Advancing Health Equity: Addressing Disparities in Prostate Cancer Care

To advance health equity in the field of urologic oncology, individual healthcare providers, practices, and institutions must make a conscious effort to understand and address health and healthcare disparities. Data from the Surveillance, Epidemiology, and End Results (SEER) Program indicate that non-Hispanic black men are 1.7 times more likely to develop prostate cancer and 2.1 times more likely to die from the disease than non-Hispanic white men. The drivers of these specific disparities are not perfectly understood, but likely are related to modifiable factors, including relatively less access to, and uptake of, prostate-specific antigen (PSA) screening and lack of inclusion in clinical trials, without which, genetic differences that may drive differential response to interventions may not be properly assessed.

Recognizing the influence that disparities in prostate cancer care have on patient outcomes, the American Urological Association (AUA) collaborated with Pfizer Oncology to assess current practice patterns for those with prostate cancer and identify promising approaches to improve care, particularly among vulnerable populations. This was accomplished by developing and fielding a survey of AUA members and conducting in-depth interviews with three physicians who have spearheaded efforts to address health and healthcare disparities in prostate cancer.

Integration in Action: A Focus on Urologic Oncology Care Through Medically Integrated Dispensing

Oral chemotherapy (i.e., oral oncolytics) is a broad class of pharmaceutical agents that may be used in the treatment of several urologic cancers, including prostate cancer. Although initially provided via specialty or mail-order pharmacies, oral oncolytics can now be dispensed from within the physician’s practice. While in-office dispensing can facilitate care coordination and close monitoring of the patients taking these medications, some practices have moved beyond simple dispensing, and now provide multi-disciplinary, integrated care to patients using a medically integrated dispensing (MID) model.

Recognizing the value of an integrated care approach to pharmacy services, the American Urological Association (AUA) collaborated with The National Community Oncology Dispensing Association (NCODA) and Pfizer Oncology to assess current practice patterns around pharmacy integration and identify existing practices to optimize urological cancer patient care through the MID approach. This was accomplished by developing and fielding a survey to assess oral oncolytic prescribing practices, medication management, and activities and challenges of MIDs, and developing an infographic to display key results. Additionally, AUA and NCODA staff conducted in-depth qualitative interviews with representatives from two urologic practices that operate MIDs. From these interviews, several key takeaways emerged for practices looking to establish or enhance existing MIDs.

While there is no one-size-fits-all model for every program, this resource offers valuable insights for those looking to promote patient education, engagement, and shared decision-making in their practice.

To learn more about MIDs, please visit www.ncoda.org.

Steps to Success: Improving Advanced Prostate Cancer Patient Management and Care Coordination Toolkit

Prostate cancer is the most commonly diagnosed solid organ malignancy for men in the United States and remains the second leading cause of cancer deaths for this population. Clinical advancement through the advent of combination therapies has resulted in a renaissance in the entire landscape for clinicians caring for men with advanced prostate cancer (APC). While offering significant survival benefits, such therapeutic development also renders clinical decision-making and the treatment environment itself increasingly complicated.

It is with such considerations in place that the American Urological Association (AUA) collaborated with Pfizer Oncology in a process improvement project to study APC patient management and identify key practices to improve patient care coordination. AUA and Pfizer Oncology jointly developed and fielded a survey of healthcare providers to assess current practice patterns in various settings and to identify best practices around care of APC patients. Survey queries touched on areas including demographics, patient monitoring, practice management, and quality and data/analytics.

There is no one-size-fits-all model for every program, but the Steps to Success Toolkit may serve as a valuable roadmap for others who are thinking about implementing an APC program or looking for guidance on how to improve the care of their patients.