Racial Disparities in Palliative Radiation for African American Men with Metastatic Prostate Cancer

Abstract

<h3>Purpose/Objective(s)</h3> African American (AA) men with prostate cancer (PCa) are at higher risk of aggressive and metastatic disease when compared with non-Hispanic White (NHW) men. Palliative radiation offers effective pain alleviation from symptomatic lesions, though little is known about the patterns of palliative radiation usage for AA vs. NHW men. We evaluated whether receipt of palliative radiation differs between AA and NHW men and investigated whether AA men receive different palliative radiation treatment courses. <h3>Materials/Methods</h3> We identified men 65 and older, diagnosed with metastatic PCa from 2004-2013 within the Surveillance, Epidemiology, and End Results (SEER) – Medicare database. Palliative radiation usage, including number of fractions, courses, and use of intensity-modulated radiation therapy (IMRT), was delineated through Medicare reimbursement claims. Short-course was defined as ≤5 fractions. Multivariable logistic regression assessed the influence of AA race on receiving palliative radiation. AA men are often diagnosed at younger age than NHW men, so we included the interaction between age and AA race in another multivariable model. For patients who received palliative radiation, we used separate multivariable logistic regressions to evaluate the impact of AA race on receiving short-course radiation, >1 course of radiation, and IMRT. <h3>Results</h3> The cohort included 7,954 men (6,552 NHW and 1,402 AA). Median age was 77 with median follow-up of 32 months. Median age for AA men: 74; NHW men: 78. A total of 1,926 patients received palliative radiation (1,628 NHW and 298 AA). On multivariable analysis, AA men had 25% reduced odds of receiving palliative radiation (odds ratio (OR), 95% confidence interval (CI): 0.75, [0.65-0.87], <i>P</i><0.01). For each year above age 65, AA men had 2% reduced odds of receiving palliative radiation when compared to NHW men (OR, 95% CI: 0.98, [0.96-0.99], <i>P_interactio</i>_n: 0.04). For those undergoing palliative radiation, multivariable analysis revealed no significant difference between AA and NHW men for receiving >1 course, short-course vs long-course radiation, and IMRT. <h3>Conclusion</h3> In this large national cohort of Medicare patients, AA race was associated with reduced odds of receiving palliative radiation, a disparity most pronounced for older AA men. Our results suggest that the racial disparity in palliative radiation exists predominantly prior to initiation of therapy. AA men who received palliative radiation displayed similar fractionation, number of courses, and usage of IMRT when compared to NHW men. Increased counseling for AA men with metastatic PCa must be emphasized to ensure AA men have equal opportunity to the benefits of palliative radiation.