Abstract
Objectives
Palliative issues are an important but understudied issue for patients with advanced cancer. Ureteral obstruction is a complication of advanced prostate cancer, usually relieved with placement of retrograde ureteral stent (RUS) or percutaneous nephrostomy (PCN) to palliate symptoms associated with obstructive uropathy and/or renal failure. We investigated predictors of receipt of RUS and PCN and their association with survival for older advanced prostate cancer patients.
Methods
Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified patients aged 65 or older with stage IV (n = 10,848) or recurrent (n = 7,872) prostate cancer. We used multivariable analysis to compare those with ureteral obstruction treated with RUS or PCN to those not treated and to analyze the association between RUS, PCN, and survival.
Results
Sixteen percent (n = 2,958) of the sample developed ureteral obstruction. Compared to no treatment, African Americans were more likely to undergo placement of PCN [odds ratio 1.48, 95 % confidence intervals (CI) 1.03–2.13] than Whites, but equally likely to receive a stent. Subjects of >80 years were less likely to undergo RUS (ages 80–84, 0.41, 95 % CI 0.27–0.63; ages ≥85, 0.30, 95 % CI 0.16–0.54) compared to patients 65–69 years. Subjects who received a PCN were 55 % more likely to die than those who were untreated. There was no difference in survival among those receiving RUS vs untreated. Nine percent of subjects received RUS or PCN within 30 days of dying.
Conclusions
This is the first population-based study to demonstrate a racial disparity in the palliative treatment of advanced prostate cancer. Reasons for disparate care need to be determined so that interventions may be developed.
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Acknowledgments
This study was supported by a grant (PC094372) from the Department of Defense.
Conflict of interest
None of the authors has a conflict of interest to report. No author has a financial relationship with the organization that sponsored the research. The authors have full control of the data used for analysis in this study. We agree to allow the journal to review the data if requested.
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The linked SEER–Medicare database was used in this study. The interpretation and reporting of these data are the sole responsibility of the authors.
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Spencer, B.A., Insel, B.J., Hershman, D.L. et al. Racial disparities in the use of palliative therapy for ureteral obstruction among elderly patients with advanced prostate cancer. Support Care Cancer 21, 1303–1311 (2013). https://doi.org/10.1007/s00520-012-1666-6
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DOI: https://doi.org/10.1007/s00520-012-1666-6