MP37-06 DELAYED TREATMENT OF HIGH-RISK PROSTATE CANCER PATIENTS: IMPACT OF SOCIOECONOMIC BARRIERS AND USE OF ADVANCED TECHNOLOGIES

Abstract

INTRODUCTION AND OBJECTIVES: Though attention has been given to overtreatment of indolent prostate cancer, there has been less focus on potential undertreatment of men with high-risk tumors. To that end, we sought to characterize factors related to delayed or lack of treatment (DT) of high-risk prostate cancer patients, and to assess the impact on case volume and use of advanced technology on this outcome. METHODS: We identified patients with high-risk (i.e., Gleason 8+, PSA>20, cT3) localized (i.e., T1-3Nx-0Mx-0) prostate cancer in the National Cancer Database (2010-2012). Primary outcome was DT (i.e., no treatment within 6 months post-diagnosis). Exposures of interest were facility-level case volume (based on number of positive biopsies), robotic-assisted radical prostatectomy (RARP) volume, and intensitymodulated radiation therapy (IMRT) volume. Multivariable regression models, adjusted for clustering at the facility-level, estimated the association between facility volume factors (arranged in quartiles) and receipt of DT. The model adjusted for patient age, comorbidity, type of cancer center (academic vs comprehensive community vs community), and diagnosis year. Statistical tests were 2-sided and significant if p<0.05. RESULTS: Among 63439 prostate cancer patients with highrisk localized prostate tumors, 3690 (5.8%) received DT. Black patients (9.7% vs 4.9% White, OR 1.67, 95% CI 1.50-1.86), men with Medicaid or no insurance (12.6% vs 5% Private/HMO, OR 1.48, 95% CI 1.251.76), and those in the poorest census tracts (7.7% < $38,000 vs 5.2% $63,000+, OR 1.17, 95%CI: 1.02-1.34) were more likely to receive DT. Patients diagnosed at academic centers were more likely to receive DT (7.7% vs 5.7% community cancer centers, OR 1.48, 95% CI 1.06-2.08). Although facilities with the highest case volume had less delayed treatment (vs. lowest quartile, OR 0.35, 95% CI 0.23-0.52), centers with the highest RARP (OR 3.21, 95% CI 2.21-4.66) and IMRT volume (OR 1.45, 95% CI 1.15-1.83) had more frequent DT of high-risk prostate cancer patients. CONCLUSIONS: Black patients, underinsured men, and patients in the poorest census tracts were more likely to receive delayed treatment of high-risk prostate cancer, which may reflect impaired access to adequate cancer care. The unexpected finding of more delayed treatment at academic and high-volume RARP and IMRT centers may reflect barriers related to treatment capacity.