A multidimensional view of racial differences in access to prostate cancer care

Craig Evan Pollack, Katrina A. Armstrong, Nandita Mitra, Xinwei Chen, Katelyn R. Ward, Archana Radhakrishnan, Michelle S. Wong, Justin E. Bekelman, Charles C. Branas, Karin V. Rhodes, David T. Grande

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Abstract

BACKGROUND: Racial disparities in prostate cancer treatment and outcomes are widespread and poorly understood. In the current study, the authors sought to determine whether access to care, measured across multiple dimensions, contributed to racial differences in prostate cancer. METHODS: The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer between 2012 and 2014. Men were surveyed to assess their experiences accessing care (response rate of 51.1%). The authors determined appointment availability at 151 urology practices using simulated patient telephone calls and calculated travel distances using geospatial techniques. Multivariable logistic regression models were used to determine the association between 5 different domains of access (availability, accessibility, accommodation, affordability, and acceptability) and receipt of treatment, perceived quality of care, and physician-patient communication. RESULTS: There were 1907 non-Hispanic white and 394 black men in the study cohort. Overall, approximately 85% of the men received definitive treatment with no differences noted by race. Black men were less likely to report a high quality of care (69% vs 81%; P<.001) and good physician-patient communication (60% vs 71%; P<.001) compared with white men. In adjusted models, none of the 5 domains of access were found to be associated with definitive treatment overall or with radical prostatectomy. All access domains were associated with perceived quality of care and communication, although these domains did not mediate racial disparities. CONCLUSIONS: To the authors' knowledge, the current study presents the first comprehensive assessment of prostate cancer care access, treatment, and patient experience, demonstrating that although access was related to overall perceived quality of care and better physician-patient communication, it did not appear to explain observed racial differences. Cancer 2017;123:4449-57.

Original languageEnglish (US)
Pages (from-to)4449-4457
Number of pages9
JournalCancer
Volume123
Issue number22
DOIs
StatePublished - Nov 15 2017

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Keywords

  • access to care
  • definitive treatment
  • prostate cancer
  • prostate cancer treatment
  • racial disparities

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Pollack, C. E., Armstrong, K. A., Mitra, N., Chen, X., Ward, K. R., Radhakrishnan, A., Wong, M. S., Bekelman, J. E., Branas, C. C., Rhodes, K. V., & Grande, D. T. (2017). A multidimensional view of racial differences in access to prostate cancer care. Cancer, 123(22), 4449-4457. https://doi.org/10.1002/cncr.30894