Factors impacting decision by African American and underserved populations to choose active surveillance in early-stage prostate cancer.

Abstract

5067 Background: African-American (AA) men have the highest rates of prostate cancer (PCa) incidence and mortality in the U.S. Screening for PCa with prostate specific antigen (PSA) has allowed detection of early stage disease, but side effects of radical prostatectomy and radiation raise concerns about unfavorable risk:benefit ratios of PSA screening and subsequent therapy. Active surveillance (AS) is an option for early-stage PCa (ESPC), but only 10% of men eligible for AS choose this approach. The 2011 NIH State-of-the-Science Conference promoted the need to enhance decision-making (DM) about AS. In 2012, the U.S. Preventive Services Task Force recommended against PSA screening, while encouraging patient DM. Our study examined DM needs by men (N=204; 68% AA; screening PSA within normal limits) and their significant others (SO) (N=181; 65% AA) regarding AS and other ESPC options. Methods: This multi-center, mixed methods study (N=402; 51% rural) included 5 sites nationwide. Subjects completed quantitative questionnaires prior to focus groups (FG); 54 FG were held, with separate groups for men and SO. Results: After adjusting for education, comorbidities, insurance, age, health literacy, distance to treatment center, willingness to travel, income and numeracy score, AA men were significantly more likely to be influenced by convenience (OR: 2.84, 95% CI: 1.42-5.65) compared to Caucasians. Rural residence, however, did not affect DM. In qualitative analysis, numerous themes were identified relevant to choice of AS: physician treatment discussions being limited to their own specialty; confusion due to conflicting sources of information; convenience; worry about untreated cancer remaining and treatment toxicities; and lack of awareness of AS as an option. SO tended to value cure over avoiding side effects. Conclusions: While the impact of new PCa screening guidelines is uncertain, for AS to become a viable treatment option, providers will need to discuss along with other therapeutic alternatives. SO are influential in DM and may be less enthusiastic about AS than men. For AA men, AS may be a particularly attractive option given the relative influence of convenience in DM.

Leveraging system sciences methods in clinical trial evaluation: An example concerning African American women diagnosed with breast cancer via the Patient Navigation in Medically Underserved Areas study

“…Based on current practices, women are assumed to be navigated until they complete care (e.g., diagnostic follow-up; treatment). For breast cancer, we will use data from published literature for AAs' prevalence of breast cancer risk factors [90,91], breast cancer transition probabilities [92], rates of false-positives and false-negatives [[92], [93], [94], [95]], linkages between screening and stage at diagnosis [49,96,97], NCI's Surveillance Epidemiology and Ends Results (SEER) data for AAs' cancer incidence, stage at diagnosis, and survival data [98].…”

Religious Coping and Types and Sources of Information Used in Making Prostate Cancer Treatment Decisions

“…The disparity in prostate cancer outcomes may be partially attributed to the treatment decisions that men make. However, these decisions are not made in a vacuum and are often a function of several factors ( Gillespie et al, 2013 ; Sajid et al, 2012 ). Understanding the potential contribution of religion to prostate cancer treatment decisions can inform the development of effective interventions to address prostate cancer health disparities in diverse populations.…”