Prevalence and characteristics of patients with metastatic prostate cancer who receive no anticancer therapy.

Abstract

101 Background: Clinical experience reveals that a subset of patients presenting with advanced solid tumors, including prostate cancer, never receive anticancer therapy due to a variety of factors including poor functional status, comorbidities, and patient preference. We sought to determine the prevalence, and characteristics, of this patient population. Methods: The National Cancer Database (NCDB) was queried to identify patients diagnosed with stage IV prostate cancer between 2000 and 2008. Patients who received no anticancer therapy (including chemotherapy, hormonal therapy, radiation, and surgery) were identified and were further categorized by age, race, insurance status, and income. For these subcategories, prevalence ratios were generated using the proportion of untreated metastatic prostate cancer (uMPC) to metastatic prostate cancer (MPC). Results: Of the 1,201,732 patients with prostate cancer diagnosed between 2000-2008, 59,074 (4.9%) had MPC. Of those patients presenting with MPC, 6582 (11.1%) received no anticancer therapy. With every 10-year increase in age, the prevalence of uMPC increased 43% (PR=1.43; p<0.0001). Blacks (PR=1.32, p<0.0001) and Hispanics (PR=1.41, p<0.0001) were more likely than Caucasians to have uMPC. With every $10,000 increase in income the prevalence of uMPC decreased by 7% (PR=0.93; p<0.0001). Patients with Medicaid were 57% more likely to be untreated, patients with Medicare were 82% more likely to be untreated, and uninsured patients were 96% more likely to be untreated than those patients with private insurance (p<0.0001). Conclusions: A large subset of patients presenting with MPC never receive anticancer therapy. While tumor biology likely plays a role with regard to rapid disease onset and progression, these data suggest that age, racial and socioeconomic disparities exist in the treatment of MPC.