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Michael A Poch,
Diana Mehedint,
Dawn J Green,
Rochelle Payne-Ondracek,
Elizabeth T H Fontham,
Jeannette T Bensen,
Kristopher Attwood,
Gregory E Wilding,
Khurshid A Guru, Willie Underwood,
James L Mohler,
Hannelore V Heemers
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ABSTRACT: BACKGROUND: Epidemiological studies indicate that calcium channel blocker (CCB) use is inversely related to prostate cancer (PCa) incidence. The association between CCB use and PCa aggressiveness at the time of radical prostatectomy (RP) and outcome after RP was examined. METHODS: Medication use, PCa aggressiveness and post-RP outcome were retrieved from a prospectively populated database that contains clinical and outcome for RP patients at Roswell Park Cancer Institute (RPCI) from 1993 to 2010. The database was queried for anti-hypertensive medication use at diagnosis for patients with ≥1 year follow-up. Recurrence was defined using NCCN guidelines. Chi-Square tests assessed the relationship between CCB use and PCa aggressiveness. Cox regression models compared the distribution of progression-free survival (PFS) and overall survival (OS) with adjustment for covariates. Results for association between CCB usage and PCa aggressiveness were validated using data from the population-based North Carolina-Louisiana Prostate Cancer Project (PCaP). RESULTS: 48%, 37%, and 15% of RPCI's RP patients (n = 875) had low, intermediate, and high aggressive PCa, respectively. 104 (11%) had a history of CCB use. Patients taking CCBs were more likely to be older, have a higher BMI and use additional anti-hypertensive medications. Diagnostic PSA levels, PCa aggressiveness, and margin status were similar for CCB users and non-users. PFS and OS did not differ between the two groups. Tumor aggressiveness was associated with PFS. CCB use in the PCaP study population was not associated with PCa aggressiveness. CONCLUSIONS: CCB use is not associated with PCa aggressiveness at diagnosis, PFS or OS. Prostate © 2012 Wiley Periodicals, Inc.
The Prostate 12/2012; · 3.48 Impact Factor
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ABSTRACT: A challenge for health behavior science is to develop theory and best practices that take cultural diversity into account. Using data from Black, Hispanic, and White respondents to the 2003 Health Information National Trends Survey, we examined racial/ethnic differences in: (1) breast cancer risk perceptions/worry; (2) the associations between perceived risk/worry and ever having received a mammogram; and (3) perceived risk/worry and having had at least 2 mammograms over a 4-year period (consecutive mammography). Compared to White race/ethnicity, Black race/ethnicity was associated with lower perceived absolute risk and comparative risk for developing cancer. For the sample as a whole, higher perceived risk (both absolute risk and comparative risk) and worry predicted greater odds of mammography use; however, this was not true for Hispanics. In stratified analyses, perceived risk and worry were not associated with mammography use for either Hispanics or Blacks whereas they were for Whites; however, this interaction effect was significant only for Hispanics vs. Whites. Results support the need for formative research to identify determinants of health behavior prior to cancer prevention message planning for diverse audiences in order to accommodate racial/ethnic differences not only in the level of perceived risk, but also the association between risk perception to behavior change in that community.
Journal of Behavioral Medicine 07/2012; · 3.10 Impact Factor
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ABSTRACT: To understand the impact of cytoreductive nephrectomy on the ability to receive systemic therapy in patients with metastatic renal cell carcinoma. Causes of delayed eligibility and effect on overall survival (OS) were investigated.
Patients with metastatic renal cell carcinoma who underwent cytoreductive nephrectomy between 2002 and 2010 were identified. Those ineligible to receive systemic therapy>2 months after surgery were considered delayed. Reasons for delay and effect on OS were investigated, including a thorough analysis of surgical morbidity.
Of 65 patients identified, 28% experienced delayed eligibility for systemic therapy. Reasons for delay were related to surgery in 33%, disease progression in 56%, and both in 11%. Of the entire cohort, pT4 and sarcomatoid disease predicted poor outcomes with median OS of 9.8 and 7.6 months, respectively. Comparison of the delay vs no delay groups revealed more intraoperative complications (P=.01), a trend toward more high-grade postoperative complications (17% vs 4%, P=.09), and a median OS of 4.8 vs 18.9 months. Controlling for grade and stage, delay and sarcomatoid features independently predicted poor OS (HR, 2.61; P=.01 and HR, 2.25; P=.02, respectively).
