Purpose: Among men in the U.S., prostate cancer is the leading cause of cancer and the second most common cause of cancer-related death. In 2014, 233,000 new cases of prostate cancer and 29,480 prostate cancer-related deaths are expected in the U.S. The purpose of this study was to identify any association between patient demographics and first course therapy decisions natiowwide and to also determine whether the national data can be compared with that of the data of patients at the Nebraska-Western Iowa (NWI) VA hospital.
Methods: We reviewed the National Cancer Database (NCDB) to determine the demographic characteristics of patients diagnosed with stage II prostate cancer between 2000 and 2011 at the NWI VA hospital as well as 1,647 ACOS-accredited hospitals nationwide. The NCDB includes 70% of all cancer diagnoses in the US. A chi-square test was used for statistical analysis of patient demographics among those that received surgery and those with no interventions.
Results: A total of 136 patients at the NWI VA hospital and 1,197,082 ACOS patients nationwide were diagnosed with stage II prostate cancer from 2000 to 2011. Of those patients, 53 at the VA and 508,586 at ACOS hospitals received surgery only as their first course treatment (39.0% vs 42.5%, P = .51). Twenty-one did not receive any first course treatment at the VA compared with 87,474 at ACOS hospitals (15.4% vs 7.3%, P < .01). Across all ACOS hospitals reported in the NCDB, those patients who received surgery as first course therapy were more likely to be white, aged < 60 years, insured, more educated, have a household income greater that $39,000, and travel > 50 miles to receive care (P < .01 across all comparisons). Alternatively, those who did not receive any therapy were more likely to be nonwhite, aged > 60 years, uninsured, less educated, have a household income < $39,000 and travel < 50 miles to the hospital (P < .01 across all comparisons). The majority of patients in both the surgical and no therapy groups had ≥ 1 comorbidities as rated by the Charlson comorbidity score (P < .01).
Conclusions: To our knowledge, this is the largest study identifying demographic characteristics associated with choice of therapy among patients with stage II prostate cancer. Compared with the VA Nebraska-Western Iowa hospital, ACOS patients were more likely to receive surgery as first course therapy but less likely to not receive any therapy at all. Among the ACOS patients who received surgery vs no therapy, there is a discrepancy between race, age, insurance status, education level, household income, and distance travelled to receive care. Patients who received surgery were more likely to be white, aged < 60 years, insured, more educated, have greater family income, and live farther from the hospital. On the other hand, patients who received no treatment were more likely to be nonwhite, aged > 60 years, uninsured, less educated, have less household income, and live closer to the hospital. The information from this study should be used to guide further research in order to determine whether or not these national demographic findings are also present more specifically in the VA population and whether or not they influence treatment choices. Identifying specific disparities in cancer care can help revise the way that VA patients are treated for their disease.
