Race and Time from Diagnosis to Radical Prostatectomy: Does Equal Access Mean Equal Timely Access to the Operating Room?—Results from the SEARCH Database
- Lionel L. Bañez1,2,
- Martha K. Terris4,
- William J. Aronson5,
- Joseph C. Presti, Jr.6,
- Christopher J. Kane7,
- Christopher L. Amling8 and
- Stephen J. Freedland1,2,3
- 1Division of Urologic Surgery and the Duke Prostate Center, Department of Surgery, Duke University Medical Center; 2Urology Section, Veterans Affairs Medical Center; 3Department of Pathology, Duke University Medical Center and Veterans Affairs Medical Center, Durham, North Carolina; 4Urology Section, Veterans Affairs Medical Center, Augusta and Section of Urology, Medical College of Georgia, Augusta, Georgia; 5Urology Section, Veterans Affairs Greater Los Angeles Healthcare System and Department of Urology, University of California, Los Angeles School of Medicine, Los Angeles, California; 6Department of Urology, Stanford University School of Medicine and Urology Section, Veterans Affairs Medical Center, Palo Alto, California; 7Urology Section, Veterans Affairs Medical Center, San Diego and Department of Urology, University of California, San Diego, San Diego, California; and 8Department of Urology, University of Alabama, Birmingham, Alabama
- Requests for reprints:
Stephen J. Freedland, Division of Urologic Surgery and the Duke Prostate Center, and Departments of Surgery and Pathology, Duke University Medical Center, Box 2626, Durham, NC 27710. Phone: 919-668-8361; Fax: 919-668-7093. E-mail: steve.freedland{at}duke.edu
Abstract
Background: African American men with prostate cancer are at higher risk for cancer-specific death than Caucasian men. We determine whether significant delays in management contribute to this disparity. We hypothesize that in an equal-access health care system, time interval from diagnosis to treatment would not differ by race.
Methods: We identified 1,532 African American and Caucasian men who underwent radical prostatectomy (RP) from 1988 to 2007 at one of four Veterans Affairs Medical Centers that comprise the Shared Equal-Access Regional Cancer Hospital (SEARCH) database with known biopsy date. We compared time from biopsy to RP between racial groups using linear regression adjusting for demographic and clinical variables. We analyzed risk of potential clinically relevant delays by determining odds of delays >90 and >180 days.
Results: Median time interval from diagnosis to RP was 76 and 68 days for African Americans and Caucasian men, respectively (P = 0.004). After controlling for demographic and clinical variables, race was not associated with the time interval between diagnosis and RP (P = 0.09). Furthermore, race was not associated with increased risk of delays >90 (P = 0.45) or >180 days (P = 0.31).
Conclusions: In a cohort of men undergoing RP in an equal-access setting, there was no significant difference between racial groups with regard to time interval from diagnosis to RP. Thus, equal-access includes equal timely access to the operating room. Given our previous finding of poorer outcomes among African Americans, treatment delays do not seem to explain these observations. Our findings need to be confirmed in patients electing other treatment modalities and in other practice settings. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1208–12)
Footnotes
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Grant support: Department of Veterans Affairs, the Duke University Department of Surgery and Division of Urology, Department of Defense Prostate Cancer Research Program, the American Urological Association Foundation/Astellas Rising Star in Urology Award, NIH Specialized Programs of Research Excellence Grant P50 CA58236, the Georgia Cancer Coalition, NIH R01CA100938, and NIH Specialized Programs of Research Excellence Grant P50 CA92131-01A1.
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- Accepted January 28, 2009.
- Received June 2, 2008.
- Revision received January 17, 2009.
