Receipt Of Definitive Treatment Research Articles

Cumulative cancer locations on prostate biopsy and active surveillance outcomes in the MRI era.

To validate the use of a cumulative cancer locations (CCLO) score, a measurement of tumor volume on biopsy, and to develop a novel magnetic resonance imaging(MRI)-informed CCLO (mCCLO) score to predict clinical outcomes on active surveillance (AS). The CCLO score is a sum of uniquely involved sextants with prostate cancer on diagnostic + confirmatory biopsy. The mCCLO score incorporates MRI findings into the CCLO score. Participants included 1284 individuals enrolled on AS between 1994 and 2022, 343 of whom underwent prostate MRI. The primary outcome was grade reclassification (GR) to grade group ≥2 disease; the secondary outcome was receipt of definitive treatment. Increasing CCLO and mCCLO risk groups were associated with higher risk of GR and undergoing definitive treatment (both p < 0.001). On multivariable analysis, increasing mCCLO score was associated with higher risk of GR and receipt of definitive treatment (hazard ratios [HRs] per 1-unit increase: 1.26 [95% confidence interval [CI]: 1.12-1.41] and 1.21 [95% CI: 1.07-1.36], respectively). The model using mCCLO score to predict GR (c-index: 0.671; 95% CI: 0.621-0.721) performed at least as well as models using the number of cores positive for cancer (0.664 [0.613-0.715]; p = 0.7) and the maximum percentage of cancer in a core (0.641 [0.585-0.696]; p = 0.14). The CCLO score is a valid, objective metric to predict GR and receipt of treatment in a large AS cohort. The ability of the MRI-informed mCCLO to predict GR is on par with traditional metrics of tumor volume but is more descriptive and may benefit from greater reproducibility. The mCCLO score can be implemented as a shorthand, informative tool for counseling patients about whether to remain on AS.

Association of race/ethnicity and patient care experiences with receipt of definitive treatment among prostate cancer survivors: a SEER-CAHPS study.

This study aimed to evaluate the association of race/ethnicity, patient care experiences (PCEs), and receipt of definitive treatment and treatment modality among older adults in the United States (US) with localized prostate cancer (PCa). Using Surveillance, Epidemiology and End Results dataset linked to Medicare Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) for 2007-2015, we identified men aged ≥ 65 years who completed a CAHPS survey within one year before and one year after PCa diagnosis. Associations of race/ethnicity (non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, non-Hispanic Asian (NHA), and other) and of interactions between race/ethnicity and PCEs (getting needed care, getting care quickly, doctor communication, and care coordination) with the receipt of definitive PCa treatment and treatment modality within 3 and 6 months of diagnosis were examined using logistic regressions. Among 1,438 PCa survivors, no racial/ethnic disparities in the receipt of definitive treatment were identified. However, NHB patients were less likely to receive surgery (vs. radiation) within 3 and 6 months of PCa diagnosis than NHW patients (OR 0.397, p = 0.006 and OR 0.419, p = 0.005), respectively. Among NHA patients, a 1-point higher score for getting care quickly was associated with lower odds (OR 0.981, p = 0.043) of receiving definitive treatment within 3 months of PCa diagnosis, whereas among NHB patients, a 1-point higher score for doctor communication was associated with higher odds (OR 1.023, p = 0.039) of receiving definitive treatment within 6 months of PCa diagnosis. We observed differential associations between PCEs and receipt of definitive treatment based on patient race/ethnicity. Further research is needed to explore these associations.

PCR120 Association of Race/Ethnicity and Patient Care Experiences with Receipt of Definitive Treatment Among Prostate Cancer Survivors: A SEER-CAHPS Study

This study aimed to evaluate the association of race/ethnicity, patient care experiences (PCEs), and receipt of definitive treatment and treatment modality among older adults in the United States (US) with localized prostate cancer (PCa).

