Daniel J Lee1, Zhiguo Zhao2, Li-Ching Huang2, Tatsuki Koyoma2, Matthew J Resnick3, David F Penson3, Daniel A Barocas3, Karen E Hoffman4. 1. Department of Urology, Center for Quantitative Sciences, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA. daniel.lee.1@vanderbilt.edu. 2. Department of Biostatistics, Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Department of Urology, Center for Quantitative Sciences, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA. 4. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
Abstract
PURPOSE: Racial disparities are apparent in the management and outcomes for prostate cancer; however, disparities in compliance to quality measures for radiation therapy for prostate cancer have not been previously studied. Therefore, the goal of the study was to characterize disparities in the compliance rates with quality measures. METHODS: The comparative effectiveness analysis of radiation therapy and surgery study is a population-based, prospective cohort study that enrolled 3708 men with clinically localized prostate cancer from 2011 to 2012. Compliance with 5 radiation-specific quality measures endorsed by national consortia as of 2011 was assessed, and compliance was compared by race using logistic regression. RESULTS: Overall, 604 men received definitive external beam radiation therapy (EBRT) of which 20% were self-reported black, 74% non-Hispanic white, and 6% Hispanic. Less than two-thirds of black and Hispanic men received EBRT that was compliant with all available quality measures (p = 0.012). Compared to white men, black men were less likely to receive dose-escalated EBRT (95% vs. 87%, p = 0.011) and less likely to avoid unnecessary pelvic radiation for low-risk disease (99% vs. 20%, p < 0.001). Compared to white men, Hispanic men were less likely to undergo image guidance (87% vs. 71%, p = 0.04). Black and Hispanic men were more likely to receive EBRT from low-quality providers than white men. CONCLUSIONS: Addressing disparities in access to providers that meet quality guidelines, and improving adherence to evidence-based processes of care may decrease racial/ethnic disparities in prostate cancer outcomes.
PURPOSE: Racial disparities are apparent in the management and outcomes for prostate cancer; however, disparities in compliance to quality measures for radiation therapy for prostate cancer have not been previously studied. Therefore, the goal of the study was to characterize disparities in the compliance rates with quality measures. METHODS: The comparative effectiveness analysis of radiation therapy and surgery study is a population-based, prospective cohort study that enrolled 3708 men with clinically localized prostate cancer from 2011 to 2012. Compliance with 5 radiation-specific quality measures endorsed by national consortia as of 2011 was assessed, and compliance was compared by race using logistic regression. RESULTS: Overall, 604 men received definitive external beam radiation therapy (EBRT) of which 20% were self-reported black, 74% non-Hispanic white, and 6% Hispanic. Less than two-thirds of black and Hispanic men received EBRT that was compliant with all available quality measures (p = 0.012). Compared to white men, black men were less likely to receive dose-escalated EBRT (95% vs. 87%, p = 0.011) and less likely to avoid unnecessary pelvic radiation for low-risk disease (99% vs. 20%, p < 0.001). Compared to white men, Hispanic men were less likely to undergo image guidance (87% vs. 71%, p = 0.04). Black and Hispanic men were more likely to receive EBRT from low-quality providers than white men. CONCLUSIONS: Addressing disparities in access to providers that meet quality guidelines, and improving adherence to evidence-based processes of care may decrease racial/ethnic disparities in prostate cancer outcomes.
Authors: Nishwant Swami; Yefri A Baez; Idalid Franco; Tiffany Nguyen; Karthik Meiyappan; Minh Ton; Bhav Jain; Crystal Seldon; Kenrick Ng; Narjust Duma; Mohammed Alshalalfa; Kosj Yamoah; Paul L Nguyen; Brandon A Mahal; Edward Christopher Dee Journal: Prostate Cancer Prostatic Dis Date: 2022-03-19 Impact factor: 5.554