Delay in eligibility for systemic therapy after cytoreductive nephrectomy adversely affects OS and is most commonly caused by disease-related factors, although high-grade complications may contribute. Those with evidence of T4 or sarcomatoid disease features may best be served by systemic therapy followed by cytoreductive nephrectomy only in those exhibiting response.
Urology 07/2011; 78(3):595-600. · 2.43 Impact Factor
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ABSTRACT: To assess the therapeutic efficacy of laparoscopic retroperitoneal lymph node dissection (L-RPLND) for testicular cancer in patients with nodal disease managed without adjuvant chemotherapy.
Consecutive patients undergoing RPLND were treated laparoscopically. Medical records for 15 patients with pathological stage I and II were reviewed. A modified template dissection was performed laparoscopically. When metastatic disease was noted on intraoperative frozen section, a bilateral template dissection was performed.
All patients had predominantly embryonal carcinoma and/or lymphovascular invasion in their orchidectomy specimen. All patients had normal tumour markers after orchidectomy. Laparoscopic RPLND was performed without intraoperative complications. The mean operative time was 299 min and mean length of hospital stay was 1.5 days. After L-RPLND, two patients were pN1 and five patients were pN2. Of the patients with nodal disease, five (two pN1 and three pN2) were followed without chemotherapy for a mean of 30 months with no evidence of recurrence. Isolated pulmonary recurrence occurred in two patients with pathologic stage I disease, and another stage I patient had recurrence in the lung and retroperitoneum outside the dissection template.
Laparoscopic RPLND appears to be safe while providing the benefits of minimally invasive surgery. Although the therapeutic benefit of L-RPLND needs to be confirmed in additional patients and with longer follow-up, our results suggest that L-RPLND provides both diagnostic and therapeutic benefits.
BJU International 06/2011; 109(2):281-5. · 2.84 Impact Factor
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ABSTRACT: The purposes of this study are to explore cancer information acquisition patterns among African-American men and to evaluate relationships between information acquisition patterns and prostate cancer prevention and control knowledge. A random sample of 268 men participated in a statewide interviewer-administered, telephone survey. Men classified as non-seekers, non-medical source seekers, and medical source seekers of prostate cancer information differed on household income, level of education, and beliefs about personal risk for developing prostate cancer. Results from multiple regression analysis indicated that age, education, and information-seeking status were associated with overall levels of prostate cancer knowledge. Results from logistic regression analyses indicated that men who included physicians as one of many information resources (medical source seekers) had superior knowledge over non-seekers and non-medical source seekers on 33% of individual knowledge details. The findings emphasize the need to connect lower-income and lower-educated African-American men to physicians as a source of prostate cancer control information.
Journal of Cancer Education 05/2011; 26(4):708-16. · 0.76 Impact Factor
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ABSTRACT: Black and Hispanic men have a lower prostate cancer (PCa) survival rate than white men. This racial/ethnic survival gap has been explained in part by differences in tumor characteristics, stage at diagnosis, and disparities in receipt of definitive treatment. Another potential contributing factor is racial/ethnic differences in the timely and accurate detection of lymph node metastases. The current study was conducted to examine the association between race/ethnicity and the receipt of pelvic lymph node dissection (PLND) among men with localized/regional PCa.
Logistic regression was used to estimate the adjusted odds of undergoing PLND among men who were diagnosed during 2000 to 2002 with PCa, who underwent radical prostatectomy or PLND without radical prostatectomy, and who were diagnosed in regions covered by the Surveillance, Epidemiology, and End Results database (n = 40,848).
Black men were less likely to undergo PLND than white men (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.84-0.98). When the analysis was stratified by PCa grade, black men with well differentiated PCa (OR, 0.48; 95% CI, 0.27-0.84) and poorly differentiated PCa (OR, 0.73; 95% CI, 0.60-0.89) were less likely to undergo PLND than their white counterparts, but racial differences were not observed among men with moderately differentiated PCa (OR, 0.96; 95% CI, 0.88-1.05).
Among men with poorly differentiated PCa, failure to undergo PLND was associated with worse survival. Racial disparities in the receipt of PLND, especially among men with poorly differentiated PCa, may contribute to racial differences in prostate cancer survival. Cancer 2011;. © 2011 American Cancer Society.
