Prostate cancer treatment for economically disadvantaged men: A comparison of county hospitals and private providers

Prostate cancer imposes a substantial burden on public health. While the majority of patients now present with localized disease, there is no consensus as to the most effective form of treatment, and patients face a daunting array of choices. Optimization of quality of life after diagnosis and treatment, a key principle of cancer survivorship, is emerging as an increasingly important aspect of improving delivery of cancer care. If different treatments for localized prostate cancer are associated with disparate morbidities and no single modality has yet proved more optimal than the others, the question arises as to what factors drive treatment selection. One potential variable that drives treatment is the type of healthcare facility. Different types of facilities might provide different environmental cues, which in turn influence treatment choice.

This presentation describes the types of treatments an ethnically diverse cohort of low-income, uninsured men enrolled in a state-funded public health program providing free prostate cancer treatment received from county hospitals and private providers between 2001 and 2006. A retrospective cohort study of 559 men was performed. Multinomial regression was used to compare types of treatments patients received from different providers.

This study found that irrespective of patient characteristics or disease severity, prostate cancer treatments varied significantly between county hospitals and private providers. Our data revealed substantial discrepancies in processes of care between different healthcare institutions. These differences have implications not only for health policy but also for the quality of prostate cancer care.