Convenience affects prostate cancer treatment choice

Atlanta-African-American men are more influenced by convenience than are Caucasian men in their choice of treatment for early-stage prostate cancer. Spouses and significant others are also influential in the decision, and they tend to be less enthusiastic about active surveillance than men.

Additionally, overall lack of awareness of active surveillance as a treatment option prevents more men from choosing this option.

These are the key findings from a mixed-methods five-center study funded by the Centers for Disease Control and Prevention (CDC) and presented at the American Society of Clinical Oncology annual meeting in Chicago.

The CDC estimates that about 50% of men diagnosed with prostate cancer through PSA screening would remain asymptomatic and not require treatment, yet about 90% of these men receive either surgery or radiation. African-American men have been reported to receive aggressive therapy significantly less often then Caucasians, although their prostate tumors are often at higher risk for poor outcomes, raising questions about health disparities in treatment selection.

“The CDC was particularly interested in knowing why people don’t choose active surveillance more and what might be some of the differential predictors or variables that could lead to more informed decision making about active surveillance,” said first author Theresa W. Gillespie, PhD, associate professor of surgery and hematology and medical oncology, Emory University, Atlanta, in explaining the rationale for the research.

Of the 214 men and 188 significant others who participated, 63% were African-American. All completed quantitative questionnaires before attending focus group sessions. There were a total of 27 focus groups for the men and 27 for their spouses/significant others.

Convenience a factor for African-Americans

Some 57.6% of African-American men reported treatment choice being influenced by convenience compared with 30.8% of Caucasian men (p=.0004). After adjusting for education, comorbidities, insurance, age, health literacy, distance to treatment center, willingness to travel, income, and numeracy score, African-American men were nearly three times as likely to be influenced by convenience (odds ratio: 2.84) compared with Caucasians. Rural residence, however, did not affect decision making.

“Convenience might mean that men would not choose surgery because of the after effects; they would be inconvenienced if they are incontinent, for example,” Dr. Gillespie said. Significant others tended to value treatment efficacy over side effects.

In qualitative analysis, themes identified included lack of awareness of active surveillance as a treatment option and no designated provider to present active surveillance as a viable choice. The focus groups discovered that physician treatment discussions tend to be limited to their own specialty.

“The urologist didn’t talk about it because he’s usually talking about surgery. Radiation oncologists don’t talk about it because they usually talk about external beam or brachytherapy. No one has skin in the game in terms of active surveillance. Many of the participants wanted their primary care physician to be engaged, which isn’t usually the case,” Dr. Gillespie said.

“Somewhere in the discussion, active surveillance has to be mentioned. There may be a real opportunity to take the time for a comprehensive discussion of treatment options, because in early-stage prostate cancer, you don’t have to choose what you’re going to do immediately,” she added.UT

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