethnic, and socioeconomic variation in therapy for localized prostate cancer based on data gleaned from the NCI SEER database.
During the period 1995-1999, 102,970 men with local/regional prostate cancer were entered into the SEER database. Of these, 96,769 had data points that allowed them to be assessable for inclusion in this study. The authors found that patients who received surgery for local/regional prostate cancer were more likely to be white, younger, and possess less than a high school education. Patients who received radiation therapy for prostate cancer were more likely to be white, older, have higher incomes, and have more well differentiated tumors. African Americans were the least likely to receive surgery or radiation therapy for their prostate cancer as compared to other ethnic groups. In fact, the odds of a black man undergoing surgery for prostate cancer were half that of whites and the odds of a black man receiving radiation therapy rather than watchful waiting were 20% lower than that of whites. The overwhelming factor that predicted any treatment (most commonly surgery) other than watchful waiting in all ethnic groups was tumor grade. More aggressive tumors were more likely to receive some form of therapy, be it surgery or radiation therapy or a combination of the two.
Other points of interest noted by the investigators were the fact that surgery was far more commonly offered as a primary therapy in the west, and least commonly offered in the northeast. Furthermore, and not surprisingly, providers were more likely to favour the treatment modality associated with their subspecialty (i.e. surgeons were more likely to recommend surgery; radiation oncologists were more likely to recommend radiation).
The authors concluded that tumor grade was the best predictor of offering aggressive therapy but that ethnicity, income, and geography all played a role in determining the primary therapy (or lack thereof) that a patient received for local/regional prostate cancer. In this study, African Americans had the lowest rate of surgery and radiation therapy as compared to other ethnic groups. Whether this phenomena is patient driven, physician driven, or represents a healthcare access issue (or a combination of all of these factors) remains to be determined, but similar patterns seem likely to be the case in the UK.
JCO 23(31): 7881-7888, November 1, 2005