Prognostic Value of the Intermediate-risk Feature in Men with Favorable Intermediate-risk Prostate Cancer: Implications for Active Surveillance

BackgroundGuidelines suggest that active surveillance (AS) may be considered for select patients with favorable intermediate-risk (fIR) prostate cancer. ObjectiveTo compare the outcomes between fIR prostate cancer patients included by Gleason score (GS) or prostate-specific antigen (PSA). Most patients are classified with fIR disease due to either a 3 + 4 = 7 GS (fIR-GS) or a PSA level of 10–20 ng/ml (fIR-PSA). Previous research suggests that inclusion by GS 7 may be associated with worse outcomes. Design, setting, and participantsWe conducted a retrospective cohort study of US veterans diagnosed with fIR prostate cancer from 2001 to 2015. Outcome measurements and statistical analysisWe compared the incidence of metastatic disease, prostate cancer–specific mortality (PCSM), all-cause mortality (ACM), and receipt of definitive treatment between fIR-PSA and fIR-GS patients managed with AS. Outcomes were compared with those of a previously published cohort of patients with unfavorable intermediate-risk disease using cumulative incidence function and Gray’s test for statistical significance. Results and limitationsThe cohort included 663 men; 404 had fIR-GS (61%) and 249 fIR-PSA (39%). There was no evidence of difference in the incidence of metastatic disease (8.6% vs 5.8%, p = 0.77), receipt of definitive treatment (77.6% vs 81.5%, p = 0.43), PCSM (5.7% vs 2.5%, p = 0.274), and ACM (16.8% vs 19.1%, p = 0.14) between the fIR-PSA and fIR-GS groups at 10 yr. On multivariate regression, unfavorable intermediate-risk disease was associated with higher rates of metastatic disease, PCSM, and ACM. Limitations included varying surveillance protocols. ConclusionsThere is no evidence of difference in oncological and survival outcomes between men with fIR-PSA and fIR-GS prostate cancer undergoing AS. Thus, presence of GS 7 disease alone should not exclude patients from consideration of AS. Shared decision-making should be utilized to optimize management for each patient. Patient summaryIn this report, we compared the outcomes of men with favorable intermediate-risk prostate cancer in the Veterans Health Administration. We found no significant difference between survival and oncological outcomes.

Definitive treatment and risk of death among men diagnosed with metastatic prostate cancer at the Veterans Health Administration

To assess the potential survival benefit associated with receipt of definitive treatment (radical prostatectomy or radiation), compared to non-definitive treatment (hormonal therapy or chemotherapy) among men with metastatic prostate cancer. A cohort of men diagnosed with metastatic (T4/M1/N1 or T4/M1) prostate cancer from 1999 to 2013 in the Veterans Health Administration were identified and followed to December 28, 2014. All-cause and prostate cancer-specific mortality were evaluated at 10 years for the T4/M1/N1 cohort and 8 years for the T4/M1/ cohort. The association of definitive treatment (radical prostatectomy or radiation), compared to non-definitive (hormonal therapy or chemotherapy) with both all-cause and prostate cancer-specific mortality was assessed using inverse probability of treatment weighted (IPTW) multivariable survival analyses. The cohort included 2919 with T4/M1/N1 disease and 1479 men with T4/M1 disease. Receipt of definitive treatment was associated with a reduced risk of 10-year all-cause (Hazard Ratio (HR): 0.61; 95% Confidence Interval (CI): 0.57-0.65) and prostate cancer-specific mortality (HR: 0.50; 95% CI: 0.46-0.55) among men diagnosed with T4/M1/N1 met-astatic disease. Definitive treatment was similarly associated with a reduced risk of all-cause (HR: 0.84; 95% CI: 0.77-0.91) and prostate cancer-specific (HR: 0.81; 95% CI: 0.73-0.90) mortality among men diagnosed with T4/M1 only metastatic disease. Definitive treatment may improve survival in men diagnosed with metastatic prostate cancer.

Access to definitive treatment and survival for intermediate-risk and high-risk prostate cancer at hospital systems serving health disparity populations.

