The impact of household income on prostate cancer diagnosis, treatment, and outcomes.

person John Panzone SUNY Upstate Medical University, Syracuse, NY info_outline John Panzone, Maximillian S Wu, Thenappan Chandrasekar, Alina Basnet, Gennady Bratslavsky, Hanan Goldberg

Authors person John Panzone SUNY Upstate Medical University, Syracuse, NY info_outline John Panzone, Maximillian S Wu, Thenappan Chandrasekar, Alina Basnet, Gennady Bratslavsky, Hanan Goldberg Organizations SUNY Upstate Medical University, Syracuse, NY, Department of Urology, University of California Davis, Sacramento, CA, SUNY Upstate Medical University, Department of Hematology/Oncology, Syracuse, NY, SUNY Upstate Medical University, Department of Urology, Syracuse, NY Abstract Disclosures Research Funding No funding received None. Background: Financial difficulties can lead to cancer patients delaying or deferring necessary care, resulting in later presentation with more advanced disease and worse clinical outcomes. Methods: A cross-sectional study was conducted assessing 488,853 prostate cancer patients from the Surveillance, Epidemiology, and End Results (SEER) Program between the years of 2010 and 2018. The association between annual household income (HHI) and diagnosis and outcomes of prostate cancer were examined using ANOVA and Chi-square analyses comparing clinical measures based on categorical HHI groupings. Results: Sociodemographic data and univariate analyses are displayed. The average age across all HHI classifications was 66.63 years. ANOVA analysis demonstrated that patients with a lower HHI had higher PSA levels upon diagnosis (12.10 vs. 10.90, 10.61, and 10.37 for <=35k, 35-55k, 55-75k, and >=75k, respectively, p<0.001). Patients with lower HHI also demonstrated lower rates of undergoing surgical treatment (31.9%, 36.9%, 37.6%, and 35.1% for <=35K, 35-55k, 55-75k, and >=75k, respectively, p<0.001) and the highest rate of disease metastasis to bone upon diagnosis (6.3%, 5.6%, 5.7%, and 5.8% for <=35k, 35-55k, 55-75k, and >=75k, respectively, p<0.001). Lastly, patients with lower HHI demonstrated progressively higher rates of cancer-specific-mortality (8.4%, 6.8%, 6.5% and 5.1% for <=35k, 35-55k, 55-75k, and >=75k, respectively, p<0.001), as well as higher overall mortality (21.2%, 18.0%, 15.0%, and 11.9% for <=35k, 35-55k, 55-75k, and >=75k, respectively, p<0.001). Conclusions: In conclusion, these data suggest that prostate cancer patients with lower household income are diagnosed with more aggressive disease, tend to undergo surgery at lower rates, develop more advanced disease, and endure worse clinical outcomes than those in higher income brackets. Healthcare providers should be made aware of the clear associations between lower income and more aggressive disease at diagnosis, lower rates of surgical treatment and worse cancer-specific and overall mortality. Sociodemographic data and univariate analyses stratified by household income. Household income (dollars) <35,000 (n=7,577) 35,000-55,000 (n=112,951) 55,000-75,000 (n=219,382) 75,000+ (n=148,943) p-value Mean age (years) 66.72 66.65 66.58 66.67 p=0.10 Cancer specific mortality (n, %) 638 (8.4%) 7,690 (6.8%) 14,253 (6.5%) 7,574 (5.1%) p<0.001 Overall mortality (n, %) 1,605 (21.2%) 20,311 (18.0%) 33,003 (15.0%) 17,790 (11.9%) p<0.001 Received Surgical treatment (n, %) 2,416 (31.9%) 41,725 (36.9%) 82,459 (37.6%) 52,348 (35.1%) p<0.001 Bone metastasis on diagnosis (n, %) 476 (6.3%) 6,345 (5.6%) 12,515 (5.7%) 8,612 (5.8%) p<0.001