Factors influencing prostate cancer treatment decisions for African American and white men.
Black or African American
/ statistics & numerical data
Aged
Clinical Decision-Making
Cohort Studies
Databases, Factual
Early Detection of Cancer
Healthcare Disparities
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
/ pathology
Neoplasm Staging
North Carolina
Prostatic Neoplasms
/ diagnosis
Retrospective Studies
White People
/ statistics & numerical data
clinical decision making
health care disparities
minority health
prostatic neoplasms
treatment outcomes
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 05 2019
15 05 2019
Historique:
received:
08
05
2018
revised:
13
10
2018
accepted:
16
11
2018
pubmed:
30
1
2019
medline:
12
2
2020
entrez:
30
1
2019
Statut:
ppublish
Résumé
Prostate cancer racial disparities in mortality outcomes are the largest in all of oncology, and less aggressive treatment received by African American (AA) patients versus white patients is likely a contributing factor. However, the reasons underlying the differences in treatment are unclear. This study examined a prospective, population-based cohort of 1170 men with newly diagnosed nonmetastatic prostate cancer enrolled from 2011 to 2013 before treatment throughout North Carolina. By phone survey, each participant was asked to rate the aggressiveness of his cancer, and his response was compared to the actual diagnosis based on a medical record review. Participants were also asked to rate the importance of 10 factors for their treatment decision-making process. Among AA and white patients with low-risk cancer (according to National Comprehensive Cancer Network guidelines), 78% to 80% perceived their cancers to be "not very aggressive." However, among high-risk patients, 54% of AA patients considered their cancers to be "not very aggressive," whereas 24% of white patients did (P < .001). Although both AA and white patients indicated that a cure was a very important decision-making factor, AAs were significantly more likely to consider cost, treatment time, and recovery time as very important. In a multivariable analysis, perceived cancer aggressiveness and cure as the most important factor were significantly associated with receiving any aggressive treatment and were associated with surgery (vs radiation). After adjustments for these factors and sociodemographic factors, race was not significantly associated with the treatment received. Racial differences in perceived cancer aggressiveness and factors important in treatment decision making provide novel insights into reasons for the known racial disparities in prostate cancer as well as potential targets for interventions to reduce these disparities.
Sections du résumé
BACKGROUND
Prostate cancer racial disparities in mortality outcomes are the largest in all of oncology, and less aggressive treatment received by African American (AA) patients versus white patients is likely a contributing factor. However, the reasons underlying the differences in treatment are unclear.
METHODS
This study examined a prospective, population-based cohort of 1170 men with newly diagnosed nonmetastatic prostate cancer enrolled from 2011 to 2013 before treatment throughout North Carolina. By phone survey, each participant was asked to rate the aggressiveness of his cancer, and his response was compared to the actual diagnosis based on a medical record review. Participants were also asked to rate the importance of 10 factors for their treatment decision-making process.
RESULTS
Among AA and white patients with low-risk cancer (according to National Comprehensive Cancer Network guidelines), 78% to 80% perceived their cancers to be "not very aggressive." However, among high-risk patients, 54% of AA patients considered their cancers to be "not very aggressive," whereas 24% of white patients did (P < .001). Although both AA and white patients indicated that a cure was a very important decision-making factor, AAs were significantly more likely to consider cost, treatment time, and recovery time as very important. In a multivariable analysis, perceived cancer aggressiveness and cure as the most important factor were significantly associated with receiving any aggressive treatment and were associated with surgery (vs radiation). After adjustments for these factors and sociodemographic factors, race was not significantly associated with the treatment received.
CONCLUSIONS
Racial differences in perceived cancer aggressiveness and factors important in treatment decision making provide novel insights into reasons for the known racial disparities in prostate cancer as well as potential targets for interventions to reduce these disparities.
Identifiants
pubmed: 30695113
doi: 10.1002/cncr.31932
pmc: PMC6604809
mid: NIHMS1031313
doi:
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1693-1700Subventions
Organisme : Patient-Centered Outcomes Research Institute
ID : CER-1310-06453
Pays : United States
Informations de copyright
© 2019 American Cancer Society.
Références
Am Soc Clin Oncol Educ Book. 2017;37:35-39
pubmed: 28561659
CA Cancer J Clin. 2013 May;63(3):151-66
pubmed: 23386565
Cancer. 2008 Oct 15;113(8):2180-7
pubmed: 18798229
Cochrane Database Syst Rev. 2011 Oct 05;(10):CD001431
pubmed: 21975733
Pharmacotherapy. 2017 Jan;37(1):85-93
pubmed: 27862122
Oncologist. 2013;18(4):381-90
pubmed: 23442307
Am J Manag Care. 2009 Nov;15(11):801-6
pubmed: 19895184
JAMA Oncol. 2016 Jan;2(1):85-93
pubmed: 26502115
Cancer Causes Control. 1998 Oct;9(5):519-27
pubmed: 9934717
J Urol. 2003 Sep;170(3):990-3
pubmed: 12913756
Cancer. 2004 Mar 1;100(5):883-91
pubmed: 14983481
J Geriatr Oncol. 2013 Jan;4(1):1-8
pubmed: 23828723
Am J Mens Health. 2012 Nov;6(6):472-84
pubmed: 22806569
Health Aff (Millwood). 2013 Jun;32(6):1143-52
pubmed: 23676531
J Clin Oncol. 2016 Mar 20;34(9):980-6
pubmed: 26811521
J Clin Oncol. 2010 Feb 20;28(6):1069-74
pubmed: 20100957
J Racial Ethn Health Disparities. 2016 Mar;3(1):35-45
pubmed: 26896103
J Natl Cancer Inst. 2008 May 21;100(10):738-44
pubmed: 18477800
Ann Oncol. 2017 May 1;28(5):1098-1104
pubmed: 28453693
J Cancer Educ. 2009;24(3):204-9
pubmed: 19526408
Cancer. 2006 Sep 15;107(6):1313-20
pubmed: 16909424
JAMA Oncol. 2015 Jun;1(3):342-9
pubmed: 26181184
J Natl Cancer Inst. 2013 Dec 4;105(23):1814-20
pubmed: 24231453
Urology. 2017 Jan;99:76-83
pubmed: 27667157
Urology. 2014 Aug;84(2):386-92
pubmed: 24975710
Ann Surg Oncol. 2009 Nov;16(11):2968-77
pubmed: 19669839
Patient Educ Couns. 2006 Sep;62(3):355-60
pubmed: 16860520
Urology. 2009 Mar;73(3):624-30
pubmed: 19167034
J Comp Eff Res. 2015 Jan;4(1):3-9
pubmed: 25565065
J Racial Ethn Health Disparities. 2018 Feb;5(1):117-140
pubmed: 28275996
Cancer. 2013 Jul 1;119(13):2486-93
pubmed: 23716470
J Immigr Minor Health. 2014 Jun;16(3):394-400
pubmed: 23576029
J Urol. 2004 Apr;171(4):1504-7
pubmed: 15017208