Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer.

PURPOSE Diagnosis of advanced prostate cancer is a major health problem, especially among low-income men. Opportunities vary for early detection of prostate cancer for low-income black and white men because of financial, cultural, and social factors. In this study, we evaluated the association of poor literacy skills with higher rates of presentation of advanced stages of prostate cancer among low-income black and white men who received care in equal-access medical systems. PATIENTS AND METHODS Literacy and stage at diagnosis of prostate cancer were evaluated in 212 low-income men who received medical care in Shreveport, LA, and Chicago, IL. The patients' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM), an individually administered reading screening test designed specifically for use in the medical setting. Logistic regression models were used to evaluate predictors of metastatic disease at presentation as a function of patient age, race, literacy, and city. RESULTS Whereas black men were almost twice as likely to present with stage D prostate cancer (49.5% v 35.9%; P < .05), they were significantly more likely to have literacy levels less than sixth grade (52.3% v 8.7%; P < .001). However, after adjustment for differences in literacy, age, and city, race was not a significant predictor of advanced-stage prostate cancer. CONCLUSION Low literacy may be an overlooked but significant barrier to the diagnosis of early-stage prostate cancer among low-income white and black men. The development of culturally sensitive, low-literacy educational materials may improve patient awareness of prostate cancer and improve the frequency of diagnosis of early-stage cancer.

Download Full-text

Income and Marital Status Interact on Obesity Among Black and White Men

American Journal of Men s Health ◽

10.1177/1557988319829952 ◽

2019 ◽

Vol 13 (1) ◽

pp. 155798831982995 ◽

Cited By ~ 3

Author(s):

Caryn N. Bell ◽

Roland J. Thorpe

Keyword(s):

Marital Status ◽

Black Men ◽

Low Income ◽

Positive Association ◽

White Men ◽

Poverty Line ◽

High Income ◽

Never Married ◽

Black And White ◽

Increased Risk

Racial disparities in obesity among men are accompanied by positive associations between income and obesity among Black men only. Race also moderates the positive association between marital status and obesity. This study sought to determine how race, income, and marital status interact on obesity among men. Using data from the 2007 to 2014 National Health and Nutrition Examination Survey, obesity was measured as body mass index ≥30 kg/m2 among 6,145 Black and White men. Income was measured by percentage of the federal poverty line and marital status was categorized as currently, formerly, or never married. Using logistic regression and interaction terms, the associations between income and obesity were assessed by race and marital status categories adjusted for covariates. Black compared to White (OR = 1.19, 95% CI [1.03, 1.38]), currently married compared to never married (OR = 1.45, 95% CI [1.24, 1.69]), and high-income men compared to low income men (OR = 1.26, 95% CI [1.06, 1.50]) had higher odds of obesity. A three-way interaction was significant and analyses identified that income was positively associated with obesity among currently married Black men and never married White men with the highest and lowest probabilities of obesity, respectively. High-income, currently married Black men had higher obesity rates and may be at increased risk for obesity-related morbidities.

Download Full-text

Overall Survival of Black and White Men With Metastatic Castration-Resistant Prostate Cancer Treated With Docetaxel

Journal of Clinical Oncology ◽

10.1200/jco.18.01279 ◽

2019 ◽

Vol 37 (5) ◽

pp. 403-410 ◽

Cited By ~ 20

Author(s):

Susan Halabi ◽

Sandipan Dutta ◽

Catherine M. Tangen ◽

Mark Rosenthal ◽

Daniel P. Petrylak ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Black Men ◽

