Skip to main content

Advertisement

Log in

Racial disparities in the use of palliative therapy for ureteral obstruction among elderly patients with advanced prostate cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objectives

Palliative issues are an important but understudied issue for patients with advanced cancer. Ureteral obstruction is a complication of advanced prostate cancer, usually relieved with placement of retrograde ureteral stent (RUS) or percutaneous nephrostomy (PCN) to palliate symptoms associated with obstructive uropathy and/or renal failure. We investigated predictors of receipt of RUS and PCN and their association with survival for older advanced prostate cancer patients.

Methods

Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified patients aged 65 or older with stage IV (n = 10,848) or recurrent (n = 7,872) prostate cancer. We used multivariable analysis to compare those with ureteral obstruction treated with RUS or PCN to those not treated and to analyze the association between RUS, PCN, and survival.

Results

Sixteen percent (n = 2,958) of the sample developed ureteral obstruction. Compared to no treatment, African Americans were more likely to undergo placement of PCN [odds ratio 1.48, 95 % confidence intervals (CI) 1.03–2.13] than Whites, but equally likely to receive a stent. Subjects of >80 years were less likely to undergo RUS (ages 80–84, 0.41, 95 % CI 0.27–0.63; ages ≥85, 0.30, 95 % CI 0.16–0.54) compared to patients 65–69 years. Subjects who received a PCN were 55 % more likely to die than those who were untreated. There was no difference in survival among those receiving RUS vs untreated. Nine percent of subjects received RUS or PCN within 30 days of dying.

Conclusions

This is the first population-based study to demonstrate a racial disparity in the palliative treatment of advanced prostate cancer. Reasons for disparate care need to be determined so that interventions may be developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kouba E, Wallen EM, Pruthi RS (2008) Management of ureteral obstruction due to advanced malignancy: optimizing therapeutic and palliative outcomes. J Urol 180:444–450

    Article  PubMed  Google Scholar 

  2. Wong LM, Cleeve LK, Milner AD, Pitman AG (2007) Malignant ureteral obstruction: outcomes after intervention. Have things changed? J Urol 178:178–183, discussion 83

    Article  PubMed  Google Scholar 

  3. Wilson JR, Urwin GH, Stower MJ (2005) The role of percutaneous nephrostomy in malignant ureteric obstruction. Ann R Coll Surg Engl 87:21–24

    Article  PubMed  CAS  Google Scholar 

  4. Ku JH, Lee SW, Jeon HG, Kim HH, Oh SJ (2004) Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic ureteral obstruction in advanced malignancies: are there differences? Urology 64:895–899

    Article  PubMed  Google Scholar 

  5. Ganatra AM, Loughlin KR (2005) The management of malignant ureteral obstruction treated with ureteral stents. J Urol 174:2125–2128

    Article  PubMed  Google Scholar 

  6. Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG, Barry MJ (2003) Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 169:1065–1069, discussion 9

    Article  PubMed  CAS  Google Scholar 

  7. Shekarriz B, Shekarriz H, Upadhyay J et al (1999) Outcome of palliative urinary diversion in the treatment of advanced malignancies. Cancer 85:998–1003

    Article  PubMed  CAS  Google Scholar 

  8. Potosky AL, Riley GF, Lubitz JD, Mentnech RM, Kessler LG (1993) Potential for cancer related health services research using a linked Medicare-tumor registry database. Med Care 31:732–748

    Article  PubMed  CAS  Google Scholar 

  9. Du XL, Fang S, Vernon SW et al (2007) Racial disparities and socioeconomic status in association with survival in a large population-based cohort of elderly patients with colon cancer. Cancer 110:660–669

    Article  PubMed  Google Scholar 

  10. Klabunde CN, Potosky AL, Legler JM, Warren JL (2000) Development of a comorbidity index using physician claims data. J Clin Epidemiol 53:1258–1267

    Article  PubMed  CAS  Google Scholar 

  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  12. Zeger SL, Liang KY, Albert PS (1988) Models for longitudinal data: a generalized estimating equation approach. Biometrics 44:1049–1060

    Article  PubMed  CAS  Google Scholar 

  13. Lee EW, Wei LJ, Amato DA, eds. Cox-type regression analysis for large numbers of small groups of correlated failure time observations; 1992.

  14. Sandhu DP, Mayor PE, Sambrook PA, George NJ (1992) Outcome and prognostic factors in patients with advanced prostate cancer and obstructive uropathy. Br J Urol 70:412–416

    Article  PubMed  CAS  Google Scholar 

  15. Oefelein MG (2004) Prognostic significance of obstructive uropathy in advanced prostate cancer. Urology 63:1117–1121

    Article  PubMed  Google Scholar 

  16. Joshi HB, Adams S, Obadeyi OO, Rao PN (2001) Nephrostomy tube or ‘JJ’ ureteric stent in ureteric obstruction: assessment of patient perspectives using quality-of-life survey and utility analysis. Eur Urol 39:695–701

    Article  PubMed  CAS  Google Scholar 

  17. Hoffman RM, Gilliland FD, Eley JW et al (2001) Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst 93:388–395

    Article  PubMed  CAS  Google Scholar 

  18. Polednak AP (2003) Black-white differences in survival from late-stage prostate cancer. Ethn Dis 13:220–225

    PubMed  Google Scholar 

  19. Radecka E, Magnusson M, Magnusson A (2006) Survival time and period of catheterization in patients treated with percutaneous nephrostomy for urinary obstruction due to malignancy. Acta Radiol 47:328–331

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant (PC094372) from the Department of Defense.

Conflict of interest

None of the authors has a conflict of interest to report. No author has a financial relationship with the organization that sponsored the research. The authors have full control of the data used for analysis in this study. We agree to allow the journal to review the data if requested.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Benjamin A. Spencer.

Additional information

The linked SEER–Medicare database was used in this study. The interpretation and reporting of these data are the sole responsibility of the authors.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spencer, B.A., Insel, B.J., Hershman, D.L. et al. Racial disparities in the use of palliative therapy for ureteral obstruction among elderly patients with advanced prostate cancer. Support Care Cancer 21, 1303–1311 (2013). https://doi.org/10.1007/s00520-012-1666-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-012-1666-6

Keywords

Navigation