Racial minorities in the United States may be less likely to receive treatment for prostate cancer and, overall, have worse survival outcomes compared with individuals who are White, according to a new study published by Nguyen et al in Urologic Oncology. Typically, patient-level and physician-level factors have been used to explain the racial and socioeconomic differences in prostate cancer disparities; however, the new study investigated the role of facilities themselves in relation to these disparities.
“This study reveals crucial data regarding health disparities,” emphasized senior study author Quoc-Dien Trinh, MD, MBA, Associate Professor of Surgery at Harvard Medical School, Co-Director of the Dana-Farber/ Brigham and Women’s Prostate Cancer Center, and Director of Ambulatory Clinical Operations in the Division of Urological Surgery at Brigham and Women’s Hospital. “The importance of this research is to acknowledge the existence of differences across hospital systems, highlight the need for dedicating resources and support to affected health systems, and improve care for all patients,” he added.
Background
Marginalized patients often receive care in minority-serving hospitals and safety-net hospitals—where patient outcomes may be worse. In the new study, these types of hospitals were referred to as hospital systems serving health disparity populations (HSDPs). HSDPs were further defined as “facilities in the highest decile of proportion of non-Hispanic Black or Hispanic patients [with cancer] and/or high-burden safety-net hospitals−facilities in the highest quartile of proportion of underinsured patients,” according to the study investigators.
Study Methods and Results
Using these descriptions, the investigators analyzed data related to racial health outcomes in those specific locations.
In the new study, the investigators conducted a retrospective analysis of 822,000 patient outcomes from 968 non-HSDPs and 373 HSDPs, and identified patients who had an immediate or high risk of developing prostate cancer using the National Cancer Database. They then calculated the time it took as well as the likelihood for these patients to receive treatment within 90 days, and subsequently, their overall rates of survival.
The investigators discovered that treatment at HSDPs was associated with a decreased likelihood of receiving care within 90 days of diagnosis, a lower chance of definitive treatment, and a lower rate of overall survival. However, among patients who received definitive treatment, there did not appear to be a difference in overall survival. Further, non-Hispanic Black patients who were treated at HSDPs had worse patient outcomes than both non-Hispanic White patients treated at HSDPs and non-Hispanic Black patients treated at non-HSDPs.
Conclusions
The investigators suggested that the racial disparities in patient outcomes were mostly driven by facilities that were both high-burden safety-net hospitals and minority-serving hospitals. As a result, the findings showed a compounding disadvantage for non-Hispanic Black patients with prostate cancer—since they may be more likely to receive treatment at hospitals with worse patient outcomes and experience worse patient outcomes than those of other racial and ethnic groups at those same institutions.
Despite only including a specific group of accredited hospitals and cancer diagnoses in the new study, the investigators highlighted that the site of care may be greatly associated with patient outcomes for minority populations. They underscored that future quantitative and qualitative studies will be needed to pinpoint exactly which hospital factors are contributing to racial disparities and whether targeted initiatives at HSDPs may be needed to reduce these inequalities.
“The receipt of treatment can vary widely across institutions. We view access to treatment as a big driver of the disparities that we see,” stressed Dr. Trinh. “We need stakeholders to work together to tackle cancer disparities at a broad level rather than in separated hospital siloes. Just as importantly, we hope that patients who are part of racial minority groups are aware of their options to make the best health decisions for themselves. That’s why we have also created the Prostate Cancer Outreach Clinic at the Brigham [and Women’s Hospital] to specifically address the health needs of minority [patients].”
Disclosure: The research in this study contributes to ongoing work funded by the American Cancer Society and Pfizer Inc. For full disclosures of the study authors, visit sciencedirect.com.
