Patients’ race linked to prostate surgery quality
- Aug 24, 2012
Black men needing surgery for advanced prostate cancer seem to have worse outcomes than white men, according to a new study.
Based on data collected from hospitals in three states, black men who had their prostates removed were more likely to need blood transfusions, stay in the hospital longer and die while hospitalized compared to white men.
They also had lower quality of care, the research suggested. Compared to whites, black men were 27 percent less likely to have their surgery at a hospital that routinely removes prostates and 33 percent less likely to be seen by a surgeon experienced in the procedure, known as radical prostatectomy.
According to the American Cancer Society, over 241,000 men will be diagnosed with prostate cancer in the U.S. in 2012, and over 28,000 will die from it.
Black men seem to be disproportionately represented in both of those numbers. They are 59 percent more likely to develop prostate cancer and more than twice as likely to die from it compared to white men, according to earlier research.
“There seems to be some event that happens after diagnosis that leads to worse outcomes,” said Dr. Daniel Barocas, the study’s lead author and an assistant professor of urologic surgery at Vanderbilt University in Nashville, Tennessee.
It could be that black men choose different or less aggressive treatments than white men, said Barocas. He and his team decided to look specifically at whether quality of care differs by race.
The researchers consulted information on 105,972 adult men who had their prostates removed because of cancer at hospitals in Florida, Maryland and New York between 1996 and 2007.
Of those, 81,112 patients were white and 14,006 were black.
Because the number of surgeries performed at a hospital or by a surgeon can be used as a measure of procedure quality, the researchers compared the experience level of the hospitals and doctors that treated white and black men.
For this study, a hospital was considered “high volume” if it did about two surgeries per month or more, while surgeons were considered experienced if they did about one per month.
The researchers found that 59 percent of black men in the study went to a high-volume surgeon, compared to 70 percent of white men.
And 66 percent of black men were treated at experienced hospitals, versus 74 percent of white men.
SOLVING THE PROBLEM
In The Journal of Urology, the researchers write that while the worse outcomes weren’t directly tied to the hospitals or surgeons, black men who went to high-volume hospitals and surgeons seemed less likely to have complications than those who went to less experienced ones.
Barocas told Reuters Health that two possible solutions could be to send patients to regional hospitals that then perform a large number of the surgeries, or to send experienced surgeons to community hospitals.
But, he noted, black men in the study who went to the high-volume hospitals and surgeons were still at greater risk of complications than white men.
He said there seem to be other differences based on race, such as how men’s cancers progress and economic factors.
“I have a suspicion what we’re detecting is an access issue and an economic issue,” said Barocas. “Those problems probably need to be addressed at a level beyond the healthcare system in terms of a policy point of view.”
In the U.S., a radical prostatectomy can cost up to $14,000.
Typically, the surgery is performed on younger people who have a long life expectancy and aggressive cancer, according to Dr. Mani Menon, director of the Vattikuti Urology Institute at the Henry Ford Health System in Detroit who wasn’t involved in the new study.
“People who have a life expectancy of 10 to 15 years and have early stage prostate cancer do not need surgery or radiation,” he told Reuters Health.
The ACS estimates that one in six American men will be diagnosed with prostate cancer at some point.
SOURCE: The Journal of Urology, online August 17, 2012.
Racial Variation in the Quality of Surgical Care for Prostate Cancer
Of 105,972 patients 81,112 (76.5%) were white, 14,006 (13.2%) were black, 6,999 (6.6%) were Hispanic and 3,855 (3.6%) were all other. In mixed effects multivariate models, black men had markedly lower use of high volume hospitals (OR 0.73, 95% CI 0.70–0.76) and surgeons (OR 0.67, 95% CI 0.64–0.70) compared to white men. Black men also had higher odds of blood transfusion (OR 1.08, 95% CI 1.01–1.14), longer length of stay (OR 1.07, 95% CI 1.06–1.07) and inpatient mortality (OR 1.73, 95% CI 1.02–2.92).
Using an all-payer data set, we identified concerning potential quality of care gaps between black and white men undergoing radical prostatectomy for prostate cancer.
Daniel A. Barocas, Darryl T. Gray, Jay H. Fowke, Nathaniel D. Mercaldo, Jeffrey D. Blume, Sam S. Chang, Michael S. Cookson, Joseph A. Smith, David F. Penson
The Journal of Urology - 17 August 2012 (10.1016/j.juro.2012.06.037)
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