Socioeconomic status and outcomes after prostate cancer treatment

It has long been recognized that socioeconomic status holds a direct relationship to quality of outcome in cancer treatment. In other words, the more educated and affluent among us can afford — and know how to gain access to — higher quality care than the less educated and less affluent. What we did not (previously) have were data documenting the size of this effect in low-risk prostate cancer.

Hellenthal et al. have now reported on the impact of socioeconomic status (SES) on the likelihood of undergoing radical prostatectomy (RP) or external beam radiation therapy (EBRT) and the ensuing effect on cancer-specific survival (CSS) after treatment for men with low-risk prostate cancer.

The researchers used data from the California Cancer Registry to identify men diagnosed with localized prostate cancer with a Gleason score of 7 or less between 1996 and 2005. The patients were categorized into 5 groups (“quintiles”) based on SES and were stratified by race, age, year of diagnosis, and treatment.

Their analysis has shown the following:

  • The total number of patients identified was 123,953.
  • 39,234 patients (31.7 percent) underwent RP as their first-line therapy.
  • 42,431 patients (34.3 percent) underwent EBRT as their first-line therapy.
  • Men of lower SES were less likely to undergo either RP or XRT.
  • Men in the lowest quintile for SES who underwent RP were twice as likely to die of prostate cancer (hazard ratio [HR] = 1.99) as men in the highest quintile for SES, regardless of race.
    • When adjusted for race, this difference was higher (HR = 2.20)
  • Men in the lowest quintile for SES who underwent EBRT were also about twice as likely to die of prostate cancer (HR = 2.24) as men of the highest SES, regardless of race.

It would seem to be an inevitability of human culture that those of higher SES get superior treatment for severe disease (and probably just for illness in general) than those of lower SES. This study does, however,  appear to make a statement about the skill levels and resources of those treating the socially disadvantaged.

In general, low-risk prostate cancer is a form of cancer that has a high potential for curative treatment when carried out well. The 10-year prostate cancer-specific survival rate for low-risk prostate cancer at high quality medical centers is well over 95 percent. It would seem that our inability to provide good, first-line therapy for patients of lower SES may well be as much a comment on who is managing and treating these patients as it is on the patients themselves.

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