A new study led by researchers at the UCLA Health Jonsson Comprehensive Cancer Center found that black men diagnosed with more advanced stages of prostate cancer are significantly less likely to be prescribed new hormone therapy than other racial and ethnic groups — including whites or Latinos men – despite The treatment has been shown to effectively control the growth of prostate tumors and prolong the lives of men with the disease.
The findings, published in JAMA Network Openreveal a troubling racial disparity in the use of the critical treatment to treat the disease.
This revelation is particularly troubling given the already disproportionate impact of prostate cancer on black men, who are 1.5 times more likely to be diagnosed and 2.4 times more likely to die from the disease than white men in the United States.
Dr. Amar Kishan, co-senior author of the study, a professor of radiation oncology at the David Geffen School of Medicine at UCLA and an investigator at the UCLA Health Jonsson Comprehensive Cancer Center
New hormone therapy agents are the next generation of hormone therapy that target the androgen signaling axis, which plays a key role in the growth and progression of prostate cancer cells. Androgens, such as testosterone, stimulate the growth of prostate cancer. Hormone therapy works by blocking the action of androgens or reducing their levels in the body.
They are also often used in combination with traditional androgen deprivation therapy to more effectively suppress androgen signaling, providing improved outcomes for patients with advanced or metastatic prostate cancer.
“Although we know that hormone therapies have significant clinical benefits in men with more advanced stages of prostate cancer, there is not much information available about how often people in the general population use these drugs – particularly in the context of equitable access to them medicines. different racial and ethnic groups,” said Dr. Michael Xiang, assistant clinical professor of radiation oncology at the David Geffen School of Medicine at UCLA and co-senior author of the study.
To examine how doctors prescribe these drugs based on the race and ethnicity of patients in the US, the research team used data from a population-based cancer registry linked to prescription drug records for 3,748 Medicare beneficiaries with median age 75 diagnosed with advanced prostate cancer from 2011 to 2017. Among them, 8% were black, 7% Hispanic, 78% white, and 7% from other racial and ethnic groups.
The majority of patients had metastatic prostate cancer, with 36% receiving new hormone therapy. White patients had the highest rate of 2-year use of new hormone therapy at 27%, followed by Hispanic patients at 25% and other racial/ethnic groups at 23%. Black patients had the lowest rate at 20%.
This disparity persisted at five years and beyond, with black patients consistently receiving this critical treatment at a lower rate than their white counterparts. The researchers found that black men were 24% less likely than white men to receive or be prescribed one of these new hormone therapy agents. In contrast, this difference was not observed among Latino men or men of other racial and ethnic groups.
“Our findings raise critical questions about the reasons behind this disparity, suggesting potential barriers to health care, financial burdens, and unconscious biases within the health care system,” Xiang said.
Future studies are needed to uncover the underlying causes and systematically address these issues for more equitable care, the authors noted.
The study’s first author is Dr. Ting Martin Ma, a former radiation oncology resident at the David Geffen School of Medicine at UCLA and currently an assistant professor of radiation oncology at the University of Washington. Other UCLA authors include: Drs. 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.
Source:
Journal Reference:
Ma, TM, et al. (2023). Racial and ethnic disparities in the use of new hormone therapy agents in patients with prostate cancer. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.45906.