6555 Background: Socioeconomic and racial disparities in prostate cancer (PCa) can be attributed to patient-level and physician-level factors. However, there is growing interest in investigating the role of the facility of care in driving cancer disparities. Therefore, we sought to examine receipt of guideline-concordant definitive treatment, time to treatment initiation (TTI), and survival for men with PCa receiving care at hospital systems serving health disparity populations (HSDPs). Methods: We conducted a retrospective analysis of the National Cancer Database (2004-2016) among men with intermediate-risk or high-risk PCa eligible for definitive treatment. The primary outcomes were receipt of definitive treatment and TTI within 90 days of diagnosis. The secondary outcome was survival. We defined HSDPs as minority-serving hospitals – facilities in the highest decile of proportion of Non-Hispanic Black (NHB) or Hispanic cancer patients – and/or high-burden safety-net hospitals – facilities in the highest quartile of proportion of underinsured patients. We used mixed-effect models with facility-level random intercept to compare outcomes between HSDPs and non-HSDPs among the entire cohort and among men who received definitive treatment. We evaluated interactions between HSDP status and race for each of the outcomes. Results: The cohort included 821,931 men with intermediate-risk or high-risk PCa. We included 968 non-HSDPs (72.2%) and 373 HSDPs (27.8%) facilities. Treatment at HSDPs was associated with lower odds of receipt of definitive treatment (aOR 0.64; 95% CI 0.57-0.71; p &lt; 0.001), lower odds of TTI within 90 days of diagnosis (aOR 0.74; 95% CI 0.68-0.79; p &lt; 0.001), and worse survival (aHR 1.05; 95% CI 1.02-1.09; p = 0.003). However, no difference was found in survival among patients who received definitive treatment. NHB men at HSDPs had also worse outcomes than NHB men treated at non-HSDPs as well as NHW men treated at HSDPs (Table). Conclusions: Patients treated at HSDPs were less likely to receive timely definitive treatment and had worse survival. NHB men have worse outcomes than NHW at HSDPs. NHB men with PCa remain largely disadvantaged since they are more likely to be treated at hospitals with worse outcomes and have worse outcomes than other patients at those same institutions. [Table: see text]

Molecular Classification to Prognosticate Response in Medically Managed Endometrial Cancers and Endometrial Intraepithelial Neoplasia.

Simple SummaryUterine cancer is the most common gynecologic cancer. The treatment for women with a newly diagnosed uterine cancer is surgery to remove the uterus, fallopian tubes, ovaries, and lymph nodes. For women who desire future pregnancy or are not healthy enough to undergo surgery with hysterectomy, treatment with hormonal therapy, using the levonorgestrel intrauterine device (IUD), is an option. Response rates to this type of therapy are promising and range between 50% and 88%. This project explores a molecular classification scheme and applies it to women with uterine cancer and pre-cancer who opt for treatment with an IUD. Evaluating the genetic alterations underlying tumor development can identify patients who would be more or less likely to respond to treatment with IUDs. Additionally, this knowledge can help physicians counsel women with uterine cancer who may be interested in non-surgical options about her odds of having her cancer respond to a hormonal treatment.Background: The aim of this study was to evaluate whether molecular classification prognosticates treatment response in women with endometrial cancers and endometrial intraepithelial neoplasia (EIN) treated with levonorgestrel intrauterine system (LNG-IUS). Methods: Patients treated with LNG-IUS for endometrial cancer or EIN from 2013 to 2018 were evaluated. Using immunohistochemistry and single gene sequencing of POLE, patients were classified into four groups as per the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE): POLE-mutated, mismatch repair-deficient (MMRd), p53 wild type (p53wt), and p53-abnormal (p53abn). Groups were assessed relative to the primary outcome of progression or receipt of definitive treatment. Results: Fifty-eight subjects with endometrioid endometrial cancer or EIN treated with LNG-IUS were included. Of these, 22 subjects (37.9%) had endometrial cancer and 36 subjects (62.1%) had EIN. Per the ProMisE algorithm, 44 patients (75.9%) were classified as p53wt, 6 (10.3%) as MMRd, 4 (6.9%) as p53abn, and 4 (6.9%) as POLE-mutated. Of the 58 patients, 11 (19.0%) progressed or opted for definitive therapy. Median time to progression or definitive therapy was 7.5 months, with p53abn tumors having the shortest time to progression or definitive therapy. Conclusions: Molecular classification of endometrial cancer and EIN prior to management with LNG-IUS is feasible and may predict patients at risk of progression.

Comparative effectiveness of posttreatment imaging modalities for Medicare patients with advanced head and neck cancer.

Persistent controversy exists with regard to how and when patients with head and neck cancer should undergo imaging after definitive therapy. The current study was conducted to evaluate whether the type of imaging modality used in posttreatment imaging impacts cancer-specific survival for patients with advanced head and neck squamous cell carcinoma. A retrospective study of National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program-Medicare-linked data in patients with an advanced stage of the 3 most common head and neck malignancies (oral cavity, oropharynx, and larynx) was conducted. Hazard ratios and 95% CIs for cancer-specific survival were estimated for patients diagnosed with any of these cancers between 2006 and 2015. Significant improvement with regard to cancer-specific survival was observed among patients with American Joint Committee on Cancer stage III and stage IVA laryngeal cancer who underwent positron emission tomography (PET) and/or computed tomography (CT) imaging during the first 6 months after receipt of definitive treatment (hazard ratio, 0.517; 95% CI, 0.33-0.811) compared with those who underwent CT. There was a trend toward an improvement in cancer-specific survival among patients with oral cavity or oropharyngeal malignancies who underwent PET/CT imaging, but it did not reach statistical significance. Compared with CT imaging, posttreatment imaging with PET was associated with improved survival in patients with advanced laryngeal carcinoma.

