(Reuters Health) – Older black men who have surgery for prostate cancer may have more complications and pay higher out-of-pocket costs than white men, a U.S. study suggests.
Researchers focused on men with localized prostate tumors who would be good candidates for removal of the prostate gland, which is recommended for higher-risk cases.
They didn’t find a difference in overall or cancer-specific survival based on race.
But they did find that compared to whites, blacks were more likely to have complications and emergency department visits after their surgery and to be readmitted to the hospital.
They were also less likely to get diagnostic tests during their surgery to verify how risky the tumors were.
The findings suggest that in certain circumstances, differences in outcomes for black men may not be due to biological differences in tumor aggressiveness, said study author Dr. Quoc-Dien Trinh of Harvard Medical School and Brigham and Women’s Hospital in Boston.
“My interpretation is that all this talk about blacks having more biologically aggressive disease and hence worse survival may in fact be more of an access to care or access to treatment problem,” Trinh said by email.
Trinh and colleagues examined outcomes for more than 25,000 men, including more than 2,000 black men, who were insured by Medicare, the U.S. health insurance program for the elderly. All had localized tumors and underwent radical prostatectomy between 1992 and 2009.
Just 59 percent of black men had surgery within 90 days, compared with about 70 percent of white men. That in itself isn’t necessarily problematic, Trinh told Reuters Health. “There is no established criteria for time between diagnosis and surgery. . . . we need to consider that prostate cancer tends to be slower growing than, say, pancreatic cancer.”
When they did have surgery, however, blacks were 24 percent less likely than whites to have some of their lymph nodes removed, which would have provided information about the stage of cancer and how risky the tumors might be.
Within 30 days of surgery, blacks were 48 percent more likely to visit the emergency department and 28 percent more likely to be readmitted to the hospital, the researchers reported in JAMA Oncology.
After that first month, black men were 45 percent more likely to wind up in the emergency department and 27 percent more likely to be admitted to the hospital than white men.
Blacks also faced higher costs, with the top 50 percent of black men spending almost $1,200 more out-of-pocket than the top 50 percent of white men.
Limitations of the study include the exclusion of patients without insurance as well as men who either were not offered or refused treatment, the authors acknowledge. This may have led the study to include men who were healthier than the typical patient.
In addition, Trinh said, the study was not designed to assess the appropriateness of care.
Even so, the findings add to a growing body of evidence on racial disparities in cancer care, Dr. Otis Brawley, chief medical officer of the American Cancer Society and an oncologist at Emory University, noted in an accompanying editorial.
Black men may be less likely to be treated by urologists who specialize in prostate cancer, Brawley said by email, a phenomenon that is seen in a number of diseases.
Men will fare best when they see specialists who do a high volume of procedures, Brawley added. Some doctors do just three or four prostatectomies a year, while others do that many in a week, he noted.
“A higher proportion of black men are challenged in terms of health literacy and less likely to seek out prostate cancer specialists,” Brawley said by email. They may also face barriers to care such as lack of transportation, difficulty getting referrals and transferring care to specialists and communicating in a complex health care system.
“There are some social impediments to getting to those specialists even when one has insurance,” Brawley said.
SOURCE: bit.ly/207tpYd JAMA Oncology, online October 22, 2015.