Overcoming disparities in prostate cancer starting with Medicaid-insured patients
Strategies to overcome disparities in care are a critical need in prostate cancer based on projections made by the American Cancer Society for 2022, showing a 30% increase in cases and a 2.4% increase disease-related deaths. The American Association for Community Cancer Centers has identified 4 cancer control programs that offer a range of approaches that may improve disparities in prostate cancer screening and treatment.1
Among the programs highlighted by the ACCC is the Ohio State University Comprehensive Cancer Center (OSUCCC), which recently proposed a new prostate cancer assessment program that follows patients from screening to diagnosis. The program involves increased screening for the at-risk patient population. For referrals, the program requires physicians to arrange initial assessment within 14 days of prostate-specific antigen (PSA) screening, followed by a televisit with a coordinator or tracing of patients who do not do not show up for their appointments. For diagnosis, the program requires scheduled secondary testing within 30 days and options for location and time of biopsies.2
The overarching goal of the program is to increase the population of Medicaid patients referred for abnormal PSA by 30% and reduce the Medicaid no-show rate to 5% or less for patients with elevated PSA levels.
In an interview with Targeted Oncology™, Shawn Dason, MD, urological oncologist at OSUCCC, discussed the existing disparities in prostate cancer, the impact of the COVID-19 pandemic on the issue, and the realization health equity for prostate cancer patients in the future.
TARGETED ONCOLOGY: Can you talk about the COVID-19 pandemic and the drop in cancer screenings. How did this impact prostate cancer?
dason: This has been an important aspect of prostate cancer screening. In the context of the pandemic, I think everyone is naturally focusing on different priorities. And some of these things that are a little more insidious, a little more chronic, like cancer screenings, I think, have taken a bit of a back seat. As you know, no one necessarily has active symptoms, or something that actively prompts them to seek [screening]. And similarly, the healthcare system has been under severe strain recently. This is first because you have COVID itself, but then because of labor shortages and stuff like that. So sometimes things like preventative health care measures can take a bit of a backseat.
What disparities have become more evident during the pandemic?
We know that in the field of prostate cancer, there are significant disparities in terms of screening and subsequently access to care. I think 2 things are important to point out. The first thing is that men of African American descent are much more likely to develop prostate cancer and then to die of breast cancer. The second thing is that socio-economic status, that if a patient has Medicaid as their insurance status, they’re also much more likely to have a delay in presenting, and possibly difficulty accessing care health. Subsequently, there may be difficulty in receiving significant treatment to optimize success in terms of outcome.
I think we kind of know about these disparities, and the accumulation of research has shown that they are permanent and significant. The data on disparities and COVID in a separate sphere is also accumulating in a way that those with more difficult socioeconomic status and African American heritage may also be feeling the brunt of some of the issues of lack of health care access we see with COVID. And I think by marrying the 2 concepts together, we can see that prostate cancer screening, prostate cancer diagnosis, and treatment have a bigger impact on some groups than others. This is a huge aspect of understanding prostate cancer in 2022. And going forward, it’s important to target groups or areas for improvement to achieve equity in this regard.
What are the key takeaways from your ACCC webinar presentation on overcoming disparities in prostate cancer?
For me, the first big thing is that although frankly there are disparities, and understanding that and knowing how to take that into account is a key aspect of being a clinician who focuses on prostate cancer. and ethnicity being an important aspect of that and how that afflicts certain groups more. Second, we discussed how access to the best screening, diagnosis and management is more difficult, based on socioeconomic status, and how this perhaps marries with race and ethnicity in the States. -United.
The second takeaway is that I think a lot of work is going on to overcome this, and that’s really what the ACCC Congress was hoping to highlight. We were lucky to have our program featured, but there was great work from multiple places. What comes to mind is the work of UCSF, Delaware and Alabama. I remember seeing practice profiles on some programs there, which were really targeted and embedded in the community. The profiles showed how, in their community, they could target disparities and try to reduce them, improve access to prostate cancer care and make it a part of improving patient outcomes. So I think the biggest thing was recognizing the disparities, and then highlighting some strategies, practice patterns, and plans to focus on.
Is there a call to action from the cancer community to overcome disparities?
I think the biggest thing is, and as a urologist oncologist, I think I’ve focused a lot more on the early stages of prostate cancer, which I think is a good thing in a lot of ways . The first is that there are many possibilities at this early stage to potentially cure prostate cancer. Or, if it may be a more indolent and less aggressive prostate cancer, there is a chance to track it and avoid overdiagnosis and overtreatment. So the biggest call to action I would have is that PSA screening is an essential aspect of prostate cancer diagnosis these days. There has been a lot of back and forth over the past decade regarding the benefits, risks, and harms of PSA screening. You know, 10 years ago there was this kind of general understanding from public health authorities, based on a few studies, that PSA screening was potentially more harmful than good. And in 10 years, we have understood significantly, that it is more beneficial than we once thought. And I think it’s pretty much a norm among all kinds of guideline organizations today to at least have a shared decision-making conversation with patients about whether to continue screening for the disease. ‘APS.
So I think if clinicians aren’t practicing this, my call to action would be to really see PSA screening as shared decision-making among at-risk men. This is probably the most important thing we can do to reduce prostate cancer mortality in the United States, at least right now. With understanding of the disparities in this regard, this may be a good opportunity to improve access for groups who may be at risk, not only of prostate cancer, but who also have reduced access to the best care. .
1. Practice Profiles: Overcoming Disparities in Prostate Cancer Care. ACCC website. Accessed April 7, 2022. https://bit.ly/3uiScPn
2. Dason S. Improving access to prostate cancer screening, diagnosis, and treatment in the Medicaid population of central Ohio. Presented at: Overcoming Disparities in Prostate Cancer Care: Effective Strategies for Community Engagement. ACCC webinar on demand.