Race, Decisional Regret and Prostate Cancer Beliefs: Identifying Targets to Reduce Racial Disparities in Prostate Cancer

DeWitt-Foy, Molly; Gam, Kristina; Modlin, Charles S.; Kim, Simon P.; Abouassaly, Robert

doi:10.1097/ju.0000000000001385

Cited by 24 publications

(6 citation statements)

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“…50 Although on average Black patients with prostate cancer receive less intensive treatment of localized disease, they unfortunately are more likely to have decisional regret afterward and may later wish they had opted for more aggressive approaches to their treatment. 51 Lastly, even if assigned the same treatment, Black patients might be less likely to complete it. In a study of 25,727 Black and 126,199 White patients, 12.8% of Black men did not complete definitive radiation therapy for localized prostate cancer as compared with 11.8% of White men (odds ratio, 1.14; 95% CI, 1.09-1.19; p , .001).…”

Section: Practical Applicationsmentioning

confidence: 99%

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Cackowski

Mahal

Heath

et al. 2021

American Society of Clinical Oncology Educational Book

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Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. Although commonly discussed in the context of men of African descent, disparities also exist based on socioeconomic level, education level, and geographic location. The factors in these disparities span systemic access issues affecting availability of care, provider awareness, and personal patient views and mistrust. In this review, we will discuss common themes that patients have noted as impediments to care. We will review how equitable access to care has helped improve outcomes among many different groups of patients, including those with local disease and those with metastatic castration-resistant prostate cancer. Even with more advanced presentation, challenges with recommended screening, and lower rates of genomic testing and trial inclusion, Black populations have benefited greatly from various modalities of therapy, achieving comparable and at times superior outcomes with certain types of immunotherapy, chemotherapy, androgen receptor–based inhibitors, and radiopharmaceuticals in advanced disease. We will also briefly discuss access to genomic testing and differences in patterns of gene expression among Black patients and other groups that are traditionally underrepresented in trials and genomic cohort studies. We propose several strategies on behalf of providers and institutions to help promote more equitable care access environments and continued decreases in prostate cancer disparities across many subgroups.

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Section: Practical Applicationsmentioning

confidence: 99%

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Cackowski

Mahal

Heath

et al. 2021

American Society of Clinical Oncology Educational Book

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show abstract

“…A different study, aimed at identifying sources of prostate cancer decisional regret with a focus on racial disparities, found that despite an increased risk of prostate cancer among African American men, they had higher medical mistrust and concerns about masculinity than non-African American men, which the authors suggested might have contributed to a higher level of decisional regret. 42 In our study, the PSA screening prevalence among men ≥ 70 years suggests potential overuse and deserves attention. The USPSTF, ACS, and AUA indicated that the length of time required to experience any potential prostate cancer mortality benefit is greater than 10 years.…”

Section: Discussionmentioning

confidence: 71%

Multilevel Small Area Estimation of Prostate-Specific Antigen Screening Test in the United States by Age Group: 2018 Behavioral Risk Factor Surveillance System

et al. 2021

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Background: In 2018, the US Preventive Services Task Force (USPSTF) recommended prostate cancer screening for men aged 55 to 69 years who express a preference for being screened after being informed about and understanding prostate-specific antigen (PSA) test benefits and risks. USPSTF recommended against screening men aged ≥70 years. We aim to generate county-level prevalence estimates, masked by national and state estimates, to identify counties with high PSA screening prevalence.Methods: We fitted multilevel logistic regression mixed models for 4 age groups (≥40, 40 to 54, 55 to 69, ≥70 years), using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 116,654) and other sources. We evaluated consistency between our model-based state and BRFSS direct state estimates with Spearman and Pearson correlation coefficients.Results: PSA screening prevalence increased with increasing age groups: 7.7% for men aged 40 to 54 years, 27.2% for men aged 55 to 69 years, and 33.7% among men age ≥70 years, and was largely clustered in the South and Appalachia. Many county estimates among men aged ≥70 years exceeded 40%, especially in the South. Correlation coefficients were 0.94 for men aged ≥40, and ≥0.85 for men aged 40 to 54 years, 55 to 69 years, and ≥70 years.Conclusions: PSA screening was highest among men ≥70 years, for whom it is not recommended, and in the South among all age groups. Screening varied substantially within states.Impact: In 2018, on average, more than 1 in 4 men aged 55 to 69 years and 1 in 3 men aged ≥70 years underwent PSA screening in the prior year, suggesting potential overuse among some men.

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“…Our analysis, further adjusting for tumor size (≤4 cm vs. 4–7 cm), yielded similar findings. Furthermore, “race” is a social construct, and “race” encompasses various unmeasured factors, such as psychosocial and cultural variables, trust issues, and discrepancies in patient–physician communication, which may play a role in the ultimate determination of whether patients undergo surgical treatment or not, whether they select active surveillance, and which surgical treatment they undergo [ 29 , 30 ]. Future studies are necessary to understand how these factors may influence treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients

Cruz

Dickerson

Pulling

et al. 2022

IJERPH

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Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08–1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84–1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.

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Race, Decisional Regret and Prostate Cancer Beliefs: Identifying Targets to Reduce Racial Disparities in Prostate Cancer

Cited by 24 publications

References 0 publications

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Multilevel Small Area Estimation of Prostate-Specific Antigen Screening Test in the United States by Age Group: 2018 Behavioral Risk Factor Surveillance System

Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients

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