Abstract D115: The interplay between rurality-urbanicity and race in prostate cancer risk, treatment, and survival in the United States

Abstract Background. In this study, we compared prostate cancer incidence and survival between rural and urban settings in the US, using a recently released census-tract rurality-urbanicity metric that serves as a proxy for geographical access to care. We also examined the associations between rurality and receipt of definitive treatment and further examined whether rural-urban status serves as an explanatory factor for observed race differences in prostate cancer incidence, treatment, and survival. Methods. Using data from the Surveillance, Epidemiology, and End Results program we identified prostate cancer patients newly diagnosed between 2000 and 2015, aged 45 years and older. Patients were classified as residing in a ‘rural’ or ‘urban’ setting based on the US Department of Agriculture’s 2-level Rural Urban Commuting Area (RUCA) measure. We defined ‘definitive treatment’ as receipt of radical prostatectomy (RP) among patients diagnosed with locoregional disease. To compare rural and urban settings we estimated relative measures for prostate cancer incidence, odds of treatment receipt, and prostate cancer survival using Poisson, logistic, and Cox regression models, respectively. We adjusted regression models for age, race, stage, or treatment, where applicable. Results. Between 2000 and 2015, men in the rural US were slightly less likely to be diagnosed with prostate cancer when compared with urban US men (incidence rate ratio (IRR) = 0.89; 95% CI: 0.88, 0.90), but were at higher risk of prostate cancer death (hazard ratio (HR) = 1.16; 95% CI: 1.13, 1.19). Patients diagnosed with locoregional disease in rural settings were also less likely to receive RP compared with their urban counterparts (odds ratio (OR) = 0.91; 95% CI: 0.89, 0.92) and were more likely to receive non-radical surgical interventions (OR = 1.31; 95% CI: 1.28, 1.35). In general, race differences were not evident by rural-urban status. Black men, however, were more likely to receive a prostate cancer diagnosis irrespective of geographical setting when compared with white men (rural IRR = 1.50; 95% CI: 1.46, 1.54 and urban IRR = 1.69; 95% CI: 1.64, 1.73). Black men were also substantially less likely to receive RP (OR = 0.49; 95% CI: 0.48, 0.49). With respect to survival, Asian or Pacific Islander men were at lower risk of prostate cancer death compared with white men (HR = 0.78; 95% CI: 0.75, 0.81). By contrast, American Indian/Alaskan Native and black men had the highest risks of death (HR = 1.26; 95% CI: 1.11, 1.43 and HR = 1.25; 95% CI: 1.22, 1.28, respectively). Conclusions. Observed differences in prostate cancer incidence, treatment, and survival may reflect spatial differences in access to cancer prevention and cancer care. Rural-urban status does not appear to modify racial/ethnic differences in prostate cancer incidence and survival. Citation Format: Eboneé N Butler, Michael B Cook. The interplay between rurality-urbanicity and race in prostate cancer risk, treatment, and survival in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D115.

