Factors in prostate Ca decision-making vary by race

Findings from a population-based cohort study of patients newly diagnosed with prostate cancer show race-related differences in what men perceive as important factors in their treatment decision-making process and also the aggressiveness of their disease.

In addition, a multivariable analysis adjusting for sociodemographic characteristics found that patients’ perception about cancer aggressiveness was the most important factor associated with the type of treatment received.

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The study, presented at the American Society of Clinical Oncology annual meeting in Chicago, was conducted by Ronald C. Chen, MD, MPH, and colleagues at the University of North Carolina at Chapel Hill, in collaboration with the North Carolina Central Cancer Registry. It included prospectively collected data from 1,170 men enrolled in the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study between 2011 and 2013.

“Racial disparities in prostate cancer are well known. Compared to Caucasian patients, African-American patients are more than twice as likely to die from prostate cancer. Part of this disparity may be due to the fact that African-American patients get less aggressive treatment overall,” Dr. Chen told Urology Times.

“We conducted this study to provide some insights on why there is this racial difference in treatment. To the best of our knowledge, there has not been a large-scale study like it before.”

Next: Findings "provide new information that can help explain and address the racial difference in treatment for prostate cancer"

Lead author Brittaney-Belle Gordon said, “The findings of our research provide new information that can help explain and address the racial difference in treatment for prostate cancer.”

The data analyzed in the study were obtained from surveys that the newly diagnosed prostate cancer patients completed before receiving any treatment. The survey asked patients to rate a variety of factors for their importance in influencing treatment selection and to indicate whether they perceived their disease as being not very aggressive, somewhat aggressive, or very aggressive.

Racial differences were analyzed after subdividing the men by disease risk. Results showed that regardless of risk category and race, men assigned foremost importance to cancer cure and quality of life issues. Compared to Caucasian patients, however, African-American patients were much more likely to indicate that cost, treatment time, and recovery time were important factors for treatment decision-making.

In addition, African-American patients were more likely than Caucasian patients to perceive their cancer as “not aggressive,” and the difference between racial groups was especially striking among patients in the high-risk subgroup who actually had aggressive prostate cancer.

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In the low-risk cohort, about 75% to 80% of men in both racial groups perceived their disease as not very aggressive. Among the African-American men, however, approximately 60% of those with intermediate-risk disease and approximately 55% of those with high-risk disease perceived their prostate cancer as not very aggressive. Approximately 47% of the Caucasian men with intermediate-risk disease and almost one-fourth of the Caucasian men with high-risk disease thought their prostate cancer was not very aggressive.

Having identified the difference between races in perception about cancer aggressiveness and the prominence of concerns about financial barriers among African-American patients, the authors believe they now have potential targets for future interventions aimed at reducing racial disparities in treatment.

“Clinicians need to ensure that their patients have an accurate understanding of their diagnosis. Available decision aids can be helpful in this process,” said Dr. Chen.

Gordon added, “Eliciting whether patients have financial concerns can reduce this potential barrier to necessary treatment.”

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