Prostate cancer treatment disparities found for low-income patients at public, private facilities

Among low-income patients enrolled in a state-funded program, prostate cancer treatments varied significantly between county hospitals and private providers. Specifically, those patients treated at county hospitals were more likely to undergo surgery, whereas those treated by a private provider were more likely to receive radiation or androgen deprivation therapy.

In the study, researchers pooled data on 559 men included in Improving Access, Counseling, and Treatment for Californians With Prostate Cancer (IMPACT) — a state-funded program for low-income patients. Multinomial regression was used to compare the types of treatments patients received at private vs. public facilities.

The median age of patients was 61 years; 49% were Hispanic; and 43% underwent surgery.

From 2001 and 2006, 315 (56%) men received treatment from county hospitals and 244 (44%) received treatment from private providers. No significant differences were found for age at diagnosis, year of enrollment, age at enrollment, PSA, Charlson comorbidity index, Gleason grade, clinical T stage or D’Amico risk criteria.

Men treated by private providers were three times more likely to be white (35% vs. 10%, P<.01) and half as likely to undergo surgery when compared with men treated by county hospitals (29% vs. 54%, P<.01).

Multinomial adjusted regression analysis indicated that those treated by private providers were almost 2.5 times more likely to receive radiotherapy (OR=2.36; 95% CI, 1.37-4.07) and more than 4.5 times likely to receive primary androgen deprivation (OR=4.71; 95% CI, 2.15-10.36) than to receive surgery when compared with those treated by public providers.

Parsons JK. Cancer. 2010;doi:10.1002/cncr.24856.