ASPO Abstracts
Measuring the Association of Racial/Ethnic Differences in the Patient Experience with Care and Gleason Score at Diagnosis of Prostate Cancer: A SEER-CAHPS study
Category: Early Detection & Risk Prediction
Conference Year: 2021
Abstract Body:
Purpose: To explore whether racial/ethnic differences in patient experiences with care are
associated with prostate cancer grade at diagnosis.
Methods: We used the SEER-CAHPS dataset to develop a retrospective cohort of Medicare
insured men age 65 and older with a prostate cancer diagnosis between 1997-2011 who
completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient
experience survey at most 3 years before cancer diagnosis. Gleason score at diagnosis, a
standard measure of prostate cancer grade, was used as the dependent variable. Independent
variables included aspects of patient experiences captured by CAHPS surveys, such as the ability
to get needed prescription drugs and quality of physician communication. Covariates included age,
education, marital status, census tract poverty, region, Medicare insurance type, comorbidities,
and primary care use. Multivariable ordinal logistic regression analyses were conducted for each
CAHPS measure.
Results: Of the 4,439 prostate cancer patients, 77.2% were non-Hispanic white (NHW), 8.7% were
non-Hispanic black (NHB), 8.5% were Hispanic, and 5.7% were Asian. Hispanics and Asians were
significantly less likely than NHWs to report an excellent ability to get care quickly (Hispanic:
OR=0.74, 95% CI=0.57-0.97; Asian: OR=0.58, 95% CI=0.42-0.81) and get needed care (Hispanic:
OR=0.75, 95% CI=0.58-0.96; Asian: OR=0.68, 95% CI=0.50-0.92). Asians were also less likely to
report an excellent ability to get needed prescription drugs (OR=0.68, 95% CI=0.49-0.95).
However, compared to NHWs, NHBs were more likely to report excellent physician communication
(OR=1.69, 95% CI=1.31-2.31). NHBs were 38% more likely to have a higher Gleason score at
diagnosis than NHWs (95% CI=1.11-1.72). Excellent ratings of ability to get needed prescription
drugs were associated with lower odds of a higher Gleason score at diagnosis (OR=0.84, 95%
CI=0.72-0.98).
Conclusions: Amongst SEER-CAHPS prostate cancer patients, there were significant racial/ethnic
differences in patient experience with care before cancer diagnosis and Gleason score at
diagnosis. Patient experiences with access to care may influence Gleason score at diagnosis;
however, more research is needed to elucidate if the relationship differs by race/ethnicity.
Keywords: patient experience, racial/ethnic disparities, cancer prognosis