A study presented during the 2021 ASCO Annual Meeting evaluated the effect of low household income on diagnosis, goals of care, and treatment choice in patients with localized prostate cancer.
“The North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS) is a population-based cohort of prostate cancer patients identified at the time of diagnosis, enrolled from 2011-2013, and followed prospectively,” the researchers explained. Data collection included sociodemographic information and decision-making factors, including goals of care. Patients reported how important they considered quality of life, cure, burden to friends and family, cost, and effect on daily activity. They also specified which goal was the most important when it came to making treatment decisions. They were stratified into three groups based on income: low (<$40,000), middle ($40,000-$90,000), and high (>$90,000).
Final analysis included 1,382 patients; income breakdown was: low, n=539 (39%); middle, n=553 (40%); and high, n=290 (21%). Patients in the low group were less likely to have a college education and more likely to be unemployed and have no or government-sponsored insurance. Prostate-specific antigen was higher and clinical stage was poorer at the time of diagnosis.
For the low-income group, compared to the middle- and high-income groups, patients were more likely to regard burden (78.8% vs. 76.0% vs. 65.2%, respectively; p<0.01) and cost of cancer (61.2% vs. 38.5% vs. 14.5%, respectively; p<0.01) as highly important. At one year, the groups did not largely differ in terms of overall treatment, but the high-income group was more likely to undergo surgery and less likely to undergo radiation.
“Poor patients with low household income have worse prostate cancer at diagnosis. These patients have different goals of care which impact their choice of treatment. These findings provide novel insight into disparities in diagnosis and outcome in prostate cancer,” the researchers concluded.