Latino Men are Much Less Likely to Receive Optimal Treatment for High Risk Prostate Cancer than White Men, According to New Research in JNCCN

Newswise — PLYMOUTH MEETING, PA [November 15, 2018] — New research in the November issue of JNCCN—Journal of the National Comprehensive Cancer Network examines disparities in care for Latino men with prostate cancer. The team of researchers from UCSF Helen Diller Family Comprehensive Cancer Center, Stanford Cancer Institute, and the Icahn School of Medicine at Mount Sinai looked at 2,421 Latino and 8,636 non-Latino white men diagnosed and treated for prostate cancer across California between 2010 and 2014. They found the Latino men were 21% less likely to receive definitive treatment for high-risk localized prostate cancer than non-Latino white men, which has been shown to result in worse outcomes.

“This disparity seems to be largely accounted for by sociodemographic and other non-clinical factors, including neighborhood socioeconomic status, health insurance, marital status, as well as care at an NCI-designated cancer center,” explained Daphne Lichtensztajn, MD, MPH, Epidemiologist, UCSF Department of Epidemiology and Biostatistics. “However, the influence of patient age, tumor grade, and insurance status, was significantly different between the two populations. This study reinforces the need for training in cultural competency and patient-centered communication, in addition to ensuring the availability of trained interpreters and in-language materials and resources.”

The data came from the California Cancer Registry, which is comprised of four registries within the SEER program. Only men with high-risk disease were included, as defined by the NCCN Guidelines^® Panel for Prostate Cancer[1]. Definitive treatment was defined as radical prostatectomy, radiation (with or without ADT), or cryoablation.

“Prostate cancer can potentially be cured with multimodal therapy, even when it presents with high-risk features. It is critical that best practices, such as recommending definitive treatment for high-risk, localized prostate cancer, are clearly translated to community urologists and oncologists,” said Tanya Dorff, MD, Medical Oncologist, City of Hope National Medical Center, and a Member of the NCCN Guidelines^® Panel for Prostate Cancer. “Furthermore, given the complexity of decision-making in localized prostate cancer, culturally tailored communication and education guides for Latino men may increase utilization of these treatments, which have been shown to improve survival.”

The researchers found that for both ethnicities, a lack of health insurance was associated with undertreatment, but the impact was significantly higher for Latinos. Uninsured non-Latino white men were 37% less likely to receive definitive treatment than those with insurance, while uninsured Latinos were 66% less likely to undergo definitive treatment compared to their insured counterparts.  Additionally, receiving treatment at an NCI-designated cancer center was associated with a 57% higher likelihood of definitive treatment for non-Latino white men, but had no such boost for Latinos. Dr. Lichtensztajn suggests communication barriers, and the influence of implicit bias, could account for some of these disparities.

“Implicit bias is pervasive in our society, and addressing it at a societal level is a complex task,” said Dr. Lichtensztajn. “However, acknowledging its existence and increasing awareness is a crucial first step. As individuals become more mindful of their spontaneous reactions to people, they can begin to check these unconscious responses and make conscious efforts to change them.”

Other factors potentially contributing to disparities include varying safety-net care availability and eligibility criteria across the different counties of California. The researchers also pointed out some cultural factors, for instance the fact that younger Latino men are more likely to be primary wage earners unable to withstand income disruption, which could contribute to the differing approaches to disease management.

The study’s authors recommend targeting interventions towards those who are at the highest risk of undertreatment, specifically Latino men who are younger and/or uninsured.

To read the entire article, visit JNCCN.org. Complimentary access to “Undertreatment of High-Risk Localized Prostate Cancer in the California Latino Population” is available until February 10, 2019.

For more on the topic of disparities in care, join NCCN at the upcoming NCCN Patient Advocacy Summit: Advocating for Equity in Cancer Care on December 10, 2018, in Washington, DC. Visit NCCN.org/policy to learn more, or join the conversation online at #NCCNPolicy.

About JNCCN—Journal of the National Comprehensive Cancer Network

More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network^® (NCCN^®), a not-for-profit alliance of 27 leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news. Follow NCCN on Twitter @NCCNnews and Facebook @National.Comprehensive.Cancer.Network.

[1] Definition of high-risk prostate cancer as having at least one of the following characteristics: Gleason score of eight to ten, clinical stage ≥ T3, or PSA level >20 ng/mL. Mohler JL, Lee RJ, Antonarakis ES, et al. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 3.2018. Accessed October 2, 2018. To view the most recent version of these guidelines, visit NCCN.org.