Harvard Researchers Identify Racial Disparity in Care of Cancer Patients on Medicare

Outcomes following a radical prostatectomy (RP) procedure for localized prostate cancer were worse in black men compared with non-Hispanic white men, a study published in JAMA Oncology has concluded.

Researchers from Brigham and Women’s Hospital at Harvard Medical School conducted a retrospective analysis on medical data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2009. They evaluated outcomes for 2020 elderly black patients and more than 24,000 elderly non-Hispanic white patients with localized prostate cancer who underwent RP within the first year of diagnosis. The authors evaluated both process of care measures (including time to treatment and lymph node dissection) and outcome measures (including complications, emergency department visits, readmissions, costs, all-cause and prostate cancer—specific mortality) for this population.

The study revealed the following:

• While only about 60% of the more than 2000 black patients underwent RP within 3 months of diagnosis (compared with nearly 70% of non-Hispanic whites), they also experienced a 7-day treatment delay compared with non-Hispanic whites (P < .001).
• While their likelihood of a lymph node dissection was low (odds ratio [OR], 0.76 [95% confidence interval (CI), 0.66-0.80]; P&thinsp;<&thinsp;.001), black patients were more likely than the non-Hispanic white population to need postoperative care—measured using visits to the emergency department (ED) as a surrogate.
• Black patients had significantly greater odds of postoperative ED visits within (OR, 1.48; 95% CI, 1.18-1.86) as well as after 30 days (OR, 1.45; 95% CI, 1.19-1.76) following surgery compared with non-Hispanic whites.
• Rates of hospital readmissions were also greater in the black population of patients.
• All-cause or prostate cancer—specific mortality was no different between the comparator cohorts.

The greater number of readmissions and visits to ED post surgery were reflected in the annual cost of care of this population. The analysis showed that the top 50% of blacks spent $1185.50 (95% CI, $804.85-1 $1566.10; P&thinsp;<&thinsp;.001) more than the top 50% of non-Hispanic whites. The authors attribute their findings to factors such as barriers to access to care (vis-à-vis the gap in RP utilization) and selection bias in definitive treatment.

“Our findings suggest that this gap has not significantly improved over time, which raises concerns that this problem is not being adequately addressed,” they conclude.