Quality of Care in the Treatment of Localized Intermediate and High Risk Prostate Cancer at Minority Serving Hospitals

Abstract

PurposeTo investigate quality of care at minority-serving hospitals (MSH) compared to other institutions for men with localized intermediate and high-risk prostate cancer (PCa). MethodsWe identified 536,539 men aged ≥40 years presenting with localized intermediate and high-risk PCa in the United States between 2004-2015 using the National Cancer Database (NCDB). Institutions were ranked according to the proportion of Black and Hispanic patients treated at a given institution, and the top decile institutions were defined as MSH. We used multivariable analyses to characterize the association between MSH and three endpoints: receipt of definitive treatment, time to definitive treatment, and receipt of androgen deprivation therapy in young (≤65 years) and healthy (no comorbidity) men treated with external beam radiation therapy. Results162 and 1168 hospitals were defined as MSH and non-MSH, respectively. In multivariable analyses, MSH was associated with decreased odds of receiving definitive treatment (Adjusted Odds Ratio [AOR] 0.73 95%-CI: 0.62–0.85, p<0.001). The adjusted mean time to treatment was significantly longer in MSHs compared to non-MSHs (4.9days, standard error 2.2; p=0.024). Among young and healthy men, there was no association between treatment at MSH and receipt of androgen deprivation therapy in conjunction with external beam radiation (AOR 0.90; 95%-CI: 0.75–1.09, p=0.291). ConclusionTreatment at MSH was associated with lower odds of receiving definitive therapy and longer time to definitive therapy for localized intermediate- and high-risk PCa, despite adjustment for race. This suggests that some of the racial disparities in PCa may be explained by the sites at which racial/ethnic minorities receive care.