Receipt of guideline-concordant treatment in elderly African American and Caucasian patients with prostate cancer.

Abstract

222 Background: Clinical management of cancer patients according to published guidelines is an important quality indicator. Prior studies have demonstrated less aggressive treatments of elderly patients with breast and colorectal cancers, raising concern about potential undertreatment of elderly patients overall. The rate of guideline concordant management in elderly prostate cancer patients is unknown, and we examined this using the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database. Given that prostate cancer is often slow growing, we were especially interested in guideline concordance in patients with "high risk" (aggressive) prostate cancer. Methods: 15,154 Caucasian (CA) and 2,924 African American (AA) men diagnosed in 2004 to 2007 with localized prostate cancer, age 66 to 79, were included. We characterized the proportions of men who received management concordant with the National Comprehensive Cancer Network guidelines within 12 months of diagnosis. Logistic regression was used to examine the odds of receiving guideline-concordant management while accounting for race, comorbidity (NCI combined index), SEER region, and sociodemographic factors. Results: Guideline concordance was more than 80% for both CA and AA patients with low- or intermediate-risk disease. Among high-risk patients, only 63% of CA and 48% AA patients received guideline-concordant management, mostly due to no treatment or hormonal therapy alone, which offer no curative potential. Findings were almost identical in the subgroup of patients with little or no comorbidity, who have more than 10 year life expectancy on average. On multivariable analysis, AA race (OR .62, p<.001) and increasing age were associated with lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not. Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease. Our results suggest a bias toward less aggressive treatment in elderly patients with less consideration for comorbidities or aggressiveness of cancer. Guideline concordance in elderly patients with aggressive prostate cancer is low.