Journal article
Prostate cancer treatment disparities during the COVID-19 pandemic, lessons from a multi-institutional collaborative
Journal of clinical oncology, v 39(15_suppl), pp 6542-6542
20 May 2021
Abstract
Abstract only
6542
Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher’s exact and Pearson’s chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race*year interaction term. Results: 647 men with untreated non-metastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.
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Details
- Title
- Prostate cancer treatment disparities during the COVID-19 pandemic, lessons from a multi-institutional collaborative
- Creators
- Adrien Bernstein - Fox Chase Cancer CenterRuchika Talwar - University of PennsylvaniaElizabeth A. Handorf - Fox Chase Cancer CenterKaynaat Syed - The Health Care Improvement Foundation, Philadelphia, PASerge Ginzburg - Einstein Medical Center PhiladelphiaLaurence H Belkoff - Main Line HealthAdam Reese - Temple UniversityEdouard John Trabulsi - Thomas Jefferson UniversityBruce Lee Jacobs - University of PittsburghJeffery Tomaszewski - Cooper University Health CareEric A. Singer - Rutgers, The State University of New JerseyThomas J. Guzzo - University of PennsylvaniaJay D. Raman - Penn State Milton S. Hershey Medical CenterAndres F Correa - Fox Chase Cancer CenterPennsylvania Urologic Regional Collaborative
- Publication Details
- Journal of clinical oncology, v 39(15_suppl), pp 6542-6542
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Number of pages
- 3
- Grant note
PURC is funded by the Health Care Improvement Foundation through practice participation
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000708120603317
- Other Identifier
- 991021916909004721
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology