Introduction: Dual eligible beneficiaries are a particularly vulnerable population, as they qualify for Medicare due to age and Medicaid due to low income. Though some dual eligible beneficiaries have access to additional social services, such as transportation coverage, others do not qualify for these services (i.e. partial dual eligibility). This heterogeneity in support services may impact access to treatment for dual eligible men with newly diagnosed prostate cancer, a condition that necessitates timely, repeated interactions with the healthcare system. Methods: We performed a cohort study of Medicare beneficiaries who were diagnosed with prostate cancer between 2015 and 2019. Beneficiaries were required to have 12-months of eligibility before and after diagnosis date. We compared pre-diagnosis testing, post-diagnosis testing, and primary prostate cancer treatment between beneficiaries who have full dual-eligibility (full duals, “F”), partial dual-eligibility (partial duals, “P”) and those who are not dual-eligible (non-duals, “N”) Results: In 138,785 men with newly diagnosed prostate cancer, 4,611 (3.3%) were full duals and 2,031 (1.5%) were partial duals. Full and partial duals (Figure) were more often of Black race than non-duals (p < 0.001). Partial duals were less likely to have a PSA (p < 0.001) or multiparametric MRI (p < 0.001) prior to diagnosis, compared to both duals and non-duals. After diagnosis, full and partial duals less commonly underwent multiparametric MRI (F-17%, P-15%, N-24%, p<0.001) and more commonly underwent bone scan (F-43%, P-42%, N-33%, p<0.001) compared to non-duals. Regarding treatment (Figure), full and partial duals less commonly underwent surgery (F-12%, P-13%, N-20%) and more commonly received androgen deprivation therapy as a primary treatment (F-16%, P-13%, N-7%) compared to non-duals (p < 0.001). Conclusions: Our findings demonstrate disparities in access for dual-eligible beneficiaries before and after a new prostate cancer diagnosis. A more advanced stage at diagnosis may be reflected by the higher rates of bone scan testing and treatment with primary androgen deprivation therapy in the duals. A deeper understanding of barriers in access to prostate cancer screening and treatment is needed for this particularly vulnerable population. SOURCE OF Funding: This study is supported by funding from the National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the Prostate Cancer Foundation-Pfizer Health Equity Grant No K08CA237638 (Herrel).
