According to a recent study released by investigators from Vanderbilt-Ingram Cancer Center (VICC), Nashville, Tenn., black men with prostate cancer receive lower quality surgical care than white men. These racial differences persist even when such control factors such as the year of surgery, age, comorbidities and insurance status are normalized. The research study first appeared in the Aug. 17 issue of the Journal of Urology and is authored by Daniel Barocas, M.D., MPH, and assistant professor of Urologic Surgery.
Investigators from VICC; the Tennessee Valley Veterans Administration Geriatric Research, Education and Clinical Center, Nashville; and the Center for Quality Improvement and Patient Safety; Agency for Healthcare Research and Quality, Rockville, Md., all participated in this research study.
Funding for the research was provided by the National Institute of Environmental Health Sciences (K12 ES15855), and the National Center for Research Resources at the National Institutes of Health through the Vanderbilt CTSA Grant (UL1 RR024975).
How the study was conducted
Study researchers analyzed records of 105,972 prostate cancer patients who received radical prostatectomies from 1996 to 2007 in all nonfederal hospitals located in Florida, Maryland and New York State. Of the patients receiving prostate cancer care, 81,112 (76.5 percent) were white, 14,006 (13.2 percent) were black, 6,999 (6.6 percent) were Hispanic and the remaining 3,855 (3.6 percent) were of other races.
The baseline for measuring the level of care received was based on previous studies that found that men receiving prostate cancer treatment at high volume hospitals (HVH) by surgeons who do a high volume of prostatectomies (HVS) have better outcomes and lower mortality.
The study findings revealed that black men had 33 percent lower odds of receiving treatment by a high volume surgeon and 27 percent lower odds of being treated at a high volume hospital than white men. Even more alarming is the fact that black men were subject to a higher rate of blood transfusion and longer stay in the hospital. Sadly, they were also more likely to die in the hospital.
Conversely, black men who received treatment at a HVH and by a HVS were at substantially decreased risk for adverse outcomes, including death, than those using lower volume health care providers. Despite the decreased risk, the outcomes for black men were still worse than their white counterparts.
Commenting on the study findings, Barocas said: “Our findings of racial variation in the quality of surgical care for prostate cancer adds to previous studies that have shown racial differences in screening behavior, stage at presentation and use of aggressive treatment, and may contribute to our understanding of why black men have much higher prostate cancer mortality than white men.”
A closer look
The results for the study suggest that black men may have more difficulty getting access to high quality care. Commenting on this disparity Barocas explains: “Racial disparities in prostate cancer outcomes may be partially explained by differences in access to high quality care, which in turn may reflect differences in patient resources. To close this gap, we may need interventions aimed at improving access to high quality care for all men, including access to high volume health care providers.”
A personal look
As alarming as the findings of this study may seem, they do not surprise me at all. I have been the product of racial disparity in employment, quality housing, education and finance my entire life. Why would healthcare be any different? It doesn’t take a research grant and a team of investigators to determine that blacks and people of color here in the United States are second class citizens. In Japan Filipinos receive similar treatment and in Rwanda in 1994 the minority Tutsi populations were the targets of mass genocide. As stated in Ecclesiastes 8:9, “…man has dominated man to his injury.” The only real solution to this and other problems, including death, war, sickness and old age, will be permanently resolved when the effects of God’s Kingdom are realized here on earth (Matthew 6:10).
Mr. Collins, a cancer survivor, has first-hand experience with surgical prostate cancer treatment, more specifically, laparoscopic radical prostatectomy. A former publisher of the New York edition of Doctor of Dentistry magazine, Henry has completed certificate courses in anatomy, medical terminology, physiology and pathophysiology. He is currently writing a book on prostate cancer and is an advocate of early PSA screening. He can be reached at: firstname.lastname@example.org.