Investigators have found that Black men diagnosed with more advanced stages of prostate cancer may be significantly less likely to be prescribed novel hormone therapy compared with men from other racial and ethnic groups, according to a recent study published by Martin et al in JAMA Network Open. The new findings have revealed concerning racial disparities in the utilization of hormone therapy to treat prostate cancer.
Background
Androgens such as testosterone can stimulate the growth and progression of prostate cancer cells. Novel hormone therapy agents are capable of inhibiting the action of androgens, reducing their levels in the body, and targeting the androgen signaling axis.
The agents are often used in combination with traditional androgen-deprivation therapy to more effectively suppress androgen signaling, providing improved outcomes for patients with advanced or metastatic prostate cancer.
Hormone therapy has been shown to effectively control the growth of prostate tumors and extend the lives of patients with the disease.
“Even though we know hormonal therapies have significant clinical benefits in men with more advanced stages of prostate cancer, there is not much information available about how often [patients] in the general population use these drugs—particularly in the context of equitable access to these medications across different race and ethnicity groups,” explained co–senior study author Michael Xiang, MD, PhD, Assistant Clinical Professor in Radiation Oncology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).
Study Methods and Results
In the new study, the investigators used data from a population-based cancer registry linked to prescription drug records for 3,748 Medicare beneficiaries with a median age of 75 years and a diagnosis of advanced prostate cancer from 2011 to 2017 to assess the prescribing behavior of physicians on the basis of race and ethnicity. Among the beneficiaries, 8% of them were Black, 7% of them were Hispanic, 78% of them were White, and 7% of them identified as other racial or ethnic groups. Further, the majority of patients had metastatic prostate cancer and 36% of them received novel hormone therapy.
The investigators discovered that the White patients had the highest 2-year novel hormone therapy utilization rate at 27%, followed by Hispanic patients at 25%, other racial and ethnic groups at 23%, and Black patients at 20%.
This disparity persisted after a follow-up of 5 years and beyond, with Black patients consistently receiving this crucial treatment at a lower rate than White patients. The investigators emphasized that Black patients had a 24% lower likelihood of receiving or being prescribed novel hormonal therapy agents compared with White patients. Conversely, this disparity was not observed among Hispanic patients or those of other racial and ethnic groups.
Conclusions
“This revelation is particularly concerning given the already disproportionate impact of prostate cancer on Black men, who are 1.5 times more likely to be diagnosed and 2.4 times more likely to die from the disease than White men in the United States,” stressed co–senior study author Amar Kishan, MD, Professor of Radiation Oncology at the David Geffen School of Medicine at UCLA and a researcher at the UCLA Health Jonsson Comprehensive Cancer Center.
“Our findings raise critical questions regarding the reasons behind this inequality, suggesting possible obstacles to health care, financial burdens, and unconscious biases within the health-care system,” underscored Dr. Xiang.
The investigators concluded that further studies may be needed to uncover the factors contributing to the health-care disparities and to systematically address these issues for more equitable care and improved survival rates.
Disclosure: The research in this study was funded by the Prostate Cancer Foundation; the American Society for Radiation Oncology; and the DeSilva, McCarrick, and Bershad families. For full disclosures of the study authors, visit jamanetwork.com.
