Factors influencing prostate cancer treatment decisions for African American and white men

Abstract

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.

Outcomes of Black men with prostate cancer treated with radiation therapy in the Veterans Health Administration

“…In addition, strategies to mitigate toxicity through survivorship care are critical for improving long‐term outcomes. It should be noted that misalignment between perceived and actual cancer aggressiveness among Black men compared with White men potentially contributes to differences in treatment decisions 31 . In a prospective, population‐based cohort study, more African American men than White men with high‐risk prostate cancer perceived their cancers as not aggressive, and such perceptions were associated with a decreased likelihood of receiving treatment.…”

Identifying Risk Profiles of Malignant Prostate Cancer Surgical Delay Using a Person-Centered Approach to Understand Prostate Cancer Disparities: The Constellation of Health Determinants Using Latent Class Analysis on Cancer Registry Data

“…Although access to health care has been known to be a main driver of health disparities and is also an important predictor of treatment behavior (Burt et al, 2018;Gordon et al, 2019;Noonan et al, 2016), our study shows that patients delayed treatment despite having health insurance coverage. A recent study by Gordon et al (2019) analyzed the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study and reported that Black patients were more likely to consider cost (69.2%), treatment (69.2%), and recovery time (73.3%) as important therapeutic decision-making factors compared to White patients (34.9%, 33.8%, and 46.9%, respectively). Another study used SEER data to assess trends in PCa treatment from 2004 to 2014 concluded significant differences exist by patient age, insurance status, socioeconomic status (SES), and geographical residence (Burt et al, 2018).…”

Influence of sociodemographic factors on treatment’s choice for localized prostate cancer in Portugal

“…In something so subjective and dependent on the individual perception of each patient and communication skills, it is highly likely that sociodemographic factors could influence patient choice and their urologist. Gordon et al (26) showed that > 50% Afro-Americans and 24% of white American studied, understood their disease as "non aggressive", even after a diagnosis of high risk disease. In our work, age was the only factor that individually influenced the choice of treatment, as patients over 70 years were virtually not subjected to RP (only 3.9%).…”