Black Men With Advanced Prostate Cancer Are Less Likely to Get the Most Effective Therapies
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Novel Hormone Therapy Is More Effective Than Traditional Therapy in Advanced Prostate Cancer
However, the newer hormone therapies in question, known as second-generation androgen receptor inhibitors, are especially effective at stopping cancer growth when used with traditional androgen deprivation therapy. These novel therapies “inhibit the synthesis of testosterone or cause its direct blockade,” Dr. Xiang says.
The problem is that Black men with prostate cancer are not taking these therapies at the same rates as other men are. Xiang’s study found that Black men with advanced or high-risk prostate cancer had the lowest two-year utilization rate of these therapies compared with white men, Hispanic men, or men of other races and ethnicities.
Xiang and his colleagues examined records from 3,748 men with prostate cancer who were on Medicare between 2011 and 2017. In any two-year period during the study, white men received one of these drugs at a rate of 27 percent, Hispanic men at a rate of 25 percent, and men of other races or ethnicities 23 percent. Black men received these therapies at a rate of 20 percent over any two years, a significantly lower rate of use. And this difference held steady over the entire period of the study.
Disparities Caused by Systemic Inequalities, Provider Bias, and Barriers to Care
Why are Black men much less likely to be prescribed these novel hormone therapies? Xiang feels that systemic inequalities in the healthcare system may be to blame. “Part of it could be provider-related implicit biases,” he says. “Possibly, some providers are just less inclined to think of [novel therapies] for underserved populations.”
The gap could also have to do with the patient’s factors, he notes, such as lack of knowledge and education, reduced access to care, insufficient insurance coverage, or a dearth of financial resources.
Xiang acknowledged that it’s possible that some Black patients might have been offered these therapies but declined them because of distrust of medical providers and the medical community, which has historically been common among Black people.
How Can This Pattern Be Changed?
Equity in prescribing novel hormone therapies needs to start with physicians. “Ideally, all doctors would stay up to date with the current evidence and the current guidelines,” Xiang says. He stresses that providers need to be mindful about applying the same guidelines and recommendations to all of their patients, although some cases may be complicated by the fact that copays for certain medications and procedures can be prohibitive, and the type of insurance a patient has may impact the care they receive.
One important way that people can optimize their outcomes, according to Xiang, is to be proactive about screening and testing protocols for prostate cancer. “It’s something to discuss with one’s primary care doctor,” he says. “I think some of the racial or ethnic disparities around prostate cancer might stem from differences in screening patterns.”
He adds that patients can educate themselves on newer therapies for their condition and ask their physicians about trying them.
Unfortunately, failure to receive one of these newer hormone therapies during prostate cancer treatment tends to lead to worse outcomes. The study did not examine survival rates, but Xiang notes that lower survival rates is a logical conclusion. Until Black men receive this therapy at the same rate as other men, these outcomes may not improve.
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