Cancer 03/2011; 117(20):4651-8. · 4.77 Impact Factor
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ABSTRACT: Breast cancer is the most common noncutaneous cancer diagnosed in women in the United States and is second only to lung cancer as the leading cause of cancer-related mortality. Although mortality rates have been dropping steadily due to a variety of factors including improved treatment modalities and screening, substantial racial differences in outcome between blacks and whites persist. Although differences in health care utilization and access, tumor biology, and cancer management have been elucidated as possible reasons for disparities seen, it is likely that other interactions exist. The purpose of this review is, therefore, to present a comprehensive overview of the literature on racial disparities in breast cancer outcome and highlight potential causative factors that may contribute to disparities seen among blacks and whites with breast cancer. In addition, we make research recommendations by discussing some of the remaining gaps in knowledge that may lead to further understanding of disparities and consequently improved outcomes for all women with breast cancer.
Cancer Research 02/2011; 71(3):640-4. · 7.86 Impact Factor
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ABSTRACT: • To assess the use of the RENAL Nephrometry Score (RNS), which has been proposed as an anatomical classification system for renal masses, aiming to predict surgical outcomes for patients undergoing laparoscopic partial nephrectomy (LPN).
• In the present study, 159 consecutive patients who underwent LPN were reviewed and RNS was calculated for 141 patients with solitary renal masses who had complete radiographic data. • Renal tumours were categorized by RNS as low (nephrometry sum 4-6), intermediate (sum 7-9) and high (sum 10-12).
• Of the 141 patients, there were 43 (30%) low, 91 (65%) intermediate and seven (5%) high score lesions. There was no statistically significant difference in the demographics of the three groups. • There was a significant difference in warm ischaemia time (16 vs 23 vs 31 min; P < 0.001), estimated blood loss (163 vs 312 vs 317 mL; P= 0.034) and length of hospital stay (1.2 vs 1.9 vs 2.3 days; P < 0.001) between the low, intermediate and high score groups, respectively. There was no difference in overall operative time (P= 0.862), transfusion rate (P= 0.665), complication rate (P= 0.419), preoperative creatinine clearance (P= 0.888) or postoperative creatinine clearance (P= 0.473) between the groups. • Sixty-one lesions (43%) were anterior and 80 (57%) were posterior. No difference was found among any intra-operative, pathological or postoperative outcomes when comparing anterior vs posterior lesions.
• In patients undergoing LPN, a higher RNS was significantly associated with an increased estimated blood loss, warm ischaemia time and length of hospital stay. • The RNS may stratify tumours based on the technical difficulty of performing LPN.
BJU International 12/2010; 108(6):876-81. · 2.84 Impact Factor
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ABSTRACT: Patients turn to their physicians for information and guidance when making a prostate cancer treatment decision. The objectives of this study were to determine the likelihood of men consulting with and receiving treatment recommendations from different providers (urologists, radiation oncologists, and primary care physicians), the content of these recommendations, the perceived influence of recommendations and which recommendations, if any, were associated with prostate cancer treatment decisions.
One hundred and fifty-eight participants with localized prostate cancer completed a survey regarding their treatment decision-making process. Associations between treatment choice and urologist recommendations, consultations with radiation oncologists and primary care physicians, potential side effects and other factors were examined using regression analysis.
Among men consulting multiple providers, more than half received at least one treatment recommendation. Most men chose a treatment recommended by at least one provider. The likelihood of choosing a treatment increased when the urologist recommended it. Consulting a radiation oncologist decreased and increased likelihood of choosing a radical prostatectomy and radiation, respectively.
Most men consulted multiple providers and received multiple treatment recommendations. Recommendations appear to play a significant role in prostate cancer treatment decision-making.
The Canadian Journal of Urology 10/2010; 17(5):5346-54. · 0.64 Impact Factor
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ABSTRACT: Sunitinib is an approved treatment for metastatic renal cell carcinoma. We performed a prospective clinical trial to evaluate the safety and clinical response to sunitinib administered before nephrectomy in patients with localized or metastatic clear cell renal cell carcinoma.
Patients with biopsy proven clear cell renal cell carcinoma were enrolled in the study and treated with 37.5 mg sunitinib malate daily for 3 months before nephrectomy. The primary end point was safety.
In an 18-month period 20 patients were enrolled. The most common toxicities were gastrointestinal symptoms and hematological effects. Grade 3 toxicity developed in 6 patients (30%). No surgical complications were attributable to sunitinib treatment. Of the 20 patients 17 (85%) experienced reduced tumor diameter (mean change -11.8%, range -27% to 11%) and cross-sectional area (mean change -27.9%, range -43% to 23%). Enhancement on contrast enhanced computerized tomography decreased in 15 patients (mean HU change -22%, range -74% to 29%). After tumor reduction 8 patients with cT1b disease underwent laparoscopic partial nephrectomy. Surgical parameters, such as blood loss, transfusion rate, operative time and complications, were similar to those in patients who underwent surgery during the study period and were not enrolled in the trial.
