Article

Racial/Ethnic Disparities in Survival Among Men Diagnosed With Prostate Cancer in Texas

Division of Epidemiology, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA.
Cancer (Impact Factor: 4.9). 03/2011; 117(5):1080-8. DOI: 10.1002/cncr.25671
Source: PubMed

ABSTRACT To the authors' knowledge, few studies to date have examined racial differences in prostate cancer survival while controlling for socioeconomic status (SES). No such studies have examined this association in Texas, a large state with significant ethnic and racial diversity. The objective of this analysis was to determine whether racial disparities in survival for men diagnosed with prostate cancer in Texas from 1995 through 2002 remained after adjusting for SES, rural residence, and stage of disease.
A cohort of 87,449 men who were diagnosed with prostate cancer was identified from the Texas Cancer Registry. The SES measure was based on census tract data reflecting median household income, median home value, and percentages of men living below poverty, with a college education, and with a management or professional occupation. The 5-year survival rates were calculated using the Kaplan-Meier method and Cox proportional hazard modeling was used to estimate hazard ratios (HRs) for race and all-cause and disease-specific mortality.
After adjusting for SES, age, stage of disease, tumor grade, year of diagnosis, and rural residence, both black and Hispanic men were more likely (adjusted HR [aHR], 1.70 [95% confidence interval (95% CI), 1.58-1.83] and aHR, 1.11 [95% CI, 1.02-1.20], respectively) to die of prostate cancer compared with white men. The pattern of survival disadvantage for black men held for those diagnosed with localized disease and advanced disease, and for those with an unknown stage of disease at diagnosis.
Substantial racial disparities in prostate cancer survival were found for men in Texas. Future studies should incorporate treatment data as well as comorbid conditions because this information may explain noted survival disparities.

