Imagine you’re a 70-year-old black man with prostate cancer. Here’s what a new study reveals about your outlook:
You’re far more likely to get worse medical care than your white counterparts, including more time waiting for your surgery and more emergency room visits and hospital readmissions after surgery. You’ll also likely spend more money on your care. Oddly, though, that inferior care won’t necessarily translate into a worse chance of survival.
The study, published online by JAMA Oncology, specifically looked at a group of men on Medicare with localized prostate cancer. The standard of care for such patients involves either removal of the prostate gland (called a radical prostatectomy or RP), radiation therapy, a combination of the two, or active surveillance (close followup of patients).
Prostate cancer is one of the most frequently diagnosed cancers among men in the U.S., with estimates of about 220,800 new cases in 2015 and approximately 27,540 deaths.
Researchers analyzed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER)-Medicare database for 26,482 men 65 or older with localized prostate cancer who underwent radical prostatectomy. The patients included 2,020 black men (7.6 percent) and 24,462 non-Hispanic white men (92.4 percent).
Some key findings:
— 59.4 percent of black men underwent RP within 90 days vs. 69.5 percent of white men.
— Black men had a seven-day treatment delay compared with white men in the top 50 percent of patients.
— Black men were less likely to undergo lymph node dissection.
— Black men were more likely to have postoperative visits to the emergency department or be readmitted to the hospital compared with white men.
— The top 50 percent of black patients had higher incremental annual costs for surgery, spending $1,185 more compared to white patients.
I asked the study’s lead researcher, Quoc-Dien Trinh, M.D., of Brigham and Women’s Hospital in Boston and Harvard Medical School, to further explain the findings. Here, edited, is our conversation:
Rachel Zimmerman: What are the most extreme examples of disparities you found between black men and white men treated for prostate cancer?
Quoc-Dien Trinh: Blacks were 35 percent less likely to undergo surgery with 3 months of diagnosis; Blacks were 45-48 percent more likely to require a visit to the emergency department after surgery; Blacks were 28 percent more likely to be readmitted after surgery; Blacks were 24 percent less likely to undergo a lymph node dissection at prostatectomy.
How do you account for these dramatic differences in care?
It is possible that blacks are not receiving their care at the best institutions and/or with the best providers. Continue reading