Moderated Poster

Poster, Podium & Video Sessions

MP92-08: Racial Disparity and Adherence to Quality Measures for Radiation Therapy of Prostate Cancer

Tuesday, May 16
7:00 AM - 9:00 AM
Location: BCEC: Room 160

Presentation Authors: Daniel Lee*, Joann Alvarez, Tatsuki Koyama, Matthew Resnick, David Penson, Daniel Barocas, Karen Hoffman, Ceasar Investigators, Nashville, TN

Introduction: Racial disparities in health care are apparent in the management and outcomes for prostate cancer, however disparities in compliance to quality measures for radiation therapy for prostate cancer have not been previously studied. Therefore, the goal of the study was to characterize disparities in the compliance rates to quality measures.

Methods: The Comparative Effectiveness Analysis of Radiation Therapy and Surgery (CEASAR) study is a population-based, prospective cohort study that enrolled 3708 men with clinically localized prostate cancer from 2011-12. Compliance with 4 radiation-specific quality measures endorsed by national consortia as of 2011 was assessed (Table), and compliance was compared by race using logistic regression.



Results: Overall, 634 men received definitive external beam radiation therapy (EBRT) of which 19% were self-reported African-American (AA), 70% Non-Hispanic White (NHW), and 11% Hispanic, Asian, and other (HAO). The median time from diagnosis to EBRT was significantly longer for AA and HAO then NHW men (3.0, 3.6 months vs. 2.7, p<0.01). Less than two-thirds of AA (64%) and HAO men (62%) received EBRT that adhered to all quality measures, compared to 77% of NHW men (p<0.01 ). The disparity in compliance to quality measures was noted in the proportion receiving dose-escalated (> 75 Gy) EBRT (87% AA, 88% HAO vs. 95% NHW, p<0.01). The proportion of men receiving prostate-only EBRT without nodal EBRT for low-risk disease was lower among AA than NHW or HAO (80% AA vs. 99% NHW, 100% HAO, p<0.01), while the proportion having image-guidance EBRT was lowest among HAO (73%) compared to NHW or AA (87%, 88%, p=0.02). On a logistic regression predicting compliance to all the quality measures, AA and HAO men had almost half the odds of receiving quality EBRT than NHW men (OR 0.54, 0.5 p=0.02), after adjusting for education, insurance status, and D’Amico risk.

Conclusions: Minority men were less likely to receive dose-escalated EBRT which improves prostate cancer control, and were more likely to receive unnecessary nodal radiation for low-risk prostate cancer that increases treatment side effects. There may be opportunities to improve care by enhancing adherence to quality measures among vulnerable groups via implementation initiatives.

Source Of Funding: none

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