Disparities in prostate cancer diagnosis, treatment, and survival among men with disabilities: Retrospective cohort study in South Korea.

BACKGROUND: Disparities in cancer care have not been well documented for individuals with disability. OBJECTIVE: To investigate potential disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status. METHODS: A retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. Totals of 7924 prostate cancer cases among patients with disabilities (diagnosed between 2005 and 2013) and 34,188 PC patients without disability were included. RESULTS: While overall PC stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18.1% vs. 16.2%, respectively). People with disabilities were less likely to undergo surgery (33.1% vs. 38.6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74-0.84), and more likely to receive androgen deprivation therapy (ADT) (57.9% vs. 55%, respectively; aOR 1.10, 95% CI 1.04-1.16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0.29 for surgery; 1.52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1.20; 95% CI, 1.15-1.25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1.11, 95% CI 1.04-1.18) than people without disability. CONCLUSIONS: PC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse.

Genotypes of TNF-alpha, VEGF, hOGG1, GSTM1, and GSTT1: useful determinants for clinical outcome of bladder cancer.

OBJECTIVES: To determine whether polymorphisms of tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), human 8-oxoguanine DNA glycosylase 1 (hOGG1), glutathione S-transferase-mu (GSTM1), and glutathione S-transferase-phi (GSTT1) are risk factors for bladder cancer among Koreans. METHODS: We performed polymerase chain reaction-restriction fragment length polymorphism and multiplex polymerase chain reaction in blood genomic DNA of 153 patients with primary bladder cancer and 153 control subjects. RESULTS: GSTM1-negative, GSTT1-positive, and hOGG1 Ser326Ser and Ser326Cys genotypes are risk factors for bladder cancer (P = 0.020, P = 0.044, and P = 0.012, respectively). The cancer stage was significantly associated with the TNF-alpha genotype (GG versus GA and AA; P = 0.036). A notable correlation was observed between the VEGF genotype and grade (P = 0.015). In patients with superficial bladder cancer, the hOGG1 genotype was related to recurrence. The hOGG1 Ser326Ser and Ser326Cys genotypes were risk factors for superficial bladder cancer recurrence compared with the Cys326Cys genotype (P = 0.033, adjusted odds ratio 5.580, 95% confidence interval 1.145 to 27.183). Patients with the GSTM1-positive genotype were at a 3.3-fold increased risk of cancer progression compared with those with the GSTM1-negative genotype (P = 0.009, adjusted odds ratio 0.303, 95% confidence interval 0.123 to 0.745). CONCLUSIONS: Our data collectively suggest that these genetic polymorphisms may be useful as prognostic markers for bladder cancer in the clinical setting.