Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Underwood, W., James S. Jackson, J.T. Wei, R. Dunn, E. Baker, S. Demonner, and D.P. Wood. 2005. "Racial Treatment Trends in Localized/Regional Prostate Carcinoma: 1992-1999." Cancer, 103:538-545.
BACKGROUND. African-American men have a greater incidence of and mortality from prostate carcinoma compared with white men, and they are less likely to receive definitive therapy (radical prostatectomy or external beam radiation therapy). During the 1990s, the use of brachytherapy increased; however, its influence on racial and ethnic prostate carcinoma treatment trends remains unclear. The objective of this study was to describe treatment trends over the period 1992-1999 for localized/ regional prostate carcinoma among white, Hispanic, and African-American men. METHODS. Using the Surveillance, Epidemiology, and End Results (SEER) registry data from 1992 through 1999, logistic regression models were used to determine whether the odds of receiving a specific treatment modality differed by racial and ethnic group and whether the differences changed over time when the models were adjusted for age, marital status, tumor grade, and SEER site (geography). RESULTS. The authors identified 142,340 men, including white men (81.670), Hispanic men (6.4%), and African-American men (12.0%). Racial and ethnic differences in the rates of use of androgen-deprivation therapy/expectant management were noted; however, these differences appeared to lessen over time (P < 0.001). The rate of utilization of radical prostatectomy increased for Hispanic men, remained flat for African-American men, and decreased for white men. The milization of brachytherapy and combination therapy increased for all three groups; however, the greatest increase in utilization was among white men. CONCLUSIONS. Further research will be required to determine the patient-level and provider-level variables that influence racial and ethnic treatment differences in localized/ regional prostate cancer. (C) 2004 American Cancer Society.
Country of focus: United States.