Role of Race and Insurance Status in Prostate Cancer Diagnosis-to-Treatment Interval

Daniel R. Nemirovsky, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC. Electronic address: dnemirov@gwmail.gwu.edu.
Charles Klose, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC; The Brody School of Medicine at East Carolina University, Greenville, NC.
Michael Wynne, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Benjamin McSweeney, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Jennica Luu, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Joyce Chen, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Matthew Atienza, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Brandon Waddell, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Benjamin Taber, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Shawn Haji-Momenian, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.
Michael J. Whalen, The George Washington University School of Medicine and Health Sciences, Washington, DC; The George Washington University Medical Faculty Associates, Washington, DC.

Document Type

Journal Article

Publication Date

6-1-2023

Journal

Clinical genitourinary cancer

Volume

21

Issue

3

DOI

10.1016/j.clgc.2022.12.009

Keywords

Cancer; Determinants; Insurance; Prostate; Race

Abstract

INTRODUCTION: Numerous studies have shown that both race and insurance status may affect prostate cancer (PCa) workup and treatment. Preliminary investigations have shown that these factors may be associated with treatment delays, which may indicate inequitable care and increase risk of tumor progression. This investigation aimed to assess whether race and insurance impacted the interval between multiparametric MRI (mpMRI)-to-biopsy, and biopsy-to-prostatectomy. MATERIALS AND METHODS: A single-institution analysis of 261 patients with recorded race and insurance data was performed using an Institutional Review Board-compliant database with information spanning from 2016 to 2022. Race was self-reported during intake, and insurance status was retrieved from the electronic medical record. Insurance was sub-divided into private, Medicare, and Medicaid. Diagnostic or treatment latency was defined as time between mpMRI-to-biopsy, or biopsy-to-surgery. RESULTS: Stratified by race, there was no difference in either latency period when comparing African American (AA) and white patients. Stratified by insurance status, there was no difference in time from mpMRI-to-biopsy (P = .50), but there was a significantly longer interval from biopsy-to-prostatectomy for patients with Medicaid insurance (P = .02). Patients with Medicaid waited on average 168 days to receive surgery, in contrast to 92 days for private and 87 for Medicare. Notably, 82% of Medicaid patients were AA. CONCLUSION: Insurance status, which is inherently linked to race and social determinants of health, portended a significantly increased interval between biopsy and surgery. Physicians should be aware of the relationship between insurance status and treatment delay, as well as its potential downstream consequences.

Department

Urology

Link to Full Text

Share

COinS