Care of Black prostate cancer patients disproportionately affected during COVID-19
medwireNews: Black men with nonmetastatic prostate cancer were significantly less likely than their White counterparts to undergo prostatectomy during the initial wave of the COVID-19 pandemic, reports a US research team.
“Although significant gains have been made to reduce racial disparities in health care, a stressor, such as a pandemic, shows the frail nature of these gains,” say the study authors, who drew on data from the Pennsylvania Urologic Regional Collaborative that comprises 11 urology practices in Pennsylvania and New Jersey.
“Furthermore, we would anticipate that these disparate findings would be further magnified for patients without established access to care,” they add.
The study included 269 men (28% Black) who had received a diagnosis of nonmetastatic prostate cancer during or within a year of the COVID-19 lockdown period of March 16–May 15, 2020, and 378 men (25% Black) who were diagnosed during or within a year of the same 9-week period in the previous year (March 11–May 10, 2019). Participants were identified from five hospitals that had caught up with pandemic-associated delays to data entry, and all were untreated at the start of the study periods.
During the pandemic, just 1.3% of Black patients underwent prostatectomy, compared with 25.9% of White patients, a significant difference. By contrast, the rates were comparable before the pandemic, at 17.7% and 19.1%, respectively.
A multivariable analysis accounting for high-risk disease and age showed that White men were a significant 30.48 times more likely to receive surgical care during the pandemic period than Black men.
And an effect modification model that included an interaction term for the year showed that the probability of receiving surgical care was a significant 94% lower for Black men during versus before the pandemic, while there was no significant impact of the pandemic on the likelihood of surgery for White men.
This same model also showed a significant 97% reduced odds of surgery among Black versus White patients during the lockdown period.
“Clinical parameters did not explain the disparity” observed during the pandemic, say the researchers, as the groups did not differ significantly with respect to the number of COVID-19 risk factors, comorbidities, biopsy Gleason grade group, or the presence of high-risk prostate cancer.
If anything, pre-biopsy prostate-specific antigen levels were significantly higher among Black than White patients (median, 8.8 vs 7.2 ng/mL) and the Black participants tended to be younger, “making them an even higher priority for surgical management,” comment the researchers in JAMA Oncology.
They also point out that the decrease in surgical volume was not because “patients may have been diverted to outpatient therapeutics, such as radiotherapy,” as “no concurrent increase in radiotherapy was noted.”
The key difference appeared to be imbalances in hospital restrictions during the initial phase of the pandemic, “with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients,” say Andres Correa (Fox Chase Cancer Center, Philadelphia, Pennsylvania) and co-authors.
Specifically, over a third (40.5%) of the patients at the two hospitals with the greatest restrictions were Black, compared with just under a fifth (18.3%) at the three hospitals that were less affected.
“This trend provides a window into the intrinsic biases present within our health care system and is likely unfolding across medicine,” comments the team.
Correa et al say in conclusion that “[t]he lessons from this study should help us to recognize and offset the implications of our pandemic-related decisions by prioritizing care in underserved communities lest we reverse decades of effort that worked to narrow racial/ethnic gaps in care.”
They continue: “As COVID-19 cases continue to periodically surge, these findings should illuminate the systemic biases within well-intentioned guidelines and act to guide future policies.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
26 July 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.