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    • "This is likely due to the combination of lead time bias through the detection of incident cases earlier, the detection of prostate cancers that have low potential to progress to cause symptoms, and the ability to treat localised cancers curatively through surgery. However, the persistence in the survival differential after adjustment for stage in several studies, (Jong et al., 2004; Schwartz et al., 2009; White et al., 2011; Shafique and Morrison, 2013; Yu et al., 2014b) along with treatment differentials by geographical location (Lyratzopoulos et al., 2010; Baade et al., 2011) suggest that treatment variation may also be important in explaining at least some of the survival disparities (Jong et al., 2004; Chu and Freedland, 2010). It has been identified that further research is needed to understand whether differences in comorbidities or treatment explain the observed inequalities in prostate cancer outcomes (Shafique et al., 2012). "
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    ABSTRACT: BACKGROUND: This study reviewed the published evidence as to how prostate cancer outcomes vary across geographical remoteness and area level disadvantage. MATERIALS AND METHODS: A review of the literature published from January 1998 to January 2014 was undertaken: Medline and CINAHL databases were searched in February to May 2014. The search terms included terms of 'Prostate cancer' and 'prostatic neoplasms' coupled with 'rural health', 'urban health', 'geographic inequalities', 'spatial', 'socioeconomic', 'disadvantage', 'health literacy' or 'health service accessibility'. Outcome specific terms were 'incidence', 'mortality', 'prevalence', 'survival', 'disease progression', 'PSA testing' or 'PSA screening', 'treatment', 'treatment complications' and 'recurrence'. A further search through internet search engines was conducted to identify any additional relevant published reports. RESULTS: 91 papers were included in the review. While patterns were sometimes contrasting, the predominate patterns were for PSA testing to be more common in urban (5 studies out of 6) and affluent areas (2 of 2), higher prostate cancer incidence in urban (12 of 22) and affluent (18 of 20), greater risk of advanced stage prostate cancer in rural (7 of 11) and disadvantaged (8 of 9), higher survival in urban (8 of 13) and affluent (16 of 18), greater access or use of definitive treatment services in urban (6 of 9) and affluent (7 of 7), and higher prostate mortality in rural (10 of 20) and disadvantaged (8 of 16) areas. CONCLUSIONS: Future studies may need to utilise a mixed methods approach, in which the quantifiable attributes of the individuals living within areas are measured along with the characteristics of the areas themselves, but importantly include a qualitative examination of the lived experience of people within those areas. These studies should be conducted across a range of international countries using consistent measures and incorporate dialogue between clinicians, epidemiologists, policy advocates and disease control specialists.
    Asian Pacific journal of cancer prevention: APJCP 03/2015; 16. · 2.51 Impact Factor
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    • "This is likely due to the combination of lead time bias through the detection of incident cases earlier, the detection of prostate cancers that have low potential to progress to cause symptoms, and the ability to treat localised cancers curatively through surgery. However, the persistence in the survival differential after adjustment for stage in several studies, (Jong et al., 2004; Schwartz et al., 2009; White et al., 2011; Shafique and Morrison, 2013; Yu et al., 2014b) along with treatment differentials by geographical location (Lyratzopoulos et al., 2010; Baade et al., 2011) suggest that treatment variation may also be important in explaining at least some of the survival disparities (Jong et al., 2004; Chu and Freedland, 2010). It has been identified that further research is needed to understand whether differences in comorbidities or treatment explain the observed inequalities in prostate cancer outcomes (Shafique et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study reviewed the published evidence as to how prostate cancer outcomes vary across geographical remoteness and area level disadvantage. A review of the literature published from January 1998 to January 2014 was undertaken: Medline and CINAHL databases were searched in February to May 2014. The search terms included terms of 'Prostate cancer' and 'prostatic neoplasms' coupled with 'rural health', 'urban health', 'geographic inequalities', 'spatial', 'socioeconomic', 'disadvantage', 'health literacy' or 'health service accessibility'. Outcome specific terms were 'incidence', 'mortality', 'prevalence', 'survival', 'disease progression', 'PSA testing' or 'PSA screening', 'treatment', 'treatment complications' and 'recurrence'. A further search through internet search engines was conducted to identify any additional relevant published reports. 91 papers were included in the review. While patterns were sometimes contrasting, the predominate patterns were for PSA testing to be more common in urban (5 studies out of 6) and affluent areas (2 of 2), higher prostate cancer incidence in urban (12 of 22) and affluent (18 of 20), greater risk of advanced stage prostate cancer in rural (7 of 11) and disadvantaged (8 of 9), higher survival in urban (8 of 13) and affluent (16 of 18), greater access or use of definitive treatment services in urban (6 of 9) and affluent (7 of 7), and higher prostate mortality in rural (10 of 20) and disadvantaged (8 of 16) areas. Future studies may need to utilise a mixed methods approach, in which the quantifiable attributes of the individuals living within areas are measured along with the characteristics of the areas themselves, but importantly include a qualitative examination of the lived experience of people within those areas. These studies should be conducted across a range of international countries using consistent measures and incorporate dialogue between clinicians, epidemiologists, policy advocates and disease control specialists.
    Asian Pacific journal of cancer prevention: APJCP 03/2015; 16(3):1259-75. DOI:10.7314/APJCP.2015.16.3.1259 · 2.51 Impact Factor
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    ABSTRACT: Introduction. Concern regarding overtreatment of prostate cancer (CaP) is leading to increased attention on active surveillance (AS). This study examined CaP survivors on AS and compared secondary treatment patterns and overall survival by race/ethnicity. Methods. The study population consisted of CaP patients self-classified as black or white followed on AS in the Center for Prostate Disease Research (CPDR) multicenter national database between 1989 and 2008. Secondary treatment included radical prostatectomy (RP), external beam radiation therapy or brachytherapy (EBRT-Br), and hormone therapy (HT). Secondary treatment patterns and overall survival were compared by race/ethnicity. Results. Among 886 eligible patients, 21% were black. Despite racial differences in risk characteristics and secondary treatment patterns, overall survival was comparable across race. RP following AS was associated with the longest overall survival. Conclusion. Racial disparity in overall survival was not observed in this military health care beneficiary cohort with an equal access to health care.
    06/2011; 2011:234519. DOI:10.1155/2011/234519
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