Preoperative treatment with sunitinib is safe. Sunitinib decreased the size of primary renal cell carcinoma in 17 of 20 patients. Future trials can be considered to evaluate neoadjuvant sunitinib to maximize nephron sparing and decrease the recurrence of high risk, localized renal cell carcinoma.
The Journal of urology 09/2010; 184(3):859-64. · 4.02 Impact Factor
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ABSTRACT: We explored racial/ethnic differences in perceived cancer risk and determinants of these differences in a nationally representative sample of whites, blacks, Hispanics, and Asians.
Multiple regression techniques, including mediational analyses, were used to identify determinants and quantify racial/ethnic differences in the perception of the risk of developing cancer among 5,581 adult respondents to the 2007 Health Information Trends Survey (HINTS).
Blacks, Hispanics, and Asians reported lower perceived cancer risk than whites [Bs = -0.40, -0.34, and -0.69, respectively; (Ps < 0.001)]. Contributing factors included relatively lower likelihood of reporting a family history of cancer, lower likelihood of having smoked, and a less strong belief that everything causes cancer among nonwhites than among whites. Racial/ethnic differences in perceived risk were attenuated in older respondents because perceived cancer risk was negatively associated with age for whites but not for nonwhites.
Nonwhites had lower perceptions of cancer risk than whites. Some of the racial/ethnic variability in perceived risk may be due to racial and ethnic differences in awareness of one's family history of cancer and its relevance for cancer risk, experiences with behavioral risk factors, and salience of cancer risk information.
Cancer Epidemiology Biomarkers & Prevention 02/2010; 19(3):746-54. · 4.12 Impact Factor
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ABSTRACT: To compare overall and prostate cancer-specific survival, using the Detroit Surveillance, Epidemiology, and End Results registry data, among 8679 Detroit area black and white men with localized or regional stage prostate cancer diagnosed from 1988 to 1992 to determine whether racial disparities in long-term survival remained after adjusting for treatment type and socioeconomic status (SES).
The cases were geocoded to the census block-group, and SES data were obtained from the 1990 U.S. Census. Cox proportional hazards regression analysis was used to estimate the hazard ratio of death from any cause. The median follow-up was 16.5 years.
Of the 7770 localized stage cases (22% black and 78% white) and 909 regional cases (24% black and 76% white), black men were more likely to receive nonsurgical treatment (P < .001) and to be of low SES (P < .0001). The survival analyses were stratified by stage. For both stages, black men had poorer survival than white men in the unadjusted model. The adjustment for age and tumor grade had little effect on the survival differences, but adjustment for SES and treatment removed the survival differences.
Low SES and nonsurgical treatment were associated with a greater risk of death among men with prostate cancer, explaining much of the survival disadvantage for black men with prostate cancer.
Urology 12/2009; 74(6):1296-302. · 2.43 Impact Factor
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Khurshid A Guru,
Abid Hussain,
Rameela Chandrasekhar,
Pamela Piacente,
Marlene Bienko,
Mark Glasgow, Willie Underwood,
Gregory Wilding,
James L Mohler,
Mani Menon,
James O Peabody
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ABSTRACT: The surgical robot is becoming an important tool for performance of minimally invasive surgical procedures around the world. We surveyed opinions about and utilization of robot-assisted surgery among urologic surgeons from 44 countries.
A total of 297 surveys were completed from September to November 2008 by participating urologic surgeons polled at various national and international urologic meetings. The survey evaluated surgeon background, personal experience with minimally invasive surgery, institutional status regarding robotic surgery surgeons' attitudes towards robot-assisted surgery, in general, and prostate, bladder and kidney oncologic procedures, specifically.
Two hundred ninety-seven participants completed the survey of which 35% were in training for and 54% in practice of urology. Although 57% of these participants were older than 40, 62% had never sat on a robotic surgical console but 61% believed they would perform robot-assisted surgery. Seventy-eight percent of respondents felt it was required or beneficial to have training in robot-assisted surgery. Only 21% of respondents were currently performing robot-assisted radical prostatectomy. Sixty-one percent of respondents felt robot-assisted radical prostatectomy was the current gold standard or as good as laparoscopic prostatectomy. Only 10% had performed robot-assisted radical cystectomy and 70% of these surgeons have transferred skills from robot-assisted radical prostectomy. Ten percent were performing robot-assisted radical nephrectomies and 30% had transferred skills for laparoscopic partial nephrectomy to robot-assisted partial nephrectomy.
