Abstract A53: Treatment for elderly prostate cancer patients: Disparities in a southern state

Background: An important aspect of quality cancer care is receipt and completion of recommended therapy. In previous studies, black prostate cancer patients were reported to be less likely to receive treatment for prostate cancer than white patients. In the Southern US, minorities may be more at risk of not receiving treatment. This study describes treatment for elderly prostate cancer patients in Alabama.

Study Design: This is a retrospective analysis of Medicare administrative claims data. We linked Medicare claims and Alabama Statewide Cancer Registry records for black and white men diagnosed with prostate cancer in 2000–2003. Treatment was identified in the 365 days post diagnosis using International Classification of Disease-v.9 procedure and Current Procedure Terminology codes. Logistic regression models were constructed to investigate the association between race and the likelihood of receiving: 1) definitive therapy (prostatectomy or XRT or brachytherapy) and 2) hormone therapy for individuals who survived at least 9 months post diagnosis. Similarly, models were constructed to examine the association between race and receiving less than 30 days of XRT and less than 6 months of hormone therapy in individuals who survived ≥ 1 month after their last treatment. In all analyses, we adjusted for age, tumor grade, comorbid conditions, and proportion of persons living below poverty level and with less than high school education in the Census track of residence.

Results: Among 4130 men, 35.7% were 75 or older, 21.7% were black, 25.5% had ≥ 1 comorbid condition, 3.1% had well differentiated tumors, 63.3% moderately differentiated, 20.7% poorly differentiated, and the remainder did not have tumor grade information. Compared to whites, blacks lived in Census tracts with a higher proportion of persons living below poverty level (22.9% vs 12.9, P <0.0001) and with of people with less than high school education (38.3% vs 35.2%, P <0.0001). Overall, 6.9% of blacks and 4.3% of whites died within 9 months of prostate cancer diagnosis. Among those who survived 9 months (N = 3930), 24.3% received prostatectomy, 45.5% XRT, 18.2% brachytherapy, 41.8% hormone therapy, and 71.5% received definitive therapy. About 16.1% received none of the treatments. After adjusting for covariates, blacks were found to be less likely to receive definitive therapy (62.7% vs 73.8%, adj. OR 0.59, P <0.0001). No difference was found in receipt of hormone therapy (46.8% vs 40.4%, adj. OR 1.18, P = 0.057). Among those who survived ≥ one month after the last treatment (N =3924), XRT lasted on average 42.7 ±1.32 days and hormone therapy lasted on average 207.5 ± 4.91 days. There were no difference in the likelihood of receiving less than 30 days of XRT (30.8% vs 32.1%, adj. OR 0.98, P = 0.90) and less than 180 days of hormone treatment (46.6% vs 52.3%, adj. OR 0.81, P = 0.11) between black and white men.

Conclusions: Treatment rates in Alabama elderly prostate cancer patients are comparable to those found in other parts of the US, particularly the SEER areas. We found that black men were less likely to received definitive therapy. This difference persisted after adjusting for socio-economic variables. However, once the treatment was started, there were no differences in duration of radiation or hormone treatment. Further research is needed to establish reasons why disparities in type of treatment exist in elderly Alabamians with prostate cancer.