Performance Status ◽

Specific Antigen ◽

White Men ◽

Phase Iii ◽

Castration Resistant Prostate Cancer ◽

Black And White ◽

Castration Resistant

Purpose Several studies have reported that among patients with localized prostate cancer, black men have a shorter overall survival (OS) time than white men, but few data exist for men with advanced prostate cancer. The primary goal of this analysis was to compare the OS in black and white men with metastatic castration-resistant prostate cancer (mCRPC) who were treated in phase III clinical trials with docetaxel plus prednisone (DP) or a DP-containing regimen. Methods Individual participant data from 8,820 men with mCRPC randomly assigned in nine phase III trials to DP or a DP-containing regimen were combined. Race was based on self-report. The primary end point was OS. The Cox proportional hazards regression model was used to assess the prognostic importance of race (black v white) adjusted for established risk factors common across the trials (age, prostate-specific antigen, performance status, alkaline phosphatase, hemoglobin, and sites of metastases). Results Of 8,820 men, 7,528 (85%) were white, 500 (6%) were black, 424 (5%) were Asian, and 368 (4%) were of unknown race. Black men were younger and had worse performance status, higher testosterone and prostate-specific antigen, and lower hemoglobin than white men. Despite these differences, the median OS was 21.0 months (95% CI, 19.4 to 22.5 months) versus 21.2 months (95% CI, 20.8 to 21.7 months) in black and white men, respectively. The pooled multivariable hazard ratio of 0.81 (95% CI, 0.72 to 0.91) demonstrates that overall, black men have a statistically significant decreased risk of death compared with white men ( P < .001). Conclusion When adjusted for known prognostic factors, we observed a statistically significant increased OS in black versus white men with mCRPC who were enrolled in these clinical trials. The mechanism for these differences is not known.

Download Full-text

Racial differences in bone mineral density and fractures in men receiving androgen deprivation therapy for prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.212 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 212-212

Author(s):

A. K. Morgans ◽

M. L. Hancock ◽

G. Barnette ◽

M. S. Steiner ◽

R. A. Morton ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Mineral Density ◽

Black Men ◽

Androgen Deprivation Therapy ◽

Bone Mineral ◽

Vertebral Fractures ◽

White Men ◽

Percentage Change ◽

Mineral Density ◽

Black And White

212 Background: In the general population, black men have higher bone mineral density (BMD) and lower fracture rates than white men. Whether race influences bone loss and fracture risk during androgen deprivation therapy (ADT) for prostate cancer is unknown. Using data from a recently completed prospective, randomized, clinical trial we compared BMD and fracture rates of black and white men receiving ADT for prostate cancer. Methods: Subjects in these analyses (n=516) were members of the placebo group of a two-year randomized controlled trial of toremifene to prevent fractures in men receiving ADT for prostate cancer. All subjects resided in United States and reported their race as either black (n=68) or white (n=448). We compared baseline characteristics, including BMD and prevalent vertebral fractures, between black (n=68) and white men (n=448). We also compared changes in BMD and rates of new vertebral fractures over the two year study period. Results: Black men had higher baseline hip BMD than white men (0.98 ± 0.15 g/m2 and 0.91 ± 0.15 g/m2, respectively; p=0.001). Black men had similar BMD of the spine (1.09 ± 0.22 g/m2 and 1.11 ± 0.22 g/m2 in black and white men, respectively; p=0.51), but fewer prevalent vertebral fractures (7.4% versus 15.0%; p=0.13). Changes in BMD from baseline to 24 months were similar between black and white men (total hip percentage change −2.54 ± 0.26 in white men and −2.09 ± 0.60 in black men; p=0.55; lumbar spine percentage change −1.30 ± 0.33 in white men and −1.67 ± 0.71 in black men; p<0.71). Rates of new vertebral fractures trended towards being lower in black men (1.15% of black men versus 4.83% of white men; relative risk 0.24; p<0.12). Conclusions: Among men receiving ADT for prostate cancer, black men had higher baseline BMD at the hip and fewer prevalent vertebral fractures. Changes in BMD during ongoing ADT were similar for black and white men. Consistent with lower baseline risk for fracture, however, black men had fewer new vertebral fractures than white men. [Table: see text]

