Prostate Cancer Treatment for Economically Disadvantaged Men

A Comparison of County Hospitals and Private

Published In: Cancer, v. 116, no. 5, Mar. 1, 2010, p. 1378-1384

Posted on on January 01, 2010

by J. Kellogg Parsons, Lorna Kwan, Sarah Connor, David C. Miller, Mark Litwin

Read More

Access further information on this document at John Wiley and Sons

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: The authors compared the types of treatments prostate cancer patients received from county hospitals and private providers as part of a statewide public assistance program. METHODS: This was a cohort study of 559 men enrolled in a state-funded program for low-income patients known as Improving Access, Counseling, and Treatment for Californians With Prostate Cancer (IMPACT). Multinomial regression was used to compare types of treatments patients received from different providers. RESULTS: Between 2001 and 2006, 315 (56%) participants received treatment from county hospitals and 244 (44%) from private providers. There were no significant between-group differences with respect to age (P = .22), enrollment year (P = .49), Charlson comorbidity index (P = .47), Gleason sum (P = .33), clinical T stage (P = .36), prostate-specific antigen (P = .39), or D'Amico risk criteria (P = .45). Participants treated by private providers were more likely than those treated in county hospitals to be white (35% vs 10%, P < .01) and less likely to undergo surgery (29% vs 54%, P < .01). Multinomial regression analyses showed that participants treated by private providers were nearly 2 times more likely than those treated by public providers to receive radiotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.37-4.07) and >4 times more likely to receive primary androgen deprivation (OR, 4.71; 95% CI, 2.15-10.36) than surgery. CONCLUSIONS: In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers. These data reveal substantial variations in treatment patterns between different types of healthcare institutions that - given the implications for health policy and quality of care - merit further scrutiny.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.