Racial Disparities in Palliative Care for Prostate Cancer

As better therapies have been developed for prostate cancer treatment, variability and disparities have been observed in their utilization, influenced by factors such as race, age, physician attitudes, patient insurance, and other issues. For patients with limited life expectancy due to metastatic or recurrent disease, effective therapies for the palliation of symptoms are increasingly available, but there has been little research into their extent of utilization and what factors predict their use.

In this study, we have chosen three common palliative care settings in patients with advanced prostate cancer -- patients with spinal cord compression; patients with ureteral obstruction; and patients with pathologic bone fractures. Each has an indicated effective therapy -- anterior decompressive surgery followed by radiotherapy, endoscopic placement of a stent or percutaneous nephrostomy, and palliative radiation therapy. We will use a large database to explore to what degree these treatments are used in these three settings, and what factors predict their use. Our emphasis will be on racial disparities in their use, and we will explore patient factors such as age, marital status, and comorbidities, and we will look at physician characteristics as well, such as physician gender, age, U.S.-trained vs. foreign-trained, and private practice setting. We hypothesize that such factors will influence the utilization of palliative treatments in these terminal patients -- no prior studies have explored these issues.

The decision to use palliative treatments in terminal patients is particularly complex and involves multiple factors, ranging from the attitudes of the patients and physicians to those of the patients' caretakers, and including factors related to access to care and finances as well as tolerability of symptoms. In order to maximize the appropriate use of these treatments, we must begin to understand what these factors are and how they interact with each other. The influence of race is particularly crucial as it can lead to major disadvantages to large portions of the population. Studies to date have demonstrated substantial racial disparities for pain management and hospice referral, two major issues in terminal patients. This proposal will help define the impact of race for these 3 scenarios and the key factors that interact and will help guide the design and implementation of future intervention trials with the goal of improving the utilization of successful palliative treatments.