Assessment of Prostate Cancer Treatment Among Black and White Patients During the COVID-19 Pandemic.
Publication/Presentation Date
10-1-2021
Abstract
IMPORTANCE: Early in the COVID-19 pandemic, racial/ethnic minority communities disproportionately experienced poor outcomes; however, the association of the pandemic with prostate cancer (PCa) care is unknown.
OBJECTIVE: To assess the association between race and PCa care delivery for Black and White patients during the first wave of the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter, regional, collaborative, retrospective cohort study compared prostatectomy rates between Black and White patients with untreated nonmetastatic PCa during the COVID-19 pandemic (269 patients from March 16 to May 15, 2020) and prior (378 patients from March 11 to May 10, 2019).
MAIN OUTCOMES AND MEASURES: Prostatectomy rates.
RESULTS: Of the 647 men with nonmetastatic PCa, 172 (26.6%) were non-Hispanic Black men, and 475 (73.4%) were non-Hispanic White men. Black men were significantly less likely to undergo prostatectomy during the pandemic compared with White patients (1 of 76 [1.3%] vs 50 of 193 [25.9%]; P < .001), despite similar COVID-19 risk factors, biopsy Gleason grade groups, and comparable prostatectomy rates prior to the pandemic (17 of 96 [17.7%] vs 54 of 282 [19.1%]; P = .75). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 ng/mL [interquartile range, 5.3-15.2 ng/mL] vs 7.2 ng/mL [interquartile range, 5.1-11.1 ng/mL]; P = .04). A linear combination of regression coefficients with an interaction term for year demonstrated an odds ratio for likelihood of surgery of 0.06 (95% CI, 0.01-0.35; P = .002) for Black patients and 1.41 (95% CI, 0.81-2.44; P = .23) for White patients during the pandemic compared with prior to the pandemic. Changes in surgical volume varied by site (from a 33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients.
CONCLUSIONS AND RELEVANCE: In this large multi-institutional regional collaborative cohort study, the odds of PCa surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized PCa does not require immediate treatment, the lessons from this study suggest systemic inequities within health care and are likely applicable across medical specialties. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the COVID-19 pandemic to develop balanced mitigation strategies as viral rates continue to fluctuate.
Volume
7
Issue
10
First Page
1467
Last Page
1473
ISSN
2374-2445
Published In/Presented At
Bernstein, A. N., Talwar, R., Handorf, E., Syed, K., Danella, J., Ginzburg, S., Belkoff, L., Reese, A. C., Tomaszewski, J., Trabulsi, E., Singer, E. A., Jacobs, B., Kutikov, A., Uzzo, R., Raman, J. D., Guzzo, T., Smaldone, M. C., & Correa, A. (2021). Assessment of Prostate Cancer Treatment Among Black and White Patients During the COVID-19 Pandemic. JAMA oncology, 7(10), 1467–1473. https://doi.org/10.1001/jamaoncol.2021.2755
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
34292311
Department(s)
Administration and Leadership
Document Type
Article