Robot-assisted surgery has begun to integrate into the minimally invasive armamentarium for urologic surgery and is applied for more procedures as experience is gained.
The Canadian Journal of Urology 09/2009; 16(4):4736-41; discussion 4741. · 0.64 Impact Factor
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ABSTRACT: Men who do not perceive themselves to be at risk of developing and dying from prostate cancer may be less likely to utilize prostate cancer screening. This, coupled with variation among organizations in recommendations about screening with prostate-specific antigen (PSA), may contribute to confusion for providers and/or patients making prostate cancer screening decisions.
Data on 1075 African American, Hispanic, and non-Hispanic white male respondents to the 2003 Health Information National Trends Study (HINTS) were analyzed to examine the association among demographic characteristics, perception of the risk of developing prostate cancer, and PSA test utilization among men aged 45 or older.
African American men less frequently, while Hispanic men more frequently, perceived their risk of developing prostate cancer to be higher than the average same-age man compared to non-Hispanic white men. Overall, men who perceived their likelihood of getting prostate cancer as very low to moderate (OR, 0.42; 95% CI, 0.24-0.73) or perceived the likelihood compared to the average same age man as less or about as likely (OR, 0.47; 95% CI, 0.27-0.81) were significantly less likely to have received a PSA test in a model adjusted for age, marital status, education, and health insurance coverage.
These findings suggest that all men, but particularly African American and Hispanic men, could benefit from information regarding their specific risk of developing prostate cancer before making a decision about prostate cancer screening.
Journal of the National Medical Association 08/2009; 101(7):698-704. · 1.16 Impact Factor
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ABSTRACT: Although the higher risk of prostate cancer for African-American men is well known in the medical community, it is not clear how prevalent this knowledge is among African-American men themselves. Both the side effects of treatment and the lack of a demonstrated mortality benefit of routine screening with the prostate-specific antigen test among men in the general population have increased the focus on patient participation in decision making about prostate cancer screening.
Data on 1075 male respondents to the 2003 Health Information National Trends Study were collected from October 2002 to April 2003 and analyzed in 2008 to examine the associations among race/ethnicity, demographic characteristics, and the perception of the risk of developing prostate cancer for African-American, Hispanic, and non-Hispanic white men aged >or=45 years without a history of prostate cancer.
Nearly 50% of African-American men, 47.4% of Hispanic men, and 43.3% of non-Hispanic white men perceived their likelihood of getting prostate cancer as somewhat or very low. Nearly 18% of African-American men, 21.6% of Hispanic men, and 12.9% of non-Hispanic white men perceived themselves to be more likely to get prostate cancer than the average man of the same age.
Despite statistics to the contrary, few African-American men perceived themselves to have a higher-than-average risk of prostate cancer, while a higher percentage of Hispanic men perceived their risk to be higher than that of the average man of the same age. These findings suggest that all men, but particularly African-American and Hispanic men, could benefit from information regarding their specific risk of developing prostate cancer before making a decision about prostate cancer screening.
American journal of preventive medicine 05/2009; 37(1):64-7. · 4.24 Impact Factor
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ABSTRACT: We report a case history of a patient with Parkinson's disease (PD) treated with androgen deprivation therapy (ADT) and external beam radiation for prostate cancer, who developed severe deterioration of his PD during ADT.
The Canadian Journal of Urology 03/2009; 16(1):4495-7. · 0.64 Impact Factor
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ABSTRACT: Prostate cancer (PCa) patients often must decide between several treatment modalities considered equally efficacious, but associated with different benefits and side-effects. For some, the decision-making process can be difficult, but little is known about patient characteristics and cognitive processes that might influence the difficulty of such decisions. This study investigated the roles of dispositional optimism and self-efficacy in PCa treatment decision-making difficulty and satisfaction.
One hundred and twenty-five patients with clinically localized PCa completed a mail-in paper-and-pencil survey after they had made their treatment decision, but prior to treatment.
After adjusting for covariates, optimism and treatment decision-making self-efficacy were associated with less difficulty and greater satisfaction with the treatment decision-making process. Effects of optimism on difficulty and satisfaction were partially mediated by self-efficacy for making the treatment decision.
Men with PCa and who are low in optimism may be at greater risk for treatment decision-making difficulty and lack of treatment decision-making satisfaction, in part, because they have lower confidence in their ability to make the decision compared with those who are more optimistic. As self-efficacy perceptions are modifiable, consideration should be given to including self-efficacy enhancing components as part of PCa treatment decision-making interventions.
