Receipt of National Comprehensive Cancer Network guideline‐concordant prostate cancer care among African American and Caucasian American men in North Carolina. Issue 12 (10th April 2013)

• Record Type: Journal Article
• Authors: Ellis, Shellie D.; Blackard, Bonny; Carpenter, William R.; Mishel, Merle; Chen, Ronald C.; Godley, Paul A.; Mohler, James L.; Bensen, Jeannette T.
• Is Part Of: Cancer. Volume 119:Issue 12(2013)
• Page Start: 2282
• Page End: 2290
• Publication Date: 2013-04-10
• Subjects: prostate cancer -- National Comprehensive Cancer Network -- quality of care -- North Carolina Health Care Access Project (HCaP‐NC) -- guideline‐concordant care; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.28004
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: African Americans have a higher incidence of prostate cancer and experience poorer outcomes compared with Caucasian Americans. Racial differences in care are well documented; however, few studies have characterized patients based on their prostate cancer risk category, which is required to differentiate appropriate from inappropriate guideline application. METHODS: The medical records of a population‐based sample of 777 North Carolina men with newly diagnosed prostate cancer were studied to assess the association among patient race, clinical factors, and National Comprehensive Cancer Network (NCCN) guideline‐concordant prostate cancer care. RESULTS: African Americans presented with significantly higher Gleason scores ( P = .025) and prostate‐specific antigen levels ( P = .008) than did Caucasian Americans. However, when clinical T stage was considered as well, difference in overall risk category only approached statistical significance ( P = .055). Across risk categories, African Americans were less likely to have surgery (58.1% versus 68.0%, P = .004) and more likely to have radiation (39.0% versus 27.4%, P = .001) compared with Caucasian Americans. However, 83.5% of men received guideline‐concordant care within 1 year of diagnosis, which did not differ by race in multivariable analysis (odds ratio = 0.83; 95% confidence interval = 0.54‐1.25). Greater patient‐perceived access to care was associated with greater odds of receiving guideline‐concordant care (odds ratio = 1.06; 95% confidence interval = 1.01‐1.12). CONCLUSIONS: After controlling for NCCN risk category, there were no racial differences in receipt of guideline‐concordant care. Efforts to improve prostate cancer treatment outcomes should focus on improving access to the health care system. Cancer 2013;2282–2290. © 2013 American Cancer Society. Abstract : Racial differences in prostate cancer care are well‐documented, but few studies characterize patients based on their prostate cancer risk category. In medical record analysis of a population‐based sample of men from North Carolina who had newly diagnosed prostate cancer, receipt of guideline‐concordant care did not differ by patient race after multivariable analysis.