Fox Chase Researchers Assess Racial Disparities in Prostate Cancer Treatment During COVID-19

Dr. Adrien Bernstein, a urologic oncology fellow at Fox Chase and lead researcher on the project
Dr. Adrien Bernstein, lead author on the study and second year urologic oncology fellow at Fox Chase

PHILADELPHIA (July 22, 2021)—In a study published today in JAMA Oncology, researchers at Fox Chase Cancer Center found that the odds of a patient undergoing prostate cancer surgery were lower among Black patients compared with white patients during the initial wave of the COVID-19 pandemic.

Prostate cancer is the most common malignancy after skin cancer and the second leading cause of cancer death in American men. It affects one in eight men, with that number rising to one in six for Black men.

“If you look at the prostate cancer literature there is an unfortunate signal that Black patients do worse than white patients when it comes to prostate cancer outcomes,” said Andres F. Correa, MD, author on the study and assistant professor for the Department of Surgical Oncology at Fox Chase.

“Historically there has been interest in exploring possible genetic links that may explain the difference in outcomes between Black and white patients. Recent reports, however, have demonstrated that when you provide equal care, those differences go away,” he said.

The study was prompted by early reports showing that minority populations were disproportionately adversely affected by the COVID-19 pandemic. Correa said they sought to assess how a significant stressor, such as the lockdown, affected the delivery of routine cancer care within a certain region.

The study compared prostatectomy rates between Black and white patients with untreated, non-metastatic prostate cancer during the COVID-19 pandemic and was based on numbers from the Pennsylvania Urologic Regional Collaborative (PURC) database. A prostatectomy is a surgical procedure involving the complete removal of the prostate.

“Prior to the pandemic, there was no difference in the rate of surgery for Black and white patients diagnosed with prostate cancer,” said Adrien Bernstein, MD, lead author on the study and second year urologic oncology fellow at Fox Chase. “During the pandemic, however, Black men were 97% less likely than white men to undergo a prostatectomy.”

The study further demonstrated that these changes in care were not secondary to difference in prostate cancer severity or the risk of severe COVID-19 infections. Rather, the disparity in surgical treatment was driven by clear systemic variations—institutions that cared for a greater proportion of black patients experience a greater decline in operative volume.

The researchers note that this study highlights the potential frailty of the healthcare system and caution that patterns such as those reported in the study are likely unfolding across medicine.

“Healthcare disparities are often multifactorial in origin and represent a key determinant of health. Only by bringing these inequities to light are we able to begin the work to rectify them,” said Bernstein. “Different policies were enacted for different communities. While prostate cancer surgery can be safely delayed up to a year, balanced mitigation strategies are needed as we continue to navigate the COVID-19 pandemic.”

The study, “Assessment of Prostate Cancer Treatment Among Black and White Patients During the COVID-19 Pandemic,” is now available.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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