Disparities in delayed diagnosis, access to treatment, and treatment delays among Hispanic men with metastatic prostate cancer.

Abstract

6550 Background: Reporting racial/ethnic disparities in aggregate for Hispanics could obscure differences between subgroups given heterogeneity in social determinants of health. We sought to identify differences in delayed diagnosis, treatment status, and time to treatment among Hispanic subpopulations with metastatic prostate cancer. Methods: 2004-2017 data from the National Cancer Database (NCDB) was used to identify patients with prostate adenocarcinoma; patients were disaggregated by racial subgroup and Hispanic country-of-origin. Ordinal logistic regression defined adjusted odds ratios (aORs) with 95% CI of 1) presenting with Stage IV cancer, 2) receiving treatment, and 3) receiving delayed treatment (defined as treatment after 90 days). Sensitivity analysis was conducted for delayed treatment after 180 days. Results: Among 1,305,785 patients, Hispanic men had greater odds of presenting with stage IV prostate cancer compared with non-Hispanic White (NHW) men (aOR = 1.54 95% CI 1.50-1.58, p < 0.001). All Hispanic racial subgroups were more likely to present with stage IV cancer with highest odds observed in Hispanic Black men (aOR 1.68 95% CI 1.46-1.93, p < 0.001). Disparities were also observed in all country of origin subgroups, particularly for men of Mexican heritage (aOR 1.99 95% CI 1.86-2.12, p < 0.001). Among men with metastatic disease, Hispanic men were less likely to receive treatment than NHW men (aOR 0.60 95% CI 0.53-0.67, p < 0.001). Hispanic White patients were less likely to receive treatment compared with NHW men (Hispanic White aOR 0.58 95% CI 0.52-0.66, p < 0.001). Upon disaggregation by country of origin, disparities persisted, particularly for men of Dominican heritage (aOR 0.52 95%CI 0.28-0.98 p = 0.044). Hispanic men were more likely to experience treatment delays when compared to NHW men (aOR 1.38 95%CI 1.26-1.52 p < 0.001). All Hispanic racial subgroups experienced greater treatment delays, particularly Hispanic Black men (aOR 1.83 95%CI 1.22-2.75 p = 0.002). Men of Central or South American heritage had the greatest odds of treatment delays (aOR 1.48 95%CI 1.07-2.04 p = 0.018). Sensitivity analysis indicated consistent findings among Hispanic patients overall, Hispanic White patients, and patients of Mexican and Puerto Rican heritage. Conclusions: We found notable differences in stage IV cancer at presentation, treatment for metastatic disease, and delays in treatment when outcomes were stratified by racial subgroup and Hispanic country of origin. Future studies in Hispanic populations with disaggregated data are needed to characterize outcomes, study mediators of the observed variations, and develop targeted interventions.