MP64-16 PROSTATE CANCER AND HISPANIC MEN: UNMASKING THE DIVERSITY AND DATA

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II (MP64)1 Apr 2020MP64-16 PROSTATE CANCER AND HISPANIC MEN: UNMASKING THE DIVERSITY AND DATA Gricelda Gomez*, Marieke J. Krimphove, Adam S. Kibel, Luis A. Kluth, Kerry Kilbridge, Thomas Seisen, and Quoc-Dien Trinh Gricelda Gomez*Gricelda Gomez* More articles by this author , Marieke J. KrimphoveMarieke J. Krimphove More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Luis A. KluthLuis A. Kluth More articles by this author , Kerry KilbridgeKerry Kilbridge More articles by this author , Thomas SeisenThomas Seisen More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000939.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hispanics in the Unites States (US) have the lowest overall incidence and mortality rates of prostate cancer (PCa) compared to other race/ethnicity groups. However, Hispanics are a heterogeneous group of individuals varying by many factors that affect cancer outcomes. We sought to determine if differences in disease severity at diagnosis, treatment, and mortality exist among US Hispanics based on country of origin. METHODS: Patients (n = 505,820) with localized PCa diagnosed between 2004 and 2015 within the National Cancer Data Base were identified. Hispanic patients were stratified by most populous ethnicities in the US: Mexican, Puerto Rican, a Caribbean group (Cuba and Dominican Republic), Central/South American, and other/unknown Hispanic. The effect of Hispanic supgroup on disease severity, receipt of definitive treatment and overall survival was assessed. Disease severity was based on the D’Amico risk classification. RESULTS: Outcomes for Hispanics as an aggregate group varied greatly to those of the Hispanic subgroups, when compared to Non-Hispanic Whites (NHWs). Hispanics overall had higher risk of presenting with intermediate-risk (relative risk ratio [RRR] 1.09, 95%CI: 1.06-1.13, p<0.001) and high-risk disease (RRR 1.15, 95%CI: 1.10-1.18, p<0.001). In subgroup analysis, Mexicans (RRR= 1.23, 95%CI: 1.12-1.33, p<0.001) and Puerto Ricans (RRR= 1.15, 95%CI: 1.00-1.32, p=0.050) had greater odds of presenting with high-risk PCa, whereas, Caribbean men had lower odds (RRR= 0.88, 95%CI: 0.78-0.99, p=0.032). Hispanics overall have lower risk of mortality relative to NHWs among all three D’amico risk groups. This effect is observed among all subgroups for patients with high-risk PCa. Among patients with low-risk disease, only Central/South Americans (HR= 0.58, 95%CI: 0.38-0.91, p<0.001) had a decreased risk of mortality. CONCLUSIONS: By aggregating the diversity of people within one broad category of Hispanic, important differences within the population are masked. Our study shows differences in the presentation, management and outcome of localized PCa across different Hispanic subgroups. Although Hispanic subgroups present with worse disease at diagnosis compared to NHWs, they fare better in terms of overall survival, underscoring the “Hispanic paradox.” This concept summarizes the fact that US Hispanics live longer and have better health outcomes compared to NHWs, despite having lower socioeconomic status and less health-care access. Our results highlight the need for disaggregation of data, which can help us understand the factors that lead to the “Hispanic Paradox.” Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e969-e969 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gricelda Gomez* More articles by this author Marieke J. Krimphove More articles by this author Adam S. Kibel More articles by this author Luis A. Kluth More articles by this author Kerry Kilbridge More articles by this author Thomas Seisen More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Individualized Prediction of Early Post-Treatment Mortality Risk in Stage I Non-Small Cell Lung Cancer: A Machine Learning-Based Approach

In stage I non-small cell lung cancer (NSCLC), the STARS/ROSEL pooled analysis showed worse overall survival (OS) but equivalent cancer-specific survival with surgical resection compared to stereotactic body radiation therapy (SBRT), with other studies demonstrating interaction effects between early post-treatment mortality and age. Therefore, appropriate patient selection is essential to optimize survival outcomes. We utilize predictive modeling using machine learning (ML) of mortality risk at 90 days post-treatment in stage I NSCLC patients. Patients with T1-T2aN0M0 NSCLC, diagnosed from 2004 to 2015, were identified using the National Cancer Database and divided into separate surgery and SBRT cohorts. All patients were censored 90 days after receipt of definitive treatment. Training and validation sets were formed by a randomized 80%/20% split. Features (age, histology, tumor size, and comorbidity score) were pre-specified based on predictors of post-treatment mortality identified in literature. Three different ML approaches were tested: 1) a Cox proportional hazards (CPH) linear model, 2) a survival Support Vector Machine (SVM) model, and 3) a gradient-boosted regression tree (GBRT) model using Cox proportional hazard loss. Hyperparameter tuning was performed manually using grid search techniques. Model performance was evaluated using Harrell’s concordance index (CI). Feature importance and interaction effects were modeled using Shapley additive explanations (SHAP) values applied to the GBRT model. The open-source scikit-survival library in Python 3.7 was used for all analyses. We identified 118,087 stage I NSCLC patients (81.0%) receiving surgery and 27,659 receiving SBRT (19.0%). Within the surgery cohort, the GBRT model had the best performance (CI=0.689), as compared to the SVM model (0.673) and CPH model (0.672). Within the SBRT cohort, similarly, the GBRT model performed the best (CI=0.591) compared to the SVM model (CI=0.572) and CPH model (0.570). Based on feature importance rankings, age had the highest importance in both the surgery and SBRT cohorts. When using SHAP values to model nonlinear interaction effects between age and treatment received, an inflection point was identified between age 73 and 74, indicating GBRT model predictions of generally greater 90-day post-treatment mortality with SBRT in patients age 18-73 and greater risk with surgery in patients age 74+. We describe a ML-based approach for analyzing comparative 90-day post-treatment mortality risk between surgery and SBRT in stage I NSCLC. We found an inflection point in the interaction between age and treatment modality, underscoring the need for patient selection when assessing treatment options. Our findings may aid individualized decision-making in early stage NSCLC.

