Prostate cancer treatment for economically disadvantaged men†
A comparison of county hospitals and private providers
Article first published online: 25 JAN 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 5, pages 1378–1384, 1 March 2010
How to Cite
Parsons, J. K., Kwan, L., Connor, S. E., Miller, D. C. and Litwin, M. S. (2010), Prostate cancer treatment for economically disadvantaged men. Cancer, 116: 1378–1384. doi: 10.1002/cncr.24856
All analyses, interpretations, and conclusions herein are those of the authors and not the State of California.
- Issue published online: 18 FEB 2010
- Article first published online: 25 JAN 2010
- Manuscript Accepted: 2 JUL 2009
- Manuscript Revised: 15 JUN 2009
- Manuscript Received: 5 MAR 2009
- prostate cancer;
- outcomes assessment;
- healthcare providers;
- operative surgical procedures;
The authors compared the types of treatments prostate cancer patients received from county hospitals and private providers as part of a statewide public assistance program.
This was a cohort study of 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling, and Treatment for Californians With Prostate Cancer (IMPACT). Multinomial regression was used to compare types of treatments patients received from different providers.
Between 2001 and 2006, 315 (56%) participants received treatment from county hospitals and 244 (44%) from private providers. There were no significant between-group differences with respect to age (P = .22), enrollment year (P = .49), Charlson comorbidity index (P = .47), Gleason sum (P = .33), clinical T stage (P = .36), prostate-specific antigen (P = .39), or D'Amico risk criteria (P = .45). Participants treated by private providers were more likely than those treated in county hospitals to be white (35% vs 10%, P < .01) and less likely to undergo surgery (29% vs 54%, P < .01). Multinomial regression analyses showed that participants treated by private providers were nearly 2½ times more likely than those treated by public providers to receive radiotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.37-4.07) and >4½ times more likely to receive primary androgen deprivation (OR, 4.71; 95% CI, 2.15-10.36) than surgery.
In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers. These data reveal substantial variations in treatment patterns between different types of healthcare institutions that—given the implications for health policy and quality of care—merit further scrutiny. Cancer 2010. © 2010 American Cancer Society.