Was the association of the COVID-19 pandemic with cancer surgery similar for Black and White patients with prostate cancer?
In this multi-institutional cohort study of patients with untreated nonmetastatic prostate cancer during the initial COVID-19 lockdown, only 1% of Black men underwent prostatectomy, while 26% of White patients did. Prior to the pandemic, there was no difference in the rate of prostatectomy between the 2 races (18% of Black men and 19% of White men).
This study suggests that during the initial phase of the COVID-19 pandemic, hospital restrictions were unbalanced, and Black patients experienced a disproportionate lower rate of prostatectomies.
Early in the COVID-19 pandemic, racial/ethnic minority communities disproportionately experienced poor outcomes; however, the association of the pandemic with prostate cancer (PCa) care is unknown.
To assess the association between race and PCa care delivery for Black and White patients during the first wave of the COVID-19 pandemic.
Design, Setting, and Participants
This multicenter, regional, collaborative, retrospective cohort study compared prostatectomy rates between Black and White patients with untreated nonmetastatic PCa during the COVID-19 pandemic (269 patients from March 16 to May 15, 2020) and prior (378 patients from March 11 to May 10, 2019).
Main Outcomes and Measures
Of the 647 men with nonmetastatic PCa, 172 (26.6%) were non-Hispanic Black men, and 475 (73.4%) were non-Hispanic White men. Black men were significantly less likely to undergo prostatectomy during the pandemic compared with White patients (1 of 76 [1.3%] vs 50 of 193 [25.9%]; P < .001), despite similar COVID-19 risk factors, biopsy Gleason grade groups, and comparable prostatectomy rates prior to the pandemic (17 of 96 [17.7%] vs 54 of 282 [19.1%]; P = .75). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 ng/mL [interquartile range, 5.3-15.2 ng/mL] vs 7.2 ng/mL [interquartile range, 5.1-11.1 ng/mL]; P = .04). A linear combination of regression coefficients with an interaction term for year demonstrated an odds ratio for likelihood of surgery of 0.06 (95% CI, 0.01-0.35; P = .002) for Black patients and 1.41 (95% CI, 0.81-2.44; P = .23) for White patients during the pandemic compared with prior to the pandemic. Changes in surgical volume varied by site (from a 33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients.
Conclusions and Relevance
In this large multi-institutional regional collaborative cohort study, the odds of PCa surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized PCa does not require immediate treatment, the lessons from this study suggest systemic inequities within health care and are likely applicable across medical specialties. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the COVID-19 pandemic to develop balanced mitigation strategies as viral rates continue to fluctuate.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: May 7, 2021.
Published Online: July 22, 2021. doi:10.1001/jamaoncol.2021.2755
Corresponding Author: Andres Correa, MD, Division of Urologic Oncology, Fox Chase Cancer Center, 300 Cottman Ave, Philadelphia, PA 19111 (firstname.lastname@example.org).
Author Contributions: Drs Bernstein and Correa had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Bernstein, Talwar, Reese, Trabulsi, Jacobs, Kutikov, Guzzo, Smaldone, Correa.
Acquisition, analysis, or interpretation of data: Bernstein, Talwar, Handorf, Syed, Danella, Ginzburg, Belkoff, Tomaszewski, Trabulsi, Singer, Uzzo, Raman, Guzzo, Smaldone.
Drafting of the manuscript: Bernstein, Talwar, Guzzo, Correa.
Critical revision of the manuscript for important intellectual content: Bernstein, Talwar, Handorf, Syed, Danella, Ginzburg, Belkoff, Reese, Tomaszewski, Trabulsi, Singer, Jacobs, Kutikov, Uzzo, Raman, Guzzo, Smaldone.
Statistical analysis: Bernstein, Talwar, Handorf, Uzzo, Smaldone.
Administrative, technical, or material support: Bernstein, Syed, Danella, Ginzburg, Reese, Trabulsi, Kutikov, Raman, Guzzo.
Supervision: Tomaszewski, Singer, Jacobs, Raman, Guzzo, Smaldone, Correa.
Conflict of Interest Disclosures: Dr Handorf reported receiving grants and personal fees from the National Cancer Care Network (NCCN)/Pfizer and grants from NCCN/Eli Lily outside the submitted work. Dr Belkoff reported serving as a consultant for Marius Pharm and Astellas. Dr Singer reported receiving grants from Astellas/Medivation outside the submitted work. Dr Jacobs reported receiving grants from the National Institutes of Health and the Agency for Healthcare Research and Quality and financial support from the Shadyside Hospital Foundation outside the submitted work. Dr Uzzo reported serving on the board for Haymarket Media, serving as a consultant for Amgen and Urogen, serving on the speaker’s bureau for Janssen, and serving as a research and data monitor for Pfizer. Dr Raman reported holding stock in United Medical Systems and serving on the speaker’s bureau for Urogen. No other disclosures were reported.
Funding/Support: Collection and management of data for the Pennsylvania Urologic Regional Collaborative is funded by the Health Care Improvement Foundation through practice participation.
Role of the Funder/Sponsor: The funding source is involved in the collection and management of the data. The funding source has no role in the design and conduct of the study; analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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