23 Oct Blacks Have Greater Complications & Costs Following Prostate Surgery
MedicalResearch.com Interview with:
Dr. Quoc-Dien Trinh MD
Assistant Professor of Surgery
Harvard Medical School
Brigham and Women’s Hospital
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Trinh: Blacks who undergo radical prostatectomy, e.g. surgical removal of the prostate for cancer, are more likely to experience complications, emergency room visits, readmissions compared to their non-hispanic White counterparts. As a result, the 1-year costs of care for Blacks is significantly higher than non-hispanic Whites. Interestingly, despite these quality of care concerns, the survival of elderly Blacks and Whites undergoing prostatectomy is the same.
Medical Research: What should clinicians and patients take away from your report?
Dr. Trinh: A possible interpretation of our findings is that the biological differences in tumor aggressiveness among Blacks (e.g. Blacks have more aggressive prostate cancer than Whites) may have been exaggerated, and that the perceived gap in survival is a result of lack of access or cultural perceptions with regard to surgical care for prostate cancer or other factors that differentiate who makes it to the operating table.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Trinh: First, we need to better understand the variation in quality of care between Blacks vs. Whites. Is this an access of care problem? May this be a biological problem (anatomical differences)? Or is this just a difference in unmeasured confounders or case mix (E.g. Black patients in this study are actually sicker than their White counterparts, however these differences may be masked by the administrative data).
Second, the lack of difference in survival between Blacks and Whites is a novel finding. Previous data from our group show that there is a significant gap in survival between Blacks and Whites with prostate cancer. In fact, the gap may even be widening. However, in elderly (this study only included Medicare beneficiaries) men undergoing prostatectomy (many have attributed the difference in survival between Blacks and Whites to the fact that Blacks are less likely to be actually treated for their prostate cancer), there was no difference. As stated in the previous answer, this raises serious questions – perhaps the biological differences in tumor aggressiveness have been exaggerated. Perhaps much of the differences are sociocultural in nature.
Quoc-Dien Trinh, MD et al. Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer. JAMA Oncology, October 2015 DOI: 10.1001/jamaoncol.2015.3384
Dr. Quoc-Dien Trinh MD (2015). Blacks Have Greater Complications & Costs Following Prostate Surgery