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National sociodemographic disparities in the treatment of high‐risk prostate cancer: Do academic cancer centers perform better than community cancer centers?
Author(s) -
Mahal Brandon A.,
Chen YuWei,
Muralidhar Vinayak,
Mahal Amandeep R.,
Choueiri Toni K.,
Hoffman Karen E.,
Hu Jim C.,
Sweeney Christopher J.,
Yu James B.,
Feng Felix Y.,
Kim Simon P.,
Beard Clair J.,
Martin Neil E.,
Trinh QuocDien,
Nguyen Paul L.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30205
Subject(s) - medicine , prostate cancer , odds ratio , cancer , confidence interval , logistic regression , health equity , demography , gerontology , public health , nursing , sociology
BACKGROUND Most major cancer organizations seek to reduce sociodemographic disparities in high‐risk cancers partly by increasing access to theoretically high‐quality, academic‐oriented cancer care. The objective of this study was to determine whether academic centers have less sociodemographic treatment disparities than community centers using high‐risk prostate cancer as a test case. METHODS The National Cancer Data Base was used to identify 138,019 patients who were diagnosed with nonmetastatic, high‐risk prostate cancer from 2004 to 2012. Multivariable logistic analysis was used to identify independent determinants of definitive therapy. The Gray test and multivariable Cox regression were used to analyze the timing of therapy. All analyses were stratified by academic versus community cancer center. RESULTS Compared with white or privately insured patients, black, Hispanic, and uninsured patients with prostate cancer were less likely to receive definitive therapy at both community centers (adjusted odds ratio: 0.60 [95% confidence interval (CI), 0.56‐0.64], 0.69 [95% CI, 0.61‐0.78], and 0.25 [95% CI, 0.22‐0.30], respectively) and academic cancer centers (adjusted odds ratio: 0.50 [95% CI, 0.46‐0.54], 0.56 [95% CI, 0.50‐0.64], and 0.31 [95% CI, 0.28‐0.36], respectively). Among patients who received definitive therapy, black, Hispanic, and uninsured patients were more likely to experience treatment delays at both community centers (≥15, ≥ 10, and ≥19 days, respectively; all Gray P < .001) and academic centers (≥19, ≥ 11, and ≥18 days, respectively); treatment delays were observed among the aforementioned groups even after multivariable Cox regression analysis ( P < .001 for all adjusted hazard ratios). CONCLUSIONS Nationally, academic cancer centers demonstrate similarly high rates of sociodemographic disparities in cancer treatment patterns as community cancer centers. Making community centers conform to academic center standards may not necessarily reduce treatment disparities. Cancer 2016;122:3371–3377 . © 2016 American Cancer Society .