Older men with prostate cancer who receive federal housing assistance at the time they are first diagnosed have better two-year survival chances compared to demographically and clinically similar men without that assistance, new UCLA-led research suggests.
The findings, to be published in the peer-reviewed Journal of the National Cancer Institute, suggest that expansion of housing assistance could lead to improved survival odds for prostate cancer patients who are unable to find affordable housing due to socioeconomic factors.
Prostate cancer causes over 36,000 deaths each year, making it the second leading cause of cancer-related death among men in the U.S., said Dr. Katherine Chen , assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and the study's lead author. Survival varies by socioeconomic status, race and ethnicity.
"Receipt of appropriate prostate cancer care may help alleviate these survival disparities but is often limited by socioeconomic barriers," Chen said. "Housing insecurity, defined as insufficient access to safe, stable, affordable housing, is increasingly recognized as one such barrier to optimal cancer care. Mitigating the harmful impact of housing insecurity on prostate cancer outcomes is especially urgent among older adults of low socioeconomic status, who face record-high housing affordability burdens and the fastest-growing rates of homelessness of any age group."
Previous work by Chen and her co-researchers found an association between receipt of housing assistance and earlier-stage cancer diagnosis among individuals with several common cancers, including breast, colorectal, and non-small-cell lung cancers. For this new study, the researchers examined the potential link between housing assistance and overall survival and cancer care.
The researchers used federal housing assistance data, Surveillance, Epidemiology, and End Results (SEER) cancer registry data, and Medicare claims to analyze workup and treatment receipt and two-year survival among men aged 66 to 95 years-old who were diagnosed with prostate cancer between 2007 and 2019. There were 1,800 men with housing assistance and 5,500 without the assistance in the researchers' workup and treatment model. For the survival models, the researchers found 4,450 men with the assistance and 13,300 without the same housing help.
They found that the men with housing assistance had a 12% lower risk of dying at a given time since diagnosis compared with their counterparts without the assistance.
The researchers had expected to find a link between housing assistance and improved participation in prostate cancer workup and treatment. They were surprised that there were no such significant associations. "However, it is important to note that this finding may not be generalizable to other cancers," she said. "Prostate cancer is unique in that most men are diagnosed at an early stage, where active surveillance--where there is no active treatment-- is a guideline-concordant strategy for care."
But housing assistance may help low-income patients obtain access to other health care, engage in healthy behaviors and reduce stress, which could support their health and longevity. This makes it less likely that they would die from non-cancer related conditions, though not less likely to die from prostate cancer itself relative to the comparison group. Due to limited funding for housing assistance, however, most income-eligible people do not receive this assistance, Chen said.
"Our results suggest that policies extending housing assistance to a greater number of eligible households could promote improved survival among low-income older adults with prostate cancer, ultimately helping to reduce socioeconomic and possibly racial/ethnic disparities," she said.
There are some study limitations. Among them, data linkage may have missed some people with Housing and Urban Development (HUD) assistance, the analysis may have obscured differences in how state and local authorities administer the federal housing assistance program, and the researchers could not distinguish between patient preferences for curative treatment versus active surveillance.
A key next step is to explore whether housing assistance improves prostate cancer survival by improving non-cancer comorbidities and other factors linked with survival, Chen said. "We are also currently examining the association of housing assistance with treatment and survival in other cancers," she said.
The National Cancer Institute at the National Institutes of Health (R01CA269488, R50CA304954) funded this study.
Study co-authors are Taylor Craig, Amanda Blackford, Dr. Daniel Song, Rebecca Smith, Jordan Kaplan, Dr. Robyn Jordan, Daniel Polsky, and Dr. Craig Evan Pollack of Johns Hopkins University; Joan Warren,. Qinjin Fan, Margaret Katana Ogongo, and K. Robin Yabroff of the American Cancer Society; Dr. S.M. Qasim Hussaini of the University of Alabama at Birmingham; Xin Hu of Emory University; and Dr. Cary Gross of Yale University.
