JAMA
1995 Nov 22-29;274(20):1599-605
Race, treatment, and long-term survival from prostate cancer in an equal-access
medical care delivery system.
Optenberg SA, Thompson IM, Friedrichs P, Wojcik B, Stein CR, Kramer B.
Center for Healthcare Education and Studies, US Army Medical Department
Center, San Antonio, TX, USA.
OBJECTIVE: To evaluate long-term survival of black and
white prostate cancer patients in an equal-access medical care system
to help distinguish biological from medical and social explanations of
mortality differences.
DESIGN AND SETTING: Retrospective study of US Department
of Defense tumor registry patients with prostate cancer. Ethnicity, age,
diagnosis, staging, risk factors, treatment, and survival end points were
extracted.
PATIENTS: Prostate cancer patients (N = 1606; 7.5% black,
92.5% white) who were active-duty personnel, dependents, or retirees eligible
for care in the military medical system.
MAIN OUTCOME MEASURES: Racial differences in tumor stage
and grade, risk factors, recurrence, and treatment wait time (time between
initial diagnosis and initial treatment); influence of stage, grade, treatment,
wait time, age, and race on survival.
RESULTS: No differences were found in behavioral risk
factors or tumor grade or size, but blacks entered active treatment (P
< .001) and exhibited a higher relative risk of cancer (P = .01) in
younger age groups, presented with higher stage (P < .001), and demonstrated
increased progression in distant metastatic disease (P = .01). No significant
differences were detected in overall wait time. When adjusted for stage,
no difference was found in type of treatment. Overall, stage, grade, and
age were found to affect survival (P = .04 to P < .001), but race did
not. When analyzed by stage, blacks demonstrated a clear trend of longer
survival for distant metastatic disease (P = .04 to P = .06). This trend
was confirmed using Kaplan-Meier estimates (P = .04, likelihood ratio).
CONCLUSIONS: This analysis suggests that in an equal-access
medical care system there are no stage-specific differences in treatment
between black and white prostate cancer patients. Survival among blacks
is similar to that among whites and may surpass it for high-stage disease.
PMID: 7474244 [PubMed - indexed for MEDLINE]
