Abstract C55: Racial disparities in receipt of initial prostate cancer treatment, SEER Medicare, 2004-2009

Abstract

Abstract Purpose: Prostate cancer death rates are higher in blacks than whites. Using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we evaluated whether racial disparities exist in the receipt of initial prostate cancer treatment. Methods: We analyzed data on prostate cancer cases diagnosed in 2004-2009 and linked with Medicare claims data from 2003-2010. We focused on cases with SEER race coded as white or black; and enrolled in both Medicare Parts A and B continuously during 12 months before diagnosis to 24 months after diagnosis, death, or December 2010, whichever was earliest. We defined prostate cancer recurrence risk categories using tumor stage, prostate specific antigen (PSA), and Gleason scores. We identified initial prostate cancer treatment using: radical prostatectomy, radiation therapy, or androgen deprivation therapy within 1 month before to 6 months after diagnosis; or evidence of active surveillance based on prostate biopsies or PSA tests from 1 to 18 months after diagnosis. We used multivariate logistic regression to determine adjusted odds ratios (OR) and 95% confidence intervals (CI). The outcome variable was receipt of initial treatment. Explanatory variables were: race; prostate cancer disease recurrence risk category; asymptomatic or symptomatic at time of first diagnosis; life expectancy from the man's age at diagnosis; comorbidity; census tract poverty; and census region. Results: Our final study cohort included 70,254 white men and 8,653 black men with prostate cancer. After adjustment for multiple variables, men were less likely to receive initial treatment if: expected survival < 5 years (OR, 0.36; 95% CI, 0.33–0.40; ref.= > 10 years); black race (OR, 0.54; 95% CI, 0.50–0.57; ref. = white); or symptomatic at time of diagnosis (OR, 0.77, 95% CI, 0.74–0.81; ref.=asymptomatic). Men were more likely to receive initial treatment if: high recurrence risk (OR, 2.75; 95% CI, 2.55–2.96; ref.= low); resided in Northeast (OR, 1.30; 95% CI 1.24–1.38; ref.= West); comorbidity score > 2 (OR, 1.24; 95% CI, 1.17–1.31; ref. = 0); or lived in a census tract with <5% poverty (OR, 1.14; 95% CI, 1.07–1.22; ref.= > 19%). Conclusion: Low expected survival and black race were relatively important reasons that older men did not receive initial treatment for prostate cancer. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Jun Li, Chunyu Li. Racial disparities in receipt of initial prostate cancer treatment, SEER Medicare, 2004-2009. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C55. doi:10.1158/1538-7755.DISP13-C55