Download Full-text

Church Attendance and Mobility Limitation Among Black and White Men With Prostate Cancer

American Journal of Men s Health ◽

10.1177/1557988321993560 ◽

2021 ◽

Vol 15 (1) ◽

pp. 155798832199356

Author(s):

Marino A. Bruce ◽

Janice V. Bowie ◽

Bettina M. Beech ◽

Keith C. Norris ◽

Thomas A. LaVeist ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Black Men ◽

Primary Outcome ◽

Church Attendance ◽

White Men ◽

The Body ◽

Mobility Limitation ◽

Outcome Variable ◽

Black And White

Prostate cancer is a significant impediment that can reduce physical functional status. Mobility is fundamental for quality of life and church attendance to be associated with improved physical functioning. Few studies have examined how religious participation have implications for mobility limitation among men in general and among prostate cancer survivors in particular. The purpose of this study was to assess the association between church attendance and mobility limitation among Black and White prostate cancer patients and survivors. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 804 Black and White men with complete information on the primary outcome and predictor variables. Mobility limitation was the primary outcome variable, and church attendance was the main independent variable. The analytic sample was almost equally divided between Black ( N = 382) and White men ( N = 422). The proportion of Black men reporting mobility limitation (30.09%) more than doubled the corresponding percentage for White men (14.7%). Black men had a higher proportion of individuals who reported weekly church attendance (49.2% vs. 45.0%). Fully adjusted modified Poisson regression models produced results indicating that respondents attending church weekly had a lower mobility limitation prevalence (PR = 0.56, 95% CI [0.39, 0.81]) than those never attending church. Results from this study contribute to the body of evidence asserting the health benefits of church attendance. These findings suggest that health providers should consider how religion and spirituality can present opportunities for improved outcomes in prostate cancer patients and survivors.

Download Full-text

Survival by race in men with chemotherapy-naive enzalutamide- or abiraterone-treated metastatic castration-resistant prostate cancer

Prostate Cancer and Prostatic Diseases ◽

10.1038/s41391-021-00463-9 ◽

2021 ◽

Author(s):

Daniel J. George ◽

Krishnan Ramaswamy ◽

Ahong Huang ◽

David Russell ◽

Jack Mardekian ◽

...

Keyword(s):

Prostate Cancer ◽

Black Men ◽

White Men ◽

Subsequent Treatment ◽

Veterans Health ◽

Health Administration ◽

Castration Resistant Prostate Cancer ◽

Cox Models ◽

Black And White ◽

Castration Resistant

Abstract Background Black men are more likely to be diagnosed with aggressive prostate cancer (PC) and die from PC than white men. However, black men with metastatic castration-resistant PC (mCRPC) had longer overall survival (OS) than white men when treated with certain agents in clinical trials. We analyzed claims data from the Veterans Health Administration (VHA) database to evaluate OS in black and white men treated with enzalutamide or abiraterone (novel hormonal therapy [NHT]) for chemotherapy-naïve mCRPC. Methods Patients with mCRPC aged ≥18 years were identified in the VHA database by diagnosis codes, evidence of surgical/medical castration, and a prescription claim for enzalutamide or abiraterone after castration from April 2014–March 2017. Cox models assessed associations between race and OS. Unadjusted and multivariable analyses were performed on the entire population and subsets based on the type of therapy received (if any) after NHT. Results In total, 2910 patients were identified (787 black, mean 71.7 years; 2123 white, mean 74.0 years). Median follow-up was 19.0 and 18.7 months in blacks and whites, respectively. Black men had better survival versus white men: hazard ratios (95% CIs) were 0.89 (0.790–0.996; P = 0.044) and 0.67 (0.592–0.758; P < 0.0001) in the unadjusted and multivariable models, respectively. Statistically significantly longer OS was seen in black versus white men regardless of subsequent treatment, including no subsequent treatment. Conclusions In the VHA, black men with chemotherapy-naïve mCRPC initiating NHT may have better outcomes than similarly treated white men.

