Undertreatment of High-Risk Prostate Cancer in Latino Men
New research by Lichtensztajn et al in JNCCN—Journal of the National Comprehensive Cancer Network examined disparities in care for Latino men with prostate cancer. A team of researchers from UCSF Helen Diller Family Comprehensive Cancer Center, Stanford Cancer Institute, and the Icahn School of Medicine at Mount Sinai looked at 2,421 Latino and 8,636 non-Latino white men diagnosed and treated for prostate cancer across California between 2010 and 2014. They found the Latino men were 21% less likely to receive definitive treatment for high-risk localized prostate cancer than non-Latino white men, which has been shown to result in worse outcomes.
“This disparity seems to be largely accounted for by sociodemographic and other nonclinical factors, including neighborhood socioeconomic status, health insurance, marital status, as well as care at a [National Cancer Institute (NCI)]-designated cancer center,” explained lead author Daphne Lichtensztajn, MD, MPH, epidemiologist in the UCSF Department of Epidemiology and Biostatistics, in a statement. “However, the influence of patient age, tumor grade, and insurance status was significantly different between the two populations. This study reinforces the need for training in cultural competency and patient-centered communication, in addition to ensuring the availability of trained interpreters and in-language materials and resources.”
Study Methods
The data came from the California Cancer Registry, which is comprised of four registries within the Surveillance, Epidemiology, and End Results (SEER) program. Only men with high-risk disease were included, as defined by the NCCN Guidelines® Panel for Prostate Cancer. Definitive treatment was defined as radical prostatectomy, radiation (with or without androgen-deprivation therapy), or cryoablation.
“Prostate cancer can potentially be cured with multimodal therapy, even when it presents with high-risk features. It is critical that best practices, such as recommending definitive treatment for high-risk, localized prostate cancer, are clearly translated to community urologists and oncologists,” said Tanya Dorff, MD, medical oncologist at City of Hope National Medical Center and a member of the NCCN Guidelines Panel for Prostate Cancer. “Furthermore, given the complexity of decision-making in localized prostate cancer, culturally tailored communication and education guides for Latino men may increase utilization of these treatments, which have been shown to improve survival.”
Key Findings
The researchers found that for both ethnicities, a lack of health insurance was associated with undertreatment, but the impact was significantly higher for Latinos. Uninsured non-Latino white men were 37% less likely to receive definitive treatment than those with insurance, whereas uninsured Latinos were 66% less likely to undergo definitive treatment compared to their insured counterparts.
Additionally, receiving treatment at an NCI-designated cancer center was associated with a 57% higher likelihood of definitive treatment for non-Latino white men, but had no such boost for Latinos. Dr. Lichtensztajn suggests communication barriers, as well as the influence of implicit bias, could account for some of these disparities.
Study Implications
“Implicit bias is pervasive in our society, and addressing it at a societal level is a complex task,” said Dr. Lichtensztajn. “However, acknowledging its existence and increasing awareness is a crucial first step. As individuals become more mindful of their spontaneous reactions to people, they can begin to check these unconscious responses and make conscious efforts to change them.”
Other factors potentially contributing to disparities include varying safety-net care availability and eligibility criteria across the different counties of California. The researchers also pointed out some cultural factors—for instance, the fact that younger Latino men are more likely to be primary wage earners unable to withstand income disruption, which could contribute to the differing approaches to disease management.
The study authors recommend targeting interventions toward those who are at the highest risk of undertreatment, specifically Latino men who are younger and/or uninsured.
Disclosure: See study authors’ full disclosures at jnccn.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