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

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.

Undertreatment of High-Risk Localized Prostate Cancer in the California Latino Population.

Background: The NCCN Clinical Practice Guidelines in Oncology recommend definitive therapy for all men with high-risk localized prostate cancer (PCa) who have a life expectancy >5 years or who are symptomatic. However, the application of these guidelines may vary among ethnic groups. We compared receipt of guideline-concordant treatment between Latino and non-Latino white men in California. Methods: California Cancer Registry data were used to identify 2,421 Latino and 8,636 non-Latino white men diagnosed with high-risk localized PCa from 2010 through 2014. The association of clinical and sociodemographic factors with definitive treatment was examined using logistic regression, overall and by ethnicity. Results: Latinos were less likely than non-Latino whites to receive definitive treatment before (odds ratio [OR], 0.79; 95% CI, 0.71-0.88) and after adjusting for age and tumor characteristics (OR, 0.84; 95% CI, 0.75-0.95). Additional adjustment for sociodemographic factors eliminated the disparity. However, the association with treatment differed by ethnicity for several factors. Latino men with no health insurance were considerably less likely to receive definitive treatment relative to insured Latino men (OR, 0.34; 95% CI, 0.23-0.49), an association that was more pronounced than among non-Latino whites (OR, 0.63; 95% CI, 0.47-0.83). Intermediate-versus high-grade disease was associated with lower odds of definitive treatment in Latinos (OR, 0.75; 95% CI, 0.59-0.97) but not non-Latino whites. Younger age and care at NCI-designated Cancer Centers were significantly associated with receipt of definitive treatment in non-Latino whites but not in Latinos. Conclusions: California Latino men diagnosed with localized high-risk PCa are at increased risk for undertreatment. The observed treatment disparity is largely explained by sociodemographic factors, suggesting it may be ameliorated through targeted outreach, such as that aimed at younger and underinsured Latino men.

Which Patients Report That Their Urologists Advised Them to Forgo Initial Treatment for Prostate Cancer?

To examine how frequently patients report that their urologist recommended forgoing definitive treatment and assess the impact of these recommendations on treatment choice and perceived quality of cancer care. We mailed surveys to men newly diagnosed with localized prostate cancer between 2014 and 2015 (adjusted response rate of 51.3%). Men reported whether their urologist recommended forgoing definitive treatment. Using logistic regression models, we assessed patient-level predictors of receiving a recommendation to forgo definitive treatment and estimated associations of receiving this recommendation with receipt of definitive treatment and perceived quality of cancer care among men with low-risk tumors and limited life expectancies. Nearly two-thirds (62.2%) of men with low-risk tumors and 46.4% with limited life expectancies received recommendations from their urologists to forgo definitive treatment. Among men with limited life expectancies, those with low-risk tumors were more likely to receive this recommendation compared with men with high-risk tumors (odds ratio [OR] 3.41; 95% confidence interval [CI] 2.17-5.37). Men with low-risk tumors who were recommended to forgo definitive treatment were less likely to receive definitive treatment (OR 0.48; 95% CI 0.32-0.73) but did not report lower perceived quality of care (OR 0.97; 95% CI 0.63-1.48). In this population-based study, a majority of men with low-risk prostate cancer report receiving recommendations from their urologists to forgo definitive treatment. Our results suggest that urologists have a strong influence on patient treatment choice and could increase active surveillance uptake in men eligible for expectant management without patients perceiving lower quality of cancer care.

The impact of treatment at minority-serving hospitals on outcomes for bladder cancer.

