A brand new study led by investigators on the UCLA Health Jonsson Comprehensive Cancer Center found Black men diagnosed with more advanced stages of prostate cancer are significantly less more likely to be prescribed novel hormone therapy than other racial and ethnic groups – including white or Latino men – despite the therapy being proven to effectively control the expansion of prostate tumors and extend the lives of men with the disease.
The findings, published in JAMA Network Open, reveal a concerning racial disparity within the utilization of the crucial therapy for the treatment of the disease.
This revelation is especially concerning given the already disproportionate impact of prostate cancer on Black men, who’re 1.5 times more more likely to be diagnosed and a pair of.4 times more more likely to die from the disease than white men in the USA.”
Dr. Amar Kishan, co-senior study writer, professor of radiation oncology on the David Geffen School of Medicine at UCLA and researcher on the UCLA Health Jonsson Comprehensive Cancer Center
Novel hormonal therapy agents are the following generation of hormonal therapy that targets the androgen signaling axis, which plays a vital role in the expansion and progression of prostate cancer cells. Androgens, corresponding to testosterone, stimulate the expansion of prostate cancer. The hormonal therapy works by inhibiting the motion of androgens or reducing their levels within the body.
Also they are often used together with traditional androgen deprivation therapy to more effectively suppress androgen signaling, providing improved outcomes for patients with advanced or metastatic prostate cancer.
“Regardless that we all know hormonal therapies have significant clinical advantages in men with more advanced stages of prostate cancer, there isn’t much information available about how often people in the final population use these drugs – particularly within the context of equitable access to those medications across different race and ethnicity groups,” said Dr. Michael Xiang, assistant clinical professor in radiation oncology on the David Geffen School of Medicine at UCLA and co-senior writer of the study.
To look into how doctors prescribe these drugs based on the race and ethnicity of patients within the U.S., the team of researchers used data from a population-based cancer registry linked to prescription drug records for 3,748 Medicare beneficiaries with a median age of 75 with a diagnosis of advanced prostate cancer from 2011 to 2017. Amongst them, 8% were Black, 7% Hispanic, 78% white, and seven% from other racial and ethnic groups.
The vast majority of patients had metastatic prostate cancer, with 36% receiving novel hormone therapy. White patients had the very best 2-year novel hormone therapy utilization rate at 27%, followed by Hispanic patients at 25% and other racial/ethnic groups at 23%. Black patients had the bottom rate at 20%.
This disparity endured at five years and beyond, with Black patients consistently receiving this significant treatment at a lower rate than their white counterparts. The researchers found Black men were 24% less more likely to receive or be prescribed one among these novel hormonal therapy agents as in comparison with white men. Against this, this disparity was not observed amongst Latino men or men of other racial and ethnic groups.
“Our findings raise critical questions regarding the explanations behind this inequality, suggesting possible obstacles to healthcare, financial burdens, and unconscious biases inside the healthcare system,” said Xiang.
Future studies are needed to uncover underlying causes and to systematically address these issues for more equitable care, noted the authors.
The study’s first writer is Dr. Ting Martin Ma, a former radiation oncology resident on the David Geffen School of Medicine at UCLA and currently an assistant professor of radiation oncology at University of Washington. Other UCLA authors include: Dr. Matthew Rettig, Dr. Luca Valle, Dr. Michael Steinberg and Dr. Isla Garraway.
This study was funded by the Prostate Cancer Foundation, the American Society for Radiation Oncology and the DeSilva, McCarrick, and Bershad families.
Ma, T. M., et al. (2023). Racial and Ethnic Disparities in Use of Novel Hormonal Therapy Agents in Patients With Prostate Cancer. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.45906.