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J Racial Ethn Health Disparities. 2019 Feb;6(1):133-142. doi: 10.1007/s40615-018-0508-8. Epub 2018 Jun 29.

Racial, Socioeconomic, and Geographic Disparities in the Receipt, Timing to Initiation, and Duration of Adjuvant Androgen Deprivation Therapy in Men with Prostate Cancer.

Author information

1
Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health, University of Texas Health Science Center in Houston, 1200 Pressler Street, RAS-E631, Houston, TX, 77030, USA.
2
Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center in Houston, Houston, TX, 77030, USA.
3
Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center in Houston, Houston, TX, 77030, USA.
4
Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas School of Public Health, University of Texas Health Science Center in Houston, 1200 Pressler Street, RAS-E631, Houston, TX, 77030, USA. Xianglin.L.Du@uth.tmc.edu.

Abstract

OBJECTIVE:

This retrospective cohort study aims to examine the receipt, timing to initiation, and duration of androgen deprivation therapy (ADT) in men with prostate cancer by race/ethnicity, socioeconomic status, and geographic location.

METHODS:

The study population are patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, who were 66 years or older and newly diagnosed with stage III and IV prostate cancer in 1992-2009 and underwent radiation therapy, where ADT was proven to be highly beneficial and its use was considered as most appropriate (n = 12,170). We use logistic regression to examine the receipt of ADT and linear regression to study factors associated with time to ADT initiation while controlling for baseline characteristics.

RESULTS:

Overall, 77% of eligible patients received at least one form of ADT in combination with radiation therapy, of which 12% underwent orchiectomy and the rest received ADT, and 77.2% of non-Hispanic white and 80.7% of Hispanic patients received ADT compared to 73.8% of non-Hispanic black. After adjustment for demographic and tumor characteristics, black men and men of other races are less likely to receive ADT compared to white counterparts (OR = 0.64 and 0.74, respectively). The median time from cancer diagnosis to ADT initiation is 2 months. Once initiated, men received a median of seven drug injections. After controlling for covariates, race/ethnicity and geographic location (SEER areas) are associated with early initiation of therapy. White, Hispanic men and men living in the South initiate ADT earlier.

CONCLUSION:

Significant racial disparities exist in the receipt and use of this highly beneficial therapy, and there are geographic variations in the utilization of this therapy.

KEYWORDS:

Androgen deprivation therapy; Disparities; Prostate cancer; Race/ethnicity; Treatment

PMID:
29959759
DOI:
10.1007/s40615-018-0508-8

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