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Black patients with prostate cancer were treated differently in urology practices that treated mostly white patients compared with practices that treated mostly Black patients, a study showed.

Nnenaya Agochukwu-Mmonu, MD, of New York University in New York City, and colleagues used a 20% sample of national Medicare data to identify 54,443 beneficiaries diagnosed with prostate cancer from 2010 through 2015 and followed through 2016.

As noted in the study in the , the researchers linked urologists to their practices with tax identification numbers, and then linked patients to practices on the basis of their primary urologist. Practices were grouped into quartiles based on the proportions of Black patients, and the researchers used multilevel mixed-effects models to examine differences in treatment and other factors among the quartiles.

The following Q&A discusses the details of the study. (The researchers did not respond to requests for comment, and the answers here are from the text of the report.)

You observed considerable variation in racial practice composition among urology practices. What did you find?

We observed a stark range in racial practice composition among urology practices. There were practices that care for up to 97% Black patients, and there were practices that do not take care of any Black patients with incident prostate cancer, reflective of practice segregation.

What did you find about how Black patients were treated, especially in relation to the racial makeup of the practice where they were treated?

Overall, definitive treatment for Black Medicare beneficiaries with incident prostate cancer was largely similar to that for white Medicare beneficiaries, although lower in every practice context. We found less definitive treatment among Black men in lower quartiles (i.e., less diverse practices) and more definitive treatment among Black men in higher quartiles (i.e., more diverse practices).

We also found that Black patients were more likely to be treated with cryotherapy, particularly in the highest quartile practices. This finding warrants further exploration since cryoablation is not recommended as a first-line treatment by the National Comprehensive Cancer Network, thus raising quality-of-care concerns.

Why do you think Black patients were treated differently depending on the racial diversity of the practice?

This may be due to more cultural competency and targeted communication to mitigate mistrust in practices that treat more Black patients. Alternatively, there may be a greater recognition of disparate outcomes among Black patients, prompting justifiable use of more definitive treatment.

On the other hand, practices with fewer Black patients may not be focused on mitigating the risks of undertreatment of Black men. There could be a lack of interpersonal skills or underappreciation of possible unconscious bias in their counseling patterns.

What other conclusions have you drawn from your findings?

We demonstrate ongoing disparities in prostate cancer treatment among Medicare beneficiaries, with a lens into the impact of racial composition of a practice. Although Black patients have higher rates of diagnosis and mortality from prostate cancer, Black Medicare beneficiaries had a lower likelihood of definitive treatment, as did those with lower socioeconomic status, who were more often Black. Despite a disparity in every quartile, Black patients in higher [more diverse] quartiles received more treatment and perhaps better care.

Practice segregation and structural racism are possible factors helping explain these findings. Evidence-based and multilevel interventions are needed to continue toward racial equity in prostate cancer care, including evaluation and restructuring of the health and social care systems and policies, and cultural competency to enhance patient-provider interactions.

What kinds of interventions could be helpful?

Engagement, feedback, and patient-driven interventions are important for progress as Black patients are less likely to report high-quality care and good physician-patient communication. There is also evidence of benefit for noninsurance-related social services including community outreach, which can improve health literacy, utilization, and outcomes.

For providers, interventions targeted at communication, culturally sensitive care, mitigating conscious and unconscious bias, and partnership with community healthcare workers are key.

Read the study here.