Abstract PR11: Development of a prostate cancer care and survivorship intervention trial for ethnically diverse Black men

Purpose: Black men are more likely to die as a result of prostate cancer than white men, despite effective treatments that improve survival for clinically significant prostate cancer. We undertook this study to identify gaps in prostate cancer care quality, racial disparities in care, and underlying reasons for poorer quality care. Methods: We identified all black men and random age-matched white men with Gleason scores ≥ 7 diagnosed between 2006 and 2013 at two urban hospitals to determine rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. We then interviewed treating physicians about the reasons for underuse. Results: Of 359 black and 282 white men, only 25 (4%) experienced treatment underuse, and 23 (92%) of these were black. Most (78%) cases of underuse were due to system failures, where treatment was recommended but not received; 38% of these men continued receiving care at the hospitals. All men with treatment underuse due to system failures were black. Conclusion: Treatment rates of prostate cancer are high. Yet, racial disparities in rates and causes of underuse remain. Only black men experienced system failures, a type of underuse amenable to health information technology–based solutions. Institutions are missing opportunities to use their health information technology capabilities to reduce disparities in cancer care.

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A multidimensional view of racial differences in access to prostate cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18048 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18048-e18048

Author(s):

Craig Evan Pollack ◽

Katrina Armstrong ◽

Nandita Mitra ◽

Xinwei Chen ◽

Katelyn R Ward ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Black Men ◽

Racial Differences ◽

Cancer Care ◽

Patient Communication ◽

Definitive Treatment ◽

Satisfaction With Care ◽

Good Doctor ◽

Doctor Patient Communication

e18048 Background: Racial differences in prostate cancer treatment and outcomes are widespread and poorly understood. We sought to determine whether access to care, measured across multiple dimensions, contribute to racial differences in prostate cancer. Methods: The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer from 2012 to 2014. Patient survey data was used to determine experiences of accessing prostate cancer care (response rate 51.1%). An audit survey using simulated patient calls was used to determine appointment availability and wait times at 151 urology practices. Patient and practice addresses were geocoded to construct distance measures. We used multivariable logistic regression models to determine the association between five different domains of access—availability, accessibility, accommodation, affordability, and acceptability—and receipt of definitive treatment with radical prostatectomy or radiation, satisfaction with care, and doctor-patient communication. Results: There were 1907 non-Hispanic white and 394 black men in our cohort, the majority (71%) with stage 1 disease. Overall, 85% of men received definitive treatment with no differences by race. None of the access domains were significantly associated with definitive treatment overall or with radical prostatectomy in adjusted models. Black men were less likely to report good doctor-patient communication (60% vs 71%, p < 0.001) and high satisfaction with their care (69% vs 81%, p < 0.001). Communication ratings remained significantly lower among black men compared to white men in adjusted models (odds ratio = 1.49, 95% Confidence Interval 1.03, 2.16). Each domain of access was significantly associated with lower satisfaction with care and worse communication; however, differences in access did not mediate racial disparities for these measures. Conclusions: This study presents the first comprehensive assessment of access to prostate cancer care, showing that while access was related to overall satisfaction and better doctor-patient communication, it did not appear to explain racial differences in these measures of cancer care.

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Prostate Cancer Care and Survivorship (CaPCaS) Model for Black Men: An Ethnographical Study of Prostate Cancer Survivors

10.21203/rs.3.rs-60444/v1 ◽

2020 ◽

Author(s):

FOLAKEMI T ODEDINA ◽

Mary Ellen Young ◽

Deidra Pereira ◽

Dagne Getachew ◽

Christopher Williams ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Survivors ◽

Cancer Prevention ◽

Black Men ◽

Cancer Care ◽

Qualitative Methodology ◽

Primary Objective ◽

Prostate Cancer Survivors ◽

Data Coding ◽

Prostate Cancer Prevention

Abstract Background: In 2020, 191,930 men will be diagnosed with prostate cancer. The lives of these men will change dramatically as they go through the prostate cancer care and survivorship process. Black men are especially affected, as they are more likely to get and die from prostate cancer. The primary objective of this study was to explain the experiences of Black men across by developing a prostate cancer care and survivorship (CaPCaS) model. Methods: Based on the principles of community engagement research and employing qualitative methodology, we interviewed Black prostate cancer survivors to document their CaPCaS experiences relative to prostate cancer prevention, detection, diagnosis, treatment, survivorship and advocacy using audio and video recordings. Our data analysis plan included preparing and verifying the narrative data, coding data, and developing an interpretive framework for Black men’s experiences across the prostate cancer care continuum. Results: Thirty-two prostate cancer survivors participated in the study. A CaPCaS model was created with themes specific to the trajectory of prostate cancer prevention, screening, diagnosis, treatment, survivorship, and advocacy. Contextual themes identified were African Diaspora, Masculinity and Socio-demographic factors. Additionally, we identified cross-cutting factors across the CaPCaS process that included Acculturation, Self-efficacy, Health literacy, Patient-provider racial concordance, Stigma and Spirituality. Conclusion: The CaPCaS model is an explanatory model of prostate cancer care and survivorship factors for Black men and will foster better understanding of behaviors associated with improved prostate cancer outcomes in Black men.

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