Authors: Adrien Bernstein, Ruchika Talwar, Elizabeth Handorf, Kaynaat Syed, John Danella, Serge Ginzburg, Laurence Belkoff, Adam Reese, Jeffery Tomaszewski, Eric Singer, Edouard Trabulsi, Bruce Jacobs, Jay Raman, Alex Kutikov, Thomas Guzzo, Robert Uzzo, Marc Smaldone, Andres Correa
: Minority communities disproportionately shouldered poor COVID-19 outcomes, however the impact of the pandemic on prostate cancer (PCa) surgery is unknown. To that end, we sought to determine the racial impact on PCa care during the first wave of the pandemic.Methods
: Using a multi-institutional collaborative we evaluated practice patterns for Black and White patients with untreated non-metastatic PCa during the initial COVID-19 lockdown (March-May 2020) compared to prior (March-May 2019). Patient and practice characteristics were compared by race using Fisher’s exact and Pearson’s chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race*year interaction term.Results
: Among the 647 men with non-metastatic PCa, 269 received care during the pandemic and 378 prior. Surgery was significantly less likely in Black men (1.3% v 25.9%;p<0.001), despite similar COVID-19 risk factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p=0.75). Black men had higher PSA (8.8 vs. 7.2 p=0.04) and were younger ( 38.2% vs. 24.4% <60yr;p=0.09). Regression results demonstrated an 94% reduced odds of surgery (OR=0.06,95%CI 0.007-0.43;p=0.006) for Black patients, with no change for White patients (OR= 1.41,95%CI 0.89-2.21;p=0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients (figure).Conclusions
: In a large multi-institutional regional collaborative, odds of prostatectomy declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, this study illuminates systemic inequities within healthcare. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.Source of Funding
: PURC is funded by the Health Care Improvement Foundation through practice participation.