492 Background: Healthcare for racial minorities is densely concentrated at a small subset of hospitals in the United States. Understanding long-term outcomes at these minority-serving hospitals is highly relevant to elucidating the sources of racial disparities in cancer care. We investigated the impact of treatment at a minority-serving hospital on overall survival and receipt of definitive treatment for bladder cancer. Methods: Using the National Cancer Database, we identified all patients diagnosed with clinically localized, muscle-invasive bladder cancer between 2004 and 2012. Univariate and multivariable analyses were performed to assess the sociodemographic, clinical, and hospital-level factors influencing overall survival and receipt of definitive treatment (radical cystectomy with or without chemotherapy; trimodal therapy) for bladder cancer. Results: In adjusted analyses, there was no significant difference in overall survival between patients treated at minority-serving hospitals versus those treated at non-minority-serving hospitals (HR: 0.95; 95% CI: 0.90-1.01). There was also no significance in receipt of definitive treatment between the two hospital types (OR: 0.85; 95% CI: 0.68-1.06). Black race was independently associated with increased likelihood of mortality (HR: 1.08; 95% CI: 1.03-1.14) and decreased odds of receiving appropriate definitive treatment (OR: 0.73; 95% CI: 0.66-0.82). Conclusions: There was no difference between minority-serving and non-minority-serving hospitals in overall survival or receipt of definitive treatment. Black patients suffered worse survival and were less likely to receive definitive treatment for bladder cancer regardless of the type of hospital in which they were treated.

Racial Differences in Prostate Cancer Treatment: The Role of Socioeconomic Status.

This study examines whether socioeconomic status (SES), measured at both the individual and neighborhood levels, is associated with receipt of definitive treatment for localized prostate cancer and whether these associations mediate racial differences in treatment between non-Hispanic White and non-Hispanic Black men. The Philadelphia Area Prostate Cancer Access Study (P2 Access) is a mailed, cross-sectional survey of men sampled from the Pennsylvania Cancer Registry, combined with neighborhood Census data. Eight counties in southeastern Pennsylvania. 2,386 men with prostate adenocarcinoma. Receipt of definitive treatment, race, self-reported income, education, employment status, and neighborhood SES. Overall, Black and White men were equally likely to receive definitive treatment. Men living in neighborhoods with higher SES were more likely to receive definitive treatment (OR 1.57, 95%CI 1.01, 2.42). Among men who received definitive treatment, Black men were significantly less likely to receive radical prostatectomy compared with White men (OR .71, 95% CI .52, .98), as were men with some college education compared with those with a high school education or less (OR .66, 95% CI .47, .94). SES does not mediate racial differences in receipt of definitive treatment or the type of definitive treatment received, and associations with income or employment status were not significant. These results stress the importance of examining racial disparities within geographic areas and highlight the unique associations that different measures of SES, particularly neighborhood SES and education, may have with prostate cancer treatment.

A multidimensional view of racial differences in access to prostate cancer care.

e18048 Background: Racial differences in prostate cancer treatment and outcomes are widespread and poorly understood. We sought to determine whether access to care, measured across multiple dimensions, contribute to racial differences in prostate cancer. Methods: The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer from 2012 to 2014. Patient survey data was used to determine experiences of accessing prostate cancer care (response rate 51.1%). An audit survey using simulated patient calls was used to determine appointment availability and wait times at 151 urology practices. Patient and practice addresses were geocoded to construct distance measures. We used multivariable logistic regression models to determine the association between five different domains of access—availability, accessibility, accommodation, affordability, and acceptability—and receipt of definitive treatment with radical prostatectomy or radiation, satisfaction with care, and doctor-patient communication. Results: There were 1907 non-Hispanic white and 394 black men in our cohort, the majority (71%) with stage 1 disease. Overall, 85% of men received definitive treatment with no differences by race. None of the access domains were significantly associated with definitive treatment overall or with radical prostatectomy in adjusted models. Black men were less likely to report good doctor-patient communication (60% vs 71%, p &lt; 0.001) and high satisfaction with their care (69% vs 81%, p &lt; 0.001). Communication ratings remained significantly lower among black men compared to white men in adjusted models (odds ratio = 1.49, 95% Confidence Interval 1.03, 2.16). Each domain of access was significantly associated with lower satisfaction with care and worse communication; however, differences in access did not mediate racial disparities for these measures. Conclusions: This study presents the first comprehensive assessment of access to prostate cancer care, showing that while access was related to overall satisfaction and better doctor-patient communication, it did not appear to explain racial differences in these measures of cancer care.

Socioeconomic factors and survival in patients with non-metastatic head and neck squamous cell carcinoma.

