UroToday.com – In the journal Cancer, Dr. J. Kellogg Parsons and colleagues report on prostate cancer treatment for economically disadvantaged men in California. They found significant variations in prostate cancer treatment patterns by healthcare institutions providing care for disadvantaged as opposed to non-disadvantaged men.

The database was a state funded program for lower income men. IMPACT (Improving Access, Counseling, and Treatment for California Men with Prostate Cancer) program eligibility requirements included California residency, biopsy-proven prostate cancer, lack of health insurance, and a household income at or below 200% of the Federal poverty level. Patients in the impact program received care through a network of publicly funded county hospitals or private providers. Participating physicians were reimbursed by the state of California in this program. The payment was the same whether a patient was treated at a public or private institution. Demographic, clinical, and provider information was collected on all men enrolled in IMPACT from 2001 to 2006. During this period a total of 772 men were enrolled. Provider type was categorized as public county hospital versus private provider based on the initial facility at which the patient received his treatment. Thirteen county facilities contracted for this program. The program also contracted with any private practice physicians in the state of California.

The initial group for analysis included 559 men with localized or locally advanced prostate cancer at presentation. Median patient age was 61 years; half were Hispanic. During the study, 56% of men had their care provided by county hospitals and 44% by private providers. There were no significant differences between the 2 groups except that men cared for as private patients were 3 times more likely to be white and half as likely to undergo surgery. Private patients were 2.5 times more likely than county patients to receive radiotherapy and 4.5 times more likely than county patients to receive androgen deprivation therapy and surgery. Because of missing data, only 375 participants were included in the regression analysis. Interestingly, the 184 men with missing data had lower risk stratifications, were more likely to have undergone surgery, and less likely to have undergone expectant management. There were no differences in facility-type, age at enrollment, race, co-morbidity index, Gleason score, clinical stage, or pretreatment PSA. Among men with low- or intermediate-risk prostate cancer, private patients were 2 times and 15 times more likely than county patients to receive radiotherapy or androgen deprivation, respectively, than surgery. Among men with a low-risk disease, there were no significant differences between private and county patients, although there was a trend towards increased likelihood of radiotherapy among private patients. Patients with private providers were twice as likely as county patients to receive expectant management as surgery, except among those with low risk disease.

Parsons JK, Kwan L, Connor SE, Miller DC, Litwin MS
Cancer. 2010 Mar 1;116(5):1378-84
doi:10.1002/cncr.24856

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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