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Study finds disparities in management of mCSPC

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Article

“These findings suggest that guideline recommended treatment intensification remains low for patients with mCSPC in both Medicare and the Veterans Health Administration, but especially for Black patients,” says Daniel J. George, MD.

Data recently published in Prostate Cancer and Prostatic Diseases indicate that Black race and Medicaid enrollment are associated with disparities in treatment and outcomes among patients with metastatic castration-sensitive prostate cancer (mCSPC).1

"This study highlights a concerning disparity in emerging treatment in mCSPC, despite the availability of life prolonging treatment," says Daniel J. George, MD.

"This study highlights a concerning disparity in emerging treatment in mCSPC, despite the availability of life prolonging treatment," says Daniel J. George, MD.

Overall, the findings showed that Black patients and those on Medicaid were less likely to receive treatment intensification and experienced worse overall survival (OS) compared with White patients and non-Medicaid recipients, respectively.

“Previous studies have found that Black patients are more likely to have worse care for their prostate cancer than White patients. However, this has not been assessed specifically in patients with metastatic castration-sensitive prostate cancer, or mCSPC. As novel hormonal therapies become incorporated into treatment guidelines, it's important to understand any potential disparities in treatment and survival of patients with mCSPC, allowing us to target treatment to those who need it,” said lead author Daniel J. George, MD, in a video presentation of the findings shared by the Analysis Group.2 George is a professor of medicine and surgery at Duke Cancer Institute in Durham, North Carolina.

The investigators used both the Medicare and Veterans Health Administration (VHA) databases to obtain data on treatment intensification and OS in mCSPC.

Overall, they observed a modest increase in treatment intensification rates among all patients over the study period (2015-2018, Medicare; 2015-2019, VHA), despite it being recommended in treatment guidelines. Specifically, the rate of treatment intensification was 10.3% in Medicare and 19.9% in the VHA.

After adjusting for patient characteristics, data showed that Black patients were 32% less likely to receive treatment intensification vs White patients in the Medicare database (adjusted OR, 0.68; 95% CI, 0.58–0.81; P < .001), and 25% less likely in the VHA database (adjusted OR 0.75; 95% CI 0.61–0.92; P = .006). Further, patients dually enrolled in Medicaid were 33% less likely to receive treatment intensification vs those not enrolled in Medicaid (adjusted OR, 0.67; 95% CI, 0.57–0.80; P < .001).

Black race was also found to be associated with worse OS in the Medicare database, with Black patients demonstrating a 20% increased risk of death compared with White patients (adjusted HR, 1.20; 95% CI 1.09–1.31;P < .001). No significant association between OS and race was seen in the VHA database. Patients enrolled in Medicaid had a 50% increased risk of death compared with those without Medicaid (HR, 1.50; 95% CI, 1.37–1.63; P < .001 for all patients).

In total, the study included 18,297 patients from the Medicare database and 3384 patients from the VHA database. Most patients from both databases were White, but 12.2% of patients in the Medicare database and 30.1% from the VHA database were Black.

In the Medicare database, the median follow-up was 15.9 months for Black patients and 17.8 months for White patients. Median OS was 44.2 months for Black patients and not reached for White patients. In the VHA database, the median follow-up was 21.2 months for Black patients and 21.4 months for White patients. The median OS was 43.6 months for Black patients and 42.2 months for White patients.

For the study, treatment intensification was defined as patients receiving androgen deprivation therapy plus novel hormonal therapy or docetaxel as first-line treatment for mCSPC.

“These findings suggest that guideline recommended treatment intensification remains low for patients with mCSPC in both Medicare and the Veterans Health Administration, but especially for Black patients,” George concluded in the video presentation.2 “As well as race, poverty was associated with worse care and outcomes, with patients enrolled in Medicaid experiencing reduced treatment intensification and worse overall survival than those not enrolled in Medicaid. This study highlights a concerning disparity in emerging treatment in mCSPC, despite the availability of life prolonging treatment.”

References

1. George DJ, Agarwal N, Ramaswamy K, et al. Emerging racial disparities among Medicare beneficiaries and Veterans with metastatic castration-sensitive prostate cancer. Prostate Cancer Prostatic Dis. 2024. doi:10.1038/s41391-024-00815-1

2. Analysis Group researchers identify racial disparities in treatment of metastatic castration-sensitive prostate cancer. News release. Analysis Group. Published online April 16, 2024. Accessed April 17, 2024. https://www.analysisgroup.com/news-and-events/press-releases/analysis-group-researchers-identify-racial-disparities-in-treatment-of-metastatic-castration-sensitive-prostate-cancer

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