Rutgers Cancer Institute of New Jersey New Brunswick, NJ
S. Mamidanna, R. Kumar, Z. Sherwani, and M. D. Mattes; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
Purpose/Objective(s): Estimating life expectancy is an important initial step in stratifying patients with localized prostate cancer for definitive treatment versus observation. Current guidelines recommend that patients have a life expectancy of at least five years to consider definitive treatment for intermediate and high-risk prostate cancer, and ten years for patients with low-risk prostate cancer. Although several tools exist to estimate life expectancy in men, these may be less accurate for certain patient populations. Our hypothesis in this study is that underserved patients at a safety net hospital will tend to be overtreated with curative-intent radiation therapy (RT) for prostate cancer due to an actual life expectancy that is shorter than predicted. Materials/
Methods: The charts of all 402 men treated with definitive or post-prostatectomy RT with curative intent at a single safety net hospital from 2004 to 2024 were retrospectively reviewed. All patients had an estimated life expectancy of at least 10 years to be considered candidates for treatment. Demographics were recorded as well as the Area Deprivation Index (ADI) for each subject based on their 9-digit zip code. Descriptive statistics are reported. The Kaplan-Meier method was used to assess overall survival (OS) for the entire cohort of patients. The log-rank test was used to evaluate the impact of various demographic features on survival outcomes. A p-value less than 0.05 was considered statistically significant. Results: The entire cohort of patients had median age of 64.7 years (interquartile range 60.8 - 70.2). 139 patients (33%) were Black, 53 (12.6%) were hispanic, 6 (1.4%) were white, and 36 (8.6%) were other or mixed race. The ethnicity was not reported for 42.9% of the patients. The median OS of the entire cohort was 14.5 years (95% CI 11.75-17.3). The- 5 and 10-year actuarial OS were 88% and 73%, respectively. Among the 54 patients who died within 10 years of completing RT, 74.1% were Black, 7.4% (n=4) were Hispanic and 5.6% (n=3) were white. Further sub-group analysis of the patients deceased within 10 years showed that 68.5% were from an ADI associated with moderate to high deprivation and worse socioeconomic status. There were non-significant trends towards inferior overall survival associated with Black race (p=0.145), and higher ADI (p=0.513). Conclusion: Along with patients medical information, social determinants such as high deprivation index, low socioeconomic status and race should also be considered when evaluating patients for curative intent-treatment of prostate cancer, as they can adversely affect life expectancy predictions.
