Association Between Sociodemographic Marginalization and Combination Therapy for Metastatic Hormone-Sensitive...

Area of Science:

• Oncology
• Health Services Research
• Health Equity

Background:

• Combination therapy improves survival for metastatic hormone-sensitive prostate cancer (mHSPC).
• Real-world use of these advanced therapies remains suboptimal.
• Sociodemographic marginalization's role in this care gap is understudied.

Purpose of the Study:

• To assess the association between sociodemographic marginalization and the receipt of combination therapy in patients with mHSPC.
• To identify specific domains of marginalization that contribute to disparities in mHSPC treatment.

Main Methods:

• Population-based cohort study in Ontario, Canada (2014-2022).
• Included 6,051 patients aged 66+ with de novo mHSPC.
• Used the Ontario Marginalization Index (ON-MARG) to measure area-level socioeconomic disadvantage.
• Hierarchical logistic regression analyzed the association between ON-MARG and combination therapy receipt.

Main Results:

• Higher overall marginalization scores were linked to lower odds of receiving combination therapy (OR, 0.91).
• The strongest disparity was observed in the domain of racialized and newcomer populations (OR, 0.89).
• Urban patients in higher income areas had greater odds of receiving combination therapy compared to rural residents (OR, 1.39).

Conclusions:

• Access to combination therapy for mHSPC is inequitable, especially for patients in marginalized, rural, or low-income communities.
• These findings highlight the need for policy interventions to promote equitable access to life-prolonging treatments.
• Ensuring all mHSPC patients benefit from treatment advances requires addressing systemic barriers.