Rates and choice of treatment for localized prostate cancer vary according to race/ethnicity in American men. We hypothesized that there were group differences in influential values and preferences related to treatment decisions.
We analyzed samples from 2 multicenter, randomized trials of the Patient Profile-Prostate (P3P) I and II decision aid, first comparing the groups on other demographic and decisional variables using Chi-square tests. Stratified (P3P I vs. II) logistic regression was then used to assess the univariate association between race/ethnicity and endorsement of moderate-or-strong influence of 14 lifestyle factors, current or future symptoms, or important others on the decision. A multivariable stratified logistic regression with backward variable selection was used to further estimate the association between influential factors and race/ethnicity.
There were 494 and 392 participants in P3P I and P3P II, respectively, with 40 Hispanic, 168 non-Hispanic black, 637 non-Hispanic white, 19 others and 6 missing. Age (P = 0.0001), education (P < 0.0001), marital status (P < 0.0001), income (P < 0.0001), Internet use for information (P < 0.0001) and decisional control preference were significantly different across racial/ethnic groups. In adjusted analyses, we saw racial/ethnic differences in the decisional influence of age (Non-Hispanic Black (NHB) vs. Non-Hispanic White (NHW) OR: 0.56 95%CI 0.38-0.85 P = 0.002), religion/spirituality (NHB vs. NHW OR: 3.2095%CI1.95-5.26, P < 0.0001), future bladder function (NHB vs. NHW OR: 0.5795%CI 0.35-0.90, P = 0.04), future ability to engage in recreation (NHB vs. NHW OR: 0.5495%CI 0.34-0.86, P = 0.02), and a story of a famous person with prostate cancer (NHB vs. NHW OR: 2,11 95%CI 1.30-3.43, P = 0.007). No interactions were found.
Our results suggest racial/ethnic differences for influences underlying treatment choice. Better understanding these influences may help us present salient information about treatment options to patients and address disparities.
Urologic oncology. 2019 Dec 26 [Epub ahead of print]
Quoc-Dien Trinh, Fangxin Hong, Barbara Halpenny, Matthew Epstein, Donna L Berry
Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: ., Dana-Farber Cancer Institute, Boston, MA., Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.