Psycho-Oncology 10/2008; 18(3):290-9. · 3.34 Impact Factor
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ABSTRACT: Patients' self-reports of family history of cancer influence physician cancer screening recommendations. Little is known about rates of reporting a family history of cancer in the immigrant population.
The study used a nationally representative probability sample of adults, 18 years of age and older, living in the United States (N=5010) who had responded to the 2005 Health Information Trends Survey (HINTS). Likelihood of reporting a family history of cancer was examined as a function of nativity status (foreign-born vs US-born) and control variables.
Immigrants were approximately one-third as likely as nonimmigrants to report a family history of cancer (odds ratio [OR], 0.35; 95% confidence index [95% CI], 0.25-0.48) after controlling for sociodemographic and cancer knowledge variables.
When healthcare providers are assessing cancer risk and making screening recommendations, they should take into account that among foreign-born patients, and especially nonwhite foreign-born patients, self-reported family history of cancer (FHC) may misrepresent their cancer risk. Failure to account for low rates of reporting FHC among immigrants could inadvertently contribute to existing disparities in cancer screening and use of genetic testing by immigrants and ethnic minorities.
Cancer 02/2008; 112(2):399-406. · 4.77 Impact Factor
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ABSTRACT: Prior studies evaluating quality of care following radical cystectomy have been constrained by the use of retrospective reviews of single institutional series and limited ability to examine risk factors in a comprehensive manner. Characterization of these factors could enhance preoperative patient counseling and facilitate perioperative management, thereby improving the quality of patient care.
The National Surgical Quality Improvement Project is a prospective quality management initiative at 123 Veterans Affairs Medical Centers nationwide. The project collects preoperative clinical and intraoperative data, and outcomes on a wide variety of surgical procedures from multiple surgical disciplines. Since 1991, 2,538 radical cystectomies have been captured by the National Surgical Quality Improvement Project. Modeling using logistic regression was performed to identify preoperative risk factors associated with mortality and prolonged length of stay (greater than 90th percentile) after radical cystectomy.
The 30 and 90-day mortality rates following cystectomy were 2.9% and 6.8%, respectively, and median hospital stay was 11 days (90th percentile 30). Robust preoperative factors associated with mortality and prolonged length of stay that uniformly increased risk were older patient age (OR 1.2 to 1.4), American Society of Anesthesiologists class 3 or greater (OR 1.5 to 3.3), dependent functional status (OR 1.7 to 2.0) and low serum albumin (OR 2.1 to 12.0).
A defined set of preoperative risk factors is independently associated with greater mortality and hospital stay following radical cystectomy. The breadth of these factors suggests that complex case mix adjustment is mandatory when comparing outcomes. Implementation of novel processes directed toward minimizing patient risk has the potential to improve outcomes following cystectomy.
The Journal of Urology 11/2006; 176(4 Pt 1):1363-8. · 3.75 Impact Factor
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ABSTRACT: White Americans have a 2-fold higher incidence of bladder cancer than black Americans but the latter have a higher mortality rate. This survival disparity has been attributable largely to the late stage presentation of black patients but other factors likely exist. We examined trends in bladder cancer presentation and survival in white and black patients in a 27-year period to gain additional insight into these factors.
Using Surveillance, Epidemiology, and End Results Program data trends in tumor presentation, treatment and survival were defined in 93,093 patients, including 89,481 white and 3,612 black patients, with bladder cancer. Parameters were measured during 5 and 7-year intervals from 1973 to 1999. Bivariate relationships between patient/disease characteristics, and the time and survival were explored. Cox proportional hazard models were used to examine the independent effect of parameters on disease specific survival.
Median followup was 10 years. Black patients consistently presented with higher stage and grade tumors (each p <0.001). This was most pronounced in black women. A trend toward earlier stage presentation was observed in black and white patients with time (p = 0.05 and <0.001, respectively). Ten-year survival in black and white patients with similar tumor stage and grade was consistently worse in black patients, except those with metastasis. An adjusted multivariable model demonstrated a persistent survival disadvantage in black patients (HR 1.35, p <0.001).
Racial disparities in bladder cancer stage, grade, treatment and adjusted survival continue to exist between white and black Americans despite improvements in stage presentation and survival of localized and regional disease. These data provide the rationale to study treatment decision making, access, delay and potential bias in the black community.
The Journal of Urology 10/2006; 176(3):927-33; discussion 933-4. · 3.75 Impact Factor
