July 29, 2009
Research Revealing Targets To Reduce Racial Disparity In Prostate Cancer Deaths
The latest findings of the North Carolina-Louisiana Prostate Cancer Project reveal potential new targets for reducing racial disparities in prostate cancer survival and highlight the importance of the health care delivery system. The study reports differences in physician trust, access to care, and continuity of care between African American and Caucasian men which result in advanced prostate cancer at the time of diagnosis and contribute to the higher death rate among African American men. The study is published in the early view issue of Cancer online July 27, 2009.
Study nurses conducted in depth in-home interviews with more than 1,000 North Carolina and Louisiana men age 50 and up, newly diagnosed with prostate cancer. Data in this manuscript were obtained from the interview and from medical record review.
This study examined health care system factors that may influence outcomes. System factors include availability of health care facilities, the services offered at those facilities, the systems in place to trigger appropriate utilization of those services, and clinician time pressures or encounter characteristics may impede their ability to fully address patient needs. Other factors such as provider bias, erroneous stereotypes or lack of understanding of minorities may also influence patient trust, health behaviors, and receptivity toward seeking or utilizing health care services.
"The lack of access to care, lack of a medical home and lack of a relationship with a medical provider may result in a delayed diagnosis that translates to advanced disease and higher rates of death from prostate cancer for African Americans," notes Elizabeth T. H. Fontham, DrPH, Dean of the School of Public Health at LSU Health Sciences Center New Orleans, who is the principal investigator of the Louisiana portion, and co- principal investigator of the entire study.
In this study, the stage at diagnosis of prostate cancer was similar between African American and Caucasian men, but African American men had more aggressive cancer as measured by Gleason score. Compared with African Americans, Caucasian men exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical visits, and being screened for prostate cancer. African American men were less likely to report prostate cancer screening prior to diagnosis, and men without a prior history of screening were more likely to be diagnosed with advanced stage or high grade prostate cancer than men who reported a history of screening.
"Importantly, no differences in prostate cancer stage at diagnosis were observed between men of either race when an established relationship with a healthcare provider existed," notes Elizabeth T. H. Fontham, DrPH, Dean of the School of Public Health at LSU Health Sciences Center New Orleans, who is the principal investigator of the Louisiana portion, and co- principal investigator of the entire study. "Through an ongoing relationship with their health care provider, patients' health status and risks are known, trust builds over time when consistent, high quality interactions between patients and providers take place, and patients are more likely to make informed decisions and receive more timely diagnosis and treatment."
According to the American Cancer Society, prostate cancer has the highest incidence of cancers among US men and is the second most deadly. The prostate cancer incidence rate among African Americans is 55% greater than among Caucasian men, and the African American death rate is two and a half times that of Caucasian men.
The researchers conclude that addressing components of how health care is delivered, including care continuity, has the potential to meaningfully address the mortality disparity observed for prostate cancer.
Funded by the Department of Defense, the North Carolina-Louisiana Prostate Cancer Project is a population-based study of individuals identified shortly after prostate cancer diagnosis designed to produce clinical data and identify racial disparities in prostate cancer, to help determine the best approach to reduce prostate cancer mortality.
Study authors include Dr. Fontham, William Carpenter, PhD, Research Assistant Professor of Health Policy and Management in the University of North Carolina Gillings School of Global Public Health, James Mohler, MD, Chair of the Department of Urology at Roswell Park Cancer Institute, principal investigator of the Consortium, and other researchers at these institutions.
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