Emerging racial disparities among Medicare beneficiaries and Veterans with metastatic castration-sensitive prostate...

Area of Science:

• Oncology
• Health Disparities
• Health Services Research

Background:

• Previous research indicates racial disparities in prostate cancer care, with Black men receiving suboptimal treatment compared to White men.
• These disparities have not been well-characterized in the current treatment landscape for metastatic castration-sensitive prostate cancer (mCSPC).

Purpose of the Study:

• To investigate racial differences in treatment intensification (TI) and overall survival (OS) among patients with mCSPC.
• To examine these disparities within the Medicare and Veterans Health Administration (VHA) healthcare systems.

Main Methods:

• Retrospective analysis of Medicare (2015-2018) and VHA (2015-2019) data for patients with mCSPC.
• First-line treatment was categorized as androgen deprivation therapy (ADT) plus novel hormonal therapy, docetaxel, first-generation nonsteroidal antiandrogen, or ADT alone.
• Treatment intensification and overall survival were compared between Black and White patients, and stratified by Medicaid status.

Main Results:

• Black Medicare patients had significantly lower TI (OR 0.68) and worse OS (HR 1.20) compared to White patients.
• Black VHA patients had significantly lower TI (OR 0.75), but no significant difference in OS compared to White patients.
• Medicaid patients in both systems received less TI and had worse OS, irrespective of race.

Conclusions:

• Guideline-recommended TI for mCSPC is low overall, with Black patients receiving less TI in both Medicare and VHA.
• Black race was linked to worse OS in Medicare but not VHA, highlighting system-specific disparities.
• Socioeconomic status, indicated by Medicaid enrollment, significantly affects TI and OS, suggesting poverty and race are intertwined factors influencing cancer care and outcomes.