September 2020


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VA study finds no disparities in prostate cancer deaths with equal access to care


is the


The Hampton Roads Messenger 11


records—the study cannot show conclusively that equal access to good medical care


reason


racial disparities were not seen in the VA patients. Additionally, Dr. de Moor said, “there may be some differences between people treated at the VA and [people in the general population].”


And while Dr. Penson called the


study “quite compelling,” he noted that other factors, such as patients leaving the VA system to get care elsewhere and the lower mortality rate from causes other than cancer among African American veterans, could have affected the results. Some studies have suggested


that biological differences may also play a role in prostate cancer disparities,


especially in the


increased incidence and younger age at diagnosis in African American men.


And it’s possible, Dr. Penson Photo by Bill Branson, NIH BY NATIONAL CANCER INSTITUTE In the United States, African


American men are more likely to be diagnosed with prostate cancer than white men, tend to be diagnosed at younger ages and with more advanced disease, and are more than twice as likely to die of the disease. The reasons for these disparities have not been clear.


some in the medical community that prostate


“There is a perception among cancer


is inherently more


aggressive among African American men, and that there’s nothing we can do about” disparities in deaths from the disease, said Brent Rose, M.D., a radiation oncologist at the University of California at San Diego. But some studies have pointed to differences in access to health care as a cause of the disparities, and a new study by Dr. Rose and his colleagues supports that hypothesis.


The team found that among


patients treated in the US Department of Veterans Affairs (VA) health care system—where all patients have equal access


to care—African American


men did not appear to have more-ag- gressive prostate cancer at the time of diagnosis or a higher death rate from the disease than non-Hispanic white men.


“Well-designed observational


studies like this one are important for helping us to better understand the importance of access to care,” said


Janet de Moor, Ph.D., M.P.H,


of the Healthcare Delivery Research Program in NCI’s Division of Cancer Control and Population Sciences, who was not involved with the study. “This study, while imperfect,


definitely adds to our understanding of racial disparities in prostate cancer outcomes,”


M.D., M.P.H., a urologic oncologist and health


Vanderbilt University, who also was not involved in the study. The


study, published


agreed David Penson, services researcher at


January


27 in Cancer, suggests that providing equal access to health care could be important for eliminating or reducing disparities in prostate cancer deaths, Dr. de Moor said. African American Men Fared as


Well as or Slightly Better than White Men


Dr. Rose’s team analyzed


information on more than 60,000 men with prostate cancer from a large, nationwide database with medical and treatment information on more than 20 million veterans treated in the VA system. The men had been diagnosed


with prostate cancer between 2000 and 2015. Of these men, 30.3% were African American and 69.7% were non-Hispanic white. The median follow-up time for


African American and non-Hispanic white men was approximately


5.8


and 5.9 years, respectively. African American men were more likely than the non-Hispanic white men to live in areas with a lower median income and lower high school graduation rates, the research team reported. In the VA system, the


team


found, African American men did not experience delays in diagnosis or care for their prostate cancer compared with non-Hispanic white men, and they were no more likely to be diagnosed with more-advanced gressive prostate


cancers.


or more-ag- African


American men also were no more likely than non-Hispanic white men to die of their disease. In fact, African American men in


the VA system were slightly less likely than non-Hispanic white men to die from prostate cancer within 10 years after diagnosis: The 10-year death rate from prostate cancer was 4.4% for African American men and 5.1% for non-Hispanic white men. This lower death rate was seen even after the researchers adjusted for factors that could potentially account for the difference, such as severity of disease at diagnosis, type of treatment received, and other illnesses. The reason for the difference in prostate cancer deaths remains unclear, and “would be interesting to explore more fully,” Dr. de Moor said. Interestingly, African American


men in the VA system also were less likely than non-Hispanic white men to die of noncancer causes, Dr. Penson said.


A "Compelling" Study, Though Questions Remain Key strengths


of this study


include the large number of patients, the fact that everyone in the VA health care system has equal access to care, and the racially diverse patient population, Drs. Penson and de Moor both said. In addition, Dr. Penson said, “the comprehensive nature of the VA’s electronic medical records and the reliability of the system to capture [patient] survival outcomes strengthen the findings considerably.” However, as the authors noted, the study also has important limitations. Because it was a retrospective observational


analysis—that is, it looked back in time at patient medical Spicy Buffalo Cauliflower �Wings� Ingredients


• 1 cup water or soy milk • 1 cup flour (any kind will work—even gluten-free!) • 2 tsp. garlic powder • 1 head of cauliflower, chopped into pieces • 1 cup buffalo or hot sauce • 1 Tbsp. vegetable oil or melted vegan butter


Instructions 1. Preheat the oven to 450°F.


2. Combine the water or soy milk, flour, and garlic powder in a bowl and stir until well combined.


3. Coat the cauliflower pieces with the flour mixture and place in a shallow baking dish. Bake for 18 minutes.


4. While the cauliflower is baking, combine your buffalo sauce and olive oil or margarine in a small bowl.


5. Pour the hot sauce mixture over the baked cauliflower and continue baking for an additional 5 to 8 minutes.


6. Serve alongside vegan blue cheese dressing and celery sticks. Makes 4 servings


Source: PETA


said, that both biology and access to care contribute to the differences in prostate


cancer outcomes that


researchers have long observed. “In the end, we need to consider strategies to address disparities that account for both possibilities,” he continued.


Addressing Disparities Beyond


the VA System Numerous studies have identified access to care as a contributor to health-related


disparities, previous studies that


including examined


disparities in prostate cancer outcomes, Dr. de Moor noted. “The bigger issue is what can be done about it,” Dr. Penson said. Legislative


solutions for increasing


access to quality health care continue to be debated, he continued. “This study underscores the importance of those efforts.”


“Further research is required to


look into what specifically can be done to improve care for everyone,” Dr. Rose said. “The solution is ... to try to figure out what factors [in the VA system] are leading to good outcomes in African American men and how we could expand those to the broader health care community.” To help identify those factors, Dr. Rose and his colleagues are planning further studies using additional data from the VA health


system. They


also intend to use the VA database to look at multiple cancer types, not just prostate cancer, to “see if preventive care, such as that provided by primary care doctors, can help reduce the rate of advanced cancers, particularly in minority communities.”


Healthy Recipe


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