Racial disparities in survivorship care adherence among Medicare beneficiaries with prostate cancer.

Abstract

72 Background: African-American men with prostate cancer have higher cancer-related and all-cause mortality than their Caucasian counterparts. Differences in adherence to guideline-based survivorship care may contribute to these disparities. Methods: Using the SEER-Medicare database, we conducted a retrospective cohort study of men ≥66 years old treated for localized prostate cancer between 2008 and 2011 who had at least two visits with a specialist or primary care physician after diagnosis. Patients were followed until 2013. We calculated rates of bone mineral density screening (among men treated with androgen deprivation therapy) and colorectal cancer screening after diagnosis, stratified by race and provider seen. We analyzed the association between continuity of care (CoC) and adherence to colorectal cancer screening after calculating a CoC index. Results: Among 107262 men with localized prostate cancer, adherence to colorectal cancer and bone mineral density screening was higher for Non-Hispanic White and Hispanic men compared to African-American men (Table). Adherence to screening was slightly higher for men who followed with primary care physicians compared to specialists. After adjusting for relevant covariates and number of providers, higher CoC with primary care physicians was associated with improved adherence to colorectal screening among Non-Hispanic Whites (OR = 1.25, 95% CI = 1.11-1.40), African-Americans (OR = 1.39, CI = 1.05-1.84) and Hispanics (OR = 2.74, CI = 1.27-5.90). However, higher CoC with specialists was significantly associated with colon cancer screening only among African Americans (OR 1.59, 95% CI 1.25-2.04). Conclusions: Among a large cohort of men with localized prostate cancer, the association between CoC and guideline-based survivorship care varied by type of provider and by racial and ethnic group. [Table: see text]