Racial Disparities Linked With High Rates of ADT-Related AEs in Prostate Cancer
Significant differences in the incidence of genitourinary events, depression, and ischemic and thrombotic events were observed based on race among patients with prostate cancer after receiving androgen deprivation therapy.
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Racial disparities contributed to the increased incidence of androgen deprivation therapy (ADT)-related adverse events (AEs) among patients with prostate cancer, according to study findings presented at the 2023 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) meeting.
While there were significant differences observed regarding the incidence of genitourinary events, depression, and ischemic and thrombotic events by race, no significant differences were seen in the incidence of cardiovascular events across race. Non-Hispanic Caucasian patients were more likely to experience genitourinary events compared with non-Hispanic African Americans (56.14% v 48.77%) and Asians or Pacific Islanders (56.14% v 44.34%), respectively.
A percentage of patients with depression was also higher among patients who were non-Hispanic Caucasian vs Asians or Pacific Islanders (21.12% v 14.24%). Also, ischemic, and thrombotic events were more likely to be found in non-Hispanic African Americans compared with non-Hispanic Caucasians (16.98% v 13.87%).
In this retrospective cohort study, male patients with a primary diagnosis of metastatic prostate cancer who were aged 66 years or older were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset from January 2010 to December 2017. The ADT-related outcomes evaluated were made up of genitourinary complications, depression, ischemic and thrombotic events, and cardiovascular events.
The study considered patients as experiencing the outcomes if they had any inpatient claim with CPT codes or at least 2 physician or outpatient claims which were billed at least 30 days apart from any of the events, and the incidence of AEs were examined stratified by race.
To assess the effects of race on ADT-related complications after controlling for many covariates, including age at diagnosis, year of diagnosis, marital status, income quintile, residence of metropolitan area, SEER region, Gleason score, and Charlson Comorbidity score, competing risk regression models were utilized.
Findings revealed differences in the incidence of genitourinary events, depression, and ischemic and thrombotic events were seen depending on race. However, when evaluating the incidence of cardiovascular events, there were no significant differences across race.
Looking at comparative risk of ADT-related complications stratified by race after adjusting for covariates, non-Hispanic African Americans had a lower incidence of genitourinary complications compared with non-Hispanic Caucasians (HR, 0.47; 95% CI, 0.23-0.98). American Indians/Alaska Natives had a higher risk of these complications vs non-Hispanic Caucasians (HR, 7.28; 95% CI, 2.63-20.16).
Asians or Pacific Islanders were less likely to experience depression compared with non-Hispanic Caucasians (HR, 0.49; 95% CI, 0.27-0.89) and ischemic and thrombotic events were also less likely to be experienced among these patients (HR, 0.39; 95% CI, 0.17-0.88). Further, there was no significant difference across race regarding the incidence of cardiovascular events.
Overall, these findings show that racial disparities exist and play a role in the incidence of ADT-related AEs among patients with prostate cancer. Clinicians must focus more attention on the patients whose populations are at greater risk for each ADT-related AE.