The effect of socioeconomic factors on receipt of definitive treatment and survival outcomes in non‐metastatic head and neck squamous cell carcinoma (HNSCC) remains unclear. Eligible patients (n = 37 995) were identified from the United States Surveillance, Epidemiology and End Results (SEER) database between 2007 and 2012. Socioeconomic factors (i.e., median household income, education level, unemployment rate, insurance status, marital status and residence) were included in univariate/multivariate Cox regression analysis; validated factors were used to generate nomograms for cause‐specific survival (CSS) and overall survival (OS), and a prognostic score model for risk stratification. Low‐ and high‐risk groups were compared for all cancer subsites. Impact of race/ethnicity on survival was investigated in each risk group. Marital status, median household income and insurance status were included in the nomograms for CSS and OS, which had higher c‐indexes than the 6th edition TNM staging system (all P < 0.001). Based on three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income <US $65 394), the prognostic score model generated four risk subgroups with scores of 0, 1, 2 or 3, which had significantly separated CSS/OS curves (all P < 0.001). Low‐risk patients (score 0–1) were more likely to receive definitive treatment and obtain better CSS/OS than high‐risk patients (score 2–3). Chinese and non‐Hispanic black patients with high‐risk socioeconomic status had best and poorest CSS/OS, respectively. Therefore, marital status, median household income and insurance status have significance for predicting survival outcomes. Low‐risk socioeconomic status and Chinese race/ethnicity confer protective effects in HNSCC.

When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment.

The role of primary care providers (PCPs) in decision making around cancer care remains largely unknown. We evaluated how frequently men with localized prostate cancer report receiving help from their PCP about their treatment, and whether those men who do are less likely to receive definitive treatment. We mailed surveys to men newly diagnosed with localized prostate cancer between 2012 and 2014 in the greater Philadelphia region. Participants were asked whether their PCP helped decide how to treat their cancer. The outcome was receipt of definitive treatment (either radical prostatectomy or radiotherapy). A total of 2386 men responded (adjusted response rate, 51.1%). Among these men, 38.2% reported receiving help from their PCP regarding choosing a treatment, and 79.6% received definitive treatment. In adjusted analyses, non-Hispanic black men (odds ratio, 1.76; 95% confidence interval, 1.37-2.27) were more likely than non-Hispanic white men to report receiving help from their PCP. However, men who did receive help were not more likely to forgo definitive treatment overall (P = .58) or in the subgroups of men who may be least likely to benefit from definitive treatment. Though a substantial proportion of men reported receiving help from their PCP about prostate cancer treatment, these discussions were not associated with different treatment patterns. Further effort is needed to determine how to optimize the role of PCPs in supporting patients to make preference-sensitive cancer decisions.

Patient and clinician perspectives on treatment decision-making for African American men with prostate cancer.

186 Background: Prostate cancer is the most common cancer for men in the US, yet the burden of this disease falls disproportionately on African Americans (AAs). The disparity’s etiology is complex. Surgery and radiotherapy offer similar survival but historically have different rates of performance with younger and white men more likely to undergo surgery and AAs more likely to experience underuse. This study aims to examine treatment decision-making (TDM) processes for AA men from patient and physician perspectives. Methods: At 1 academic and 1 municipal urban hospital, pathology records and a tumor registry from 2007-2012 were used to identify 359 AA and 282 white men with locally advanced prostate cancer, a Gleason score of 7-10, and receipt of definitive treatment. 15/17 treating physicians of participating patients were interviewed. Underuse overall was 4%, AA had higher rate of underuse compared to whites (6% vs. 1% respectively, p = 0.0002). 14 patients with longer times between diagnosis and treatment were recruited for 4 focus groups &amp; 2 interviews lasting 60-90 minutes eliciting perspectives on themes related to TDM. Transcripts were coded and analyzed using a grounded theory approach. Results: Preliminary analysis of patient interviews suggests that patients primarily base their treatment decisions on physician recommendations. Patients were often unaware of treatment side effects. However, some patients felt this deficit helped them decide to receive treatment, whereas if they had known about possible impotence and incontinence, they would have refused treatment. Physicians recognized that patient concerns about side effects were a critical TDM factor. Physicians attributed prolonged delays between diagnosis and treatment to waiting times for tests of possible tumor spread and medical comorbidities. Conclusions: Understanding decision making and care processes for AA men with local advanced prostate cancer is critical to reducing the treatment and outcome disparities in this population. This study identifies several patient and physician/system factors that contribute to this process. These data can help inform interventions to improve prostate cancer care for AA men.