Cancer prevalence worldwide is rapidly increasing, with cases expected to increase from 18.1 to 24.6 million by 2030. Differences in carcinogen exposure, diagnostic center access, and treatment affordability have increased gaps in cancer outcomes and death rates worldwide. In this review, the authors highlight factors contributing to prostate cancer care disparities among African Americans and highlight possible solutions.
Prostate cancer is more prevalent in Western countries, with African American males accounting for 30% of all prostate cancer deaths. African Americans are 1.5 times more likely to develop prostate cancer and 2.2 times more likely to die than white males.
While data suggest that Black men are more likely to develop aggressive forms of prostate cancer, clinical trials suggest that Black males with metastatic castration-resistant prostate cancer may respond better to chemotherapy than white males. However, factors driving these differences remain largely unknown.
African Americans remain underrepresented in prostate cancer clinical trials. This fact may result from socioeconomic determinants that influence accessibility to clinical trials, as well as patient-specific attributes (e.g., skepticism, fear of exploitation, and lack of information) and physician-specific attributes (e.g., implicit bias). Since these trials often focus on genomic stratification of prostate cancer, genetic differences in African Americans may not be uncovered, resulting in inferior treatment options and outcomes for this population.
Additionally, newly approved cancer drugs are costly, with out-of-pocket costs increasing from $617 in 2010 to $1,107 annually in most recent years. This expense negatively impacts treatment adherence, resulting in poorer health outcomes. Globally, many advanced treatments are unavailable, further widening the gap in prostate cancer care and outcomes.
The Centers for Medicare and Medicaid Services (CMS) are studying the benefit of financial navigators to serve as liaisons between treatment costs and patients. They are also examining value-based cancer drug pricing and policy reform focused on decreasing medication copayments.
Additionally, the American Society of Clinical Oncology (ASCO) recently published a policy statement underscoring the importance of value-based, patient-driven solutions that result in decreased pharmaceutical costs for cancer medications and equitable access to cancer treatments. Overall, innovative health policy efforts are needed to improve prostate cancer outcomes for underrepresented and vulnerable populations [1].
Source:
[1] Borno, H., George, D. J., Schnipper, L. E., Cavalli, F., Cerny, T., & Gillessen, S. (2019). All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care. American Society of Clinical Oncology Educational Book, 39, 302–308. https://doi.org/10.1200/edbk_238879
