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Racial/ethnic disparities in patient experiences with care and Gleason score at diagnosis of prostate cancer: a SEER-CAHPS study

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Abstract

Purpose

To determine whether racial/ethnic differences in patient experiences with care, potentially leading to underutilization of necessary care, are associated with disparities in Gleason score at diagnosis.

Methods

We used the SEER-CAHPS linked dataset to identify Medicare beneficiaries who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey prior to diagnosis of prostate cancer. Independent variables included aspects of patient experiences with care captured by CAHPS surveys. We conducted survey weighted multivariable multinomial logistic regression analyses, stratified by patient race/ethnicity, to estimate associations of CAHPS measures with Gleason score at diagnosis.

Results

Of the 4,245 patients with prostate cancer, most were non-Hispanic white (NHW) (77.6%), followed by non-Hispanic black (NHB) (8.4%), Hispanic (8.4%), and Asian (5.6%). Excellent experience with getting needed prescription drugs was associated with lower odds of Gleason scores of 7 and 8–10 in NHBs (7: OR = 0.19, 95% CI = 0.05–0.67; 8–10: OR = 0.04, 95% CI = 0.01–0.2) and lower odds of 8–10 in NHWs (OR = 0.61, 95% CI = 0.40–0.93). For NHBs, excellent primary physician ratings were associated with greater odds of a Gleason score of 8–10 (OR = 13.28, 95% CI = 1.53–115.21).

Conclusion

Patient experiences with access to care and physician relationships may influence Gleason score in different ways for patients of different racial/ethnic groups. More research, including large observational studies with greater proportions of racial/ethnic minority patients, is necessary to understand these relationships and target interventions to overcome disparities and improve patient outcomes.

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Data availability

This study used the linked SEER-CAHPS data resource. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-CAHPS data resource.

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Funding

This work was not supported by any external funding sources.

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Authors and Affiliations

  1. Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, 2001 N. Soto Street, Suite 318B, Los Angeles, CA, 90032, USA

    Stephanie Navarro, Xiaohui Hu, Aaron Mejia, Carol Y. Ochoa, Trevor A. Pickering & Albert J. Farias

  2. USC Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, 1441 Eastlake Avenue, Los Angeles, CA, 90033, USA

    Leslie Ballas

  3. Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of the University of Southern California, 2020 Zonal Avenue, IRD 318, Los Angeles, CA, 90033, USA

    Albert J. Farias

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  1. Stephanie Navarro
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  2. Xiaohui Hu
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Contributions

SN, XH, TAP, and AJF completed conception and design of the research; all authors partook in analysis and interpretation of data, manuscript writing, and approval of the final article.

Corresponding author

Correspondence to Albert J. Farias.

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The authors have no conflict of interest to disclose.

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This study was granted exempt status as it involved the secondary analysis of de-identified patient data.

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Navarro, S., Hu, X., Mejia, A. et al. Racial/ethnic disparities in patient experiences with care and Gleason score at diagnosis of prostate cancer: a SEER-CAHPS study. Cancer Causes Control 33, 601–612 (2022). https://doi.org/10.1007/s10552-022-01552-3

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  • DOI: https://doi.org/10.1007/s10552-022-01552-3

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