Adrien Bernstein, MD Second Year Urologic Oncology Fellow

Black Men Less Likely to Have Prostate Surgery During COVID Lockdown

MedicalResearch.com Interview with:

Andres F. Correa, MD, Assistant Professor Department of Surgical Oncology

Dr. Correa

Andres F. Correa, MD
Assistant Professor
Department of Surgical Oncology, and

Adrien Bernstein, MD Second Year Urologic Oncology Fellow

Dr. Bernstein

Adrien Bernstein, MD
Second Year Urologic Oncology Fellow

Fox Chase Cancer Center


MedicalResearch.com: What is the background for this study?

Response: Unfortunately, it has been well-established that historically Black Americans experience increased cancer specific mortality compared to white patients. In prostate cancer specifically studies have shown that when access to care is equitable this gap resolves. This suggests that biological factors are not driving these differences but rather the result of the complex interplay of social determinants and systemic inequities in our healthcare system.

Early in the pandemic, multiple studies demonstrated that minority communities disproportionately shouldered poor COVID-19 outcomes.  On March 13th 2020, the American College of Surgeons recommended against elective procedures; however, the definition of an elective oncologic case was left to the discretion of the provider. As prostate cancer treatment can be safely deferred up to a year follow diagnosis, management of prostate cancer during the initial lockdown period of the COVID-19 Pandemic provided a useful analysis of the differential restrictions placed on non-emergent health care during the Pandemic.

MedicalResearch.com: What are the main findings? 

Response: Overall, our study demonstrated that during the initial lockdown period, Black men with localized prostate cancer were 94% less likely to undergo surgery compared to Black patient prior to the Pandemic. Further, compared to White men during the same time period, Black men were 97% less likely to undergo prostate surgery. On the other hand, the likelihood of surgery did not change during the pandemic for White patients.

Looking at the changes in volume at the site level, Black men experienced a 91% decrease in prostatectomies across sites, while surgery declined by only 17% for White men. The degree to which sites reduced surgery varied substantially and notably, sites that cared for more Black patients were those most impacted by the lockdown. The top two affected practice sites were 40% Black patients prior to the pandemic, in comparison, those sites less affected (A,B,&C) were 82% White and all sites experienced a reduction in the volume of surgery for Black patients.

MedicalResearch.com: What should readers take away from your report?

Response: Our report highlights the unbalanced impact of COVID-19 pandemic on the surgical management of prostate cancer for minority patients in a large regional cohort. While prostate cancer treatment can be safely deferred, there was an unbalanced reduction in care for minority communities. We feel that these findings, highlight the fragility of our health care ecosystem when stressed by a significant event, bring to light significant systemic and structural biases that need to be address. Unfortunately, we believe that this pattern likely unfolded across medicine, housing and education and serves as an example of a much larger theme. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We hope that our findings, bring light to the structural biases embedded within the health care system and help shape future guidelines as we continue to navigate this global pandemic. We believe this study highlights the structural biases that affect minority communities on a regular basis, which were further amplified by an emergency event such as the COVID-19 pandemic. As we continue to navigate cancer care during an ongoing pandemic, as an oncological community we need to further leverage our resources to establish outreach programs aimed to leveling the playing field for minority communities. Further future research is needed to understand the long term implications of the COVID-19 pandemic on health care.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study was limited to patients that already had a diagnosis of prostate cancer and were very well integrated into the health care system. These findings may be even more pronounced for patients that are underinsured, or uninsured and future studies are needed to evaluate these populations.

We have no disclosures to report.

Citation:

Bernstein AN, Talwar R, Handorf E, et al. Assessment of Prostate Cancer Treatment Among Black and White Patients During the COVID-19 Pandemic. JAMA Oncol. Published online July 22, 2021. doi:10.1001/jamaoncol.2021.2755

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