Download Full-text

Religious Coping and Quality of Life Among Black and White Men With Prostate Cancer

Cancer Control ◽

10.1177/1073274820936288 ◽

2020 ◽

Vol 27 (3) ◽

pp. 107327482093628

Author(s):

Marino A. Bruce ◽

Janice V. Bowie ◽

Haley Barge ◽

Bettina M. Beech ◽

Thomas A. LaVeist ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Religious Coping ◽

Black Men ◽

Primary Outcome ◽

White Men ◽

Cancer Data ◽

Black And White ◽

Positive Religious Coping

Prostate cancer is a significant impediment in men’s lives as this condition often exacerbates stress and reduces quality of life. Faith can be a resource through which men cope with health crises; however, few studies examine how religion or spirituality can have implications for racial disparities in health outcomes among men. The purpose of this study is to assess the associations between religious coping and quality of life among black and white men with prostate cancer. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 624 black and white men with complete information on the primary outcome and predictor variables. The primary outcome for this study was overall quality of life as measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The main independent variable was religious coping measured by 2 subscales capturing positive and negative forms of coping. Black men in the study had lower overall quality of life scores (134.6 ± 19.6) than their white peers (139.8 ± 14.1). Black men in the sample also had higher average positive religious coping scores (12.9 ± 3.3) than white men (10.3 ± 4.5). Fully adjusted linear regression models of the total sample produced results indicating that positive religious coping was correlated with an increase in quality of life (β = .38, standard error [SE] = 0.18, P < .05). Negative religious coping was associated with a reduction in quality of life (β = −1.48, SE = 0.40, P < .001). Faith-oriented beliefs or perceptions can have implications for quality of life among men with prostate cancer. Sensitivity to the role of religion, spirituality, and faith should be seen by providers of health care as potential opportunities for improved outcomes in patients with prostate cancer and survivors.

Download Full-text

Trends in mortality among Black and White men with prostate cancer in Massachusetts and Pennsylvania: Race and neighborhood socioeconomic position

Cancer ◽

10.1002/cncr.33506 ◽

2021 ◽

Author(s):

Hari S. Iyer ◽

Scarlett L. Gomez ◽

Jarvis T. Chen ◽

Quoc‐Dien Trinh ◽

Timothy R. Rebbeck

Keyword(s):

Prostate Cancer ◽

Socioeconomic Position ◽

White Men ◽

Black And White

Download Full-text

A review of new hormonal therapies for prostate cancer in black men: is there enough data?

BMC Cancer ◽

10.1186/s12885-020-07780-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Matthias E. Meunier ◽

Pascal Blanchet ◽

Yann Neuzillet ◽

Thierry Lebret ◽

Laurent Brureau

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Androgen Receptor ◽

Black Men ◽

White Men ◽

Molecular Characteristics ◽

Black Patients ◽

First Results ◽

Black Populations ◽

Hormonal Therapies

Abstract Background Prostate cancer among black men is known to have specific molecular characteristics, especially the androgen receptor or enzymes related to the androgen metabolism. These targets are keys to the action of new hormonal therapies. Nevertheless, literature has a lack of data regarding black men. We aimed to gather the available literature data on new hormonal therapies among black populations. Methods We conducted a literature review from the PubMed / MEDLINE database until October 2020. All clinical studies of new hormonal therapies and black populations, regardless of methodology, were included. Results Four studies provided data on new hormonal therapies in black populations. Three studies reported a PSA decline in black patients treated with Abiraterone, higher in black men than in white men. Overall survival also appears to be higher in black patients treated with Abiraterone only or first. Conclusion Few articles have evaluated the effectiveness and safety of use of these treatments among black populations. The first results seem to show that Abiraterone can provide a benefit in overall survival in black populations. Prospective studies are needed to answer these questions in the future.

Download Full-text