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Role of Race and Insurance Status in Prostate Cancer Diagnosis-to-Treatment Interval

  • Daniel R. Nemirovsky
    Correspondence
    Address for correspondence: Daniel R. Nemirovsky B.S., School of Medicine and Health Sciences, George Washington University, 2300 I Street NW, Washington, DC 20037
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Charles Klose
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC

    The Brody School of Medicine at East Carolina University, Greenville, NC
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  • Michael Wynne
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Benjamin McSweeney
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Jennica Luu
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Joyce Chen
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Matthew Atienza
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Brandon Waddell
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Benjamin Taber
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Shawn Haji-Momenian
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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  • Michael J. Whalen
    Affiliations
    The George Washington University School of Medicine and Health Sciences, Washington, DC

    The George Washington University Medical Faculty Associates, Washington, DC
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Published:December 30, 2022DOI:https://doi.org/10.1016/j.clgc.2022.12.009

      Abstract

      Introduction

      Numerous studies have shown that both race and insurance status may affect prostate cancer (PCa) workup and treatment. Preliminary investigations have shown that these factors may be associated with treatment delays, which may indicate inequitable care and increase risk of tumor progression. This investigation aimed to assess whether race and insurance impacted the interval between multiparametric MRI (mpMRI)-to-biopsy, and biopsy-to-prostatectomy.

      Materials and Methods

      A single-institution analysis of 261 patients with recorded race and insurance data was performed using an Institutional Review Board-compliant database with information spanning from 2016 to 2022. Race was self-reported during intake, and insurance status was retrieved from the electronic medical record. Insurance was sub-divided into private, Medicare, and Medicaid. Diagnostic or treatment latency was defined as time between mpMRI-to-biopsy, or biopsy-to-surgery.

      Results

      Stratified by race, there was no difference in either latency period when comparing African American (AA) and white patients. Stratified by insurance status, there was no difference in time from mpMRI-to-biopsy (P = .50), but there was a significantly longer interval from biopsy-to-prostatectomy for patients with Medicaid insurance (P = .02). Patients with Medicaid waited on average 168 days to receive surgery, in contrast to 92 days for private and 87 for Medicare. Notably, 82% of Medicaid patients were AA.

      Conclusion

      Insurance status, which is inherently linked to race and social determinants of health, portended a significantly increased interval between biopsy and surgery. Physicians should be aware of the relationship between insurance status and treatment delay, as well as its potential downstream consequences.

      Keywords

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