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UPJ INSIGHT Inequities in Treatment for Localized Prostate Cancer Among Those With Mental Health Disorders

By: Joshua Cabral, MD, University of Chicago, Illinois; Sarah K. Holt, PhD, University of Washington, Seattle, Fred Hutch Cancer Center, Seattle, Washington; Samuel L. Washington, III, MD, MAS, University of California-San Francisco; Erin Dwyer, MS, University of Washington, Seattle; Jenney R. Lee, MA, University of Washington, Seattle; Erika M. Wolff, PhD, University of Washington, Seattle; John L. Gore, MD, MS, University of Washington, Seattle, Fred Hutch Cancer Center, Seattle, Washington; Yaw A. Nyame, MD, MS, MBA, University of Washington, Seattle, Fred Hutch Cancer Center, Seattle, Washington | Posted on: 15 Dec 2023

Cabral J, Holt SK, Washington SL 3rd, et al. Inequities in definitive treatment for localized prostate cancer among those with clinically significant mental health disorders. Urol Pract. 2023;10(6):656-663.

Study Need and Importance

It is estimated that approximately half of US adults would meet the criteria for a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) disorder at some point in their lifetime. With the incidence of mental health disorders increasing, there exists a need to understand treatment trends in this population. There are limited data currently on the associations between mental health, social factors (ie, race), and prostate cancer–related treatment and outcomes.

What We Found

The Figure shows the distribution of treatment among the cohort and subgroups. Among individuals diagnosed with a mental health disorder, most patients received either no treatment or androgen deprivation therapy alone. On multivariable analysis, we found that individuals were less likely to receive definitive treatment if diagnosed with a mental health disorder than those without. Among patients who received definitive treatment, patients were less likely to have undergone a radical prostatectomy if they were diagnosed with a mental health disorder, were unpartnered, or were Black.

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Figure. The distribution of treatments by mental health diagnosis among men in Surveillance, Epidemiology, and End Results–Medicare (2004-2015) with localized, clinically significant prostate cancer. ADT indicates androgen deprivation therapy; PTSD, post-traumatic stress disorder.

Limitations

To maximize the accuracy of mental health diagnoses in the cohort, we required individuals to have a code associated with a mental health condition at 2 different visits within 2 years of diagnosis of prostate cancer. This restriction may have excluded many individuals with mental health disorders. Furthermore, we did not have information on disease severity and treatment for mental health diagnosis, which is a factor to consider in the impact on prostate cancer care.

Interpretation for Patient Care

It is evident that individuals with a history of a mental health disorder demonstrated a disproportionately lower rate of receiving definitive treatment and a higher rate of primary androgen deprivation therapy when compared to individuals without. Identifying this disparity is a crucial first step in helping to address the specific clinical and social needs in receiving prostate cancer treatments in this population.

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