ASPO Abstracts
Treatment related race disparities in long term survival among very low risk prostate cancer patients
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose: Active surveillance and watchful waiting are often employed as a viable treatment strategy in addition to surgery or radiotherapy, for patients with NCCN defined very low risk status. However, effectiveness of these treatment recommendations with respect to long term survival has been explored in predominantly white patient populations. In this study, we utilized a population based cancer registry to explore whether racial disparities in survival exist in the context of treatment recommendations for very low risk disease.Methods: We leveraged data from the National Cancer Database (NCDB), which contains records on 45,773 prostate cancer patients who were diagnosed with NCCN very low risk disease. Propensity scores, using optimal match methods with caliper distance of 0.25, were used to match 6,574 African American Men (AAM) patients to their white counter parts in a 1:1 ratio. Cox proportional hazards models assessed overall survival differences by race.Results: Median follow up time was 44 months. In the unmatched cohort, AAM were diagnosed at higher rates, were more likely to lack health insurance, had higher comorbidity indices, and travelled shorter distances to seek primary care compared to white patients. Among those who received curative treatment, a higher proportion of AAM opted for radiation (46.1%) compared to white (35.9%) who were likely to receive surgery, p < 0.001. In survival analyses, AAM experienced inferior survival outcomes compared to white men HR = 1.30, 95% CI 1.09 — 1.54, p = 0.002). When stratified by patients who did not receive any curative treatment, AAM showed a strong trend towards poor survival (HR = 1.29, 95% CI, 0.97 — 1.73, p = 0.07). Furthermore, race disparities persisted in treatment stratified Cox models, especially among those who received surgery: AAM who received surgery had increased risk of poor survival (HR = 1.60, 95% CI, 1.11 — 2.30, p = 0.01). Conclusion: At the national level, race disparities continue to exist even among very low risk PCa patients, with AAM more likely experience poor survival outcomes. Observed outcome deficits among very low risk AAM patients warrant careful consideration of treatment recommendations including active surveillance.
Keywords: African American, Race disparity, Curative treatment