Outcomes in Men Denied Access to a California Public Assistance Program for Prostate Cancer

Anger, Jennifer T.; Maliski, Sally L.; Krupski, Tracey L.; Kwan, Lorna; Gore, John L.; Fink, Arlène; Connor, Sarah E.; Orecklin, James R.; Litwin, Mark S.

doi:10.1177/003335490712200211

Cited by 11 publications

(6 citation statements)

References 17 publications

(18 reference statements)

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“…Without question, IMPACT enables eligible men to receive previously unattainable—and high quality—prostate cancer care 3,4. Moreover, individual program participants are highly satisfied with IMPACT services and providers 7,8.…”

Section: Discussionmentioning

confidence: 99%

“…Initiated in 2001, IMPACT provides free and comprehensive prostate cancer treatment to uninsured Californian men with incomes below 200% of the Federal Poverty Level 3,4. Based on preliminary clinical observations,4 we hypothesized that—in contrast to the broader population—the prevalence of non-metastatic prostate cancers with low-risk features has not increased over time among the disadvantaged men served by IMPACT.…”

Section: Introductionmentioning

confidence: 99%

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Prostate Cancer Severity Among Low Income, Uninsured Men

et al. 2009

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Purpose The proportion of American men with organ-confined, low-risk prostate cancers has increased significantly over the last two decades. Whether this trend also applies to men at the extremes of socioeconomic disadvantage remains unknown. We therefore evaluated trends in prostate cancer severity among an ethnically diverse cohort of low-income, uninsured men served by a state-funded public health program in California. Materials and Methods We performed a retrospective cohort study of 570 disadvantaged men enrolled in the California program from 2001 through 2006. Using routinely collected clinical variables, we defined two measures of cancer severity: 1) the proportion of enrollees with metastases at diagnosis; and 2) the proportions of men with non-metastatic tumors whose cancers had low-, intermediate-, or high-risk features at diagnosis. We performed bivariate analyses to assess time trends in cancer severity. Results Prostate-specific antigen levels at diagnosis exceeded 10 ng/mL for 51% of enrollees; 50% of men had a Gleason score ≥ 7; and 43% had a clinical T stage ≥ T2. Nineteen percent of disadvantaged men had metastatic cancer at the time of diagnosis; this proportion remained stable over time (p=0.66). Among men with non-metastatic cancers, 24% had tumors with low-risk features; the proportion of low-risk cancers did not increase over time (p=0.34). Conclusions Unlike the broader US population, the proportion of disadvantaged men with organ-confined, low-risk prostate cancers has not been increasing. Thus, while much attention focuses on potential overdiagnosis and overtreatment of men with screen-detected prostate cancers, our findings suggest that—for low-income, uninsured men—underdetection and undertreatment remain significant concerns.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prostate Cancer Severity Among Low Income, Uninsured Men

et al. 2009

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“…Without question, IMPACT enables eligible men to receive previously unattainable-and high qualityprostate cancer care. 3,4 Moreover, individual program participants are highly satisfied with IMPACT services and providers.7 , 8 From a population perspective, however, the persistent preponderance of metastatic and higher-risk localized cancers suggests that morecomprehensive strategies are needed to eradicate socioeconomic disparities in prostate cancer-specific morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Prostate Cancer Severity Among Low-Income, Uninsured Men

Miller¹,

Litwin²,

Stepanian³

et al. 2008

Journal of Urology

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Purpose-The proportion of American men with organ-confined, low-risk prostate cancers has increased significantly over the last two decades. Whether this trend also applies to men at the extremes of socioeconomic disadvantage remains unknown. We therefore evaluated trends in prostate cancer severity among an ethnically diverse cohort of low-income, uninsured men served by a state-funded public health program in California. Materials and Methods-We performed a retrospective cohort study of 570 disadvantaged men enrolled in the California program from 2001 through 2006. Using routinely collected clinical variables, we defined two measures of cancer severity: 1) the proportion of enrollees with metastases at diagnosis; and 2) the proportions of men with non-metastatic tumors whose cancers had low-, intermediate-, or high-risk features at diagnosis. We performed bivariate analyses to assess time trends in cancer severity.Results-Prostate-specific antigen levels at diagnosis exceeded 10 ng/mL for 51% of enrollees; 50% of men had a Gleason score ≥ 7; and 43% had a clinical T stage ≥ T2. Nineteen percent of disadvantaged men had metastatic cancer at the time of diagnosis; this proportion remained stable over time (p=0.66). Among men with non-metastatic cancers, 24% had tumors with low-risk features; the proportion of low-risk cancers did not increase over time (p=0.34).Conclusions-Unlike the broader US population, the proportion of disadvantaged men with organ-confined, low-risk prostate cancers has not been increasing. Thus, while much attention focuses on potential overdiagnosis and overtreatment of men with screen-detected prostate cancers, our findings suggest that-for low-income, uninsured men-underdetection and undertreatment remain significant concerns.

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“…accrued a control group of waitlisted patients to measure the significance of access to the IMPACT Program on HRQOL. 15 Eighty-three men in each group (waitlist vs enrolled) were matched on age, race, and tumor stage. Wait-listed men had worse symptom distress and less perceived efficacy than those actively enrolled.…”

Section: Ucla Men’s Health Studymentioning

confidence: 99%

Prostate cancer survivorship: Lessons from caring for the uninsured

Chamie¹,

Connor²,

Maliski³

et al. 2012

Urologic Oncology: Seminars and Original Investigations

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Since 2001, UCLA has operated IMPACT: Improving Access, Counseling and Treatment for Californians with prostate cancer. Funded by the California Department of Public Health, with a cumulative budget of over $80 million, the program provides comprehensive care for low-income, uninsured Californian men with biopsy-proven prostate cancer. Health services research conducted with program enrollees, through the UCLA Men’s Health Study, yields an opportunity to perform qualitative and quantitative assessments of patient-reported outcomes in these men, all members of historically underserved, primarily minority populations. This review summarizes data from several studies in which validated instruments were administered longitudinally in 727 participants, prospectively measuring health-related quality of life (HRQOL), self-efficacy in interactions with physician interactions, social and emotional health, symptom distress, satisfaction with care, and other patient-reported outcomes.

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Outcomes in Men Denied Access to a California Public Assistance Program for Prostate Cancer

Cited by 11 publications

References 17 publications

Prostate Cancer Severity Among Low Income, Uninsured Men

Prostate Cancer Severity Among Low Income, Uninsured Men

Prostate Cancer Severity Among Low-Income, Uninsured Men

Prostate cancer survivorship: Lessons from caring for the uninsured

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