Treatment options, selection, and satisfaction among african american and white men with prostate carcinoma in north carolina

• Published in: Cancer Vol. 83; no. 2; pp. 320 - 330
• Main Authors: Demark‐Wahnefried, Wendy, Schildkraut, Joellen M., Iselin, Christophe E., Conlisk, Elizabeth, Kavee, Andrew, Aldrich, Tim E., Lengerich, Eugene J., Walther, Philip J., Paulson, David F.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15-07-1998; Wiley-Liss
• Subjects: African Americans; Aged; Biological and medical sciences; Black or African American; Black People; Carcinoma - ethnology; Carcinoma - mortality; Carcinoma - therapy; Disease Management; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; North Carolina - epidemiology; Patient Satisfaction; Prostate; prostatic neoplasms; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - mortality; Prostatic Neoplasms - therapy; Quality of Health Care; Risk Factors; Tumors of the urinary system; Urinary tract. Prostate gland; White People; whites; North Carolina; United States; North America; America; Human; Urinary system disease; Carcinoma; Prostate disease; Negroid; Malignant tumor; Treatment; Race; Black American; Caucasoid; Male genital diseases; Prostate; Comparative study
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19980715)83:2<320::AID-CNCR16>3.0.CO;2-V

BACKGROUND
In the U.S., prostate carcinoma mortality is greatest among African Americans. In North Carolina, the state with the fourth largest population of African Americans, the prostate carcinoma mortality rate is 2.5 times greater among African Americans than among whites and is the highest reported rate for any state in the nation. To explore potential reasons for the racial differential in mortality, a study was undertaken to determine whether differences related to treatment existed between African American and white men who were diagnosed with prostate carcinoma during the period 1994‐1995.
METHODS
Cases were selected from 16 institutions within a region comprising 63 contiguous counties where the overall population was >20% African American. A stratified design was employed to accrue subjects into groups of even size according to race and disease stage (n = 231). A telephone survey was conducted, which assessed treatment options discussed by patients with their physicians, treatment(s) received, factors influencing treatment, satisfaction with treatments discussed and options given, and sociodemographic information.
RESULTS
All measures related to treatment were consistently associated with stage at diagnosis (P < 0.001) rather than other variables measured (i.e., race, age, income, comorbidity, education, and residential status). Furthermore, most subjects reported that their physicians presented several treatment options (65%), that they were satisfied with the options presented (90%), and that the physician was the most important factor influencing their treatment decision (57%).
CONCLUSIONS
These data suggest that African American and white men in North Carolina receive comparable treatment for prostate carcinoma. Therefore, efforts to reduce the racial disparity in mortality should be directed toward lessening the high incidence of later stage disease at diagnosis and exploring potential biologic differences that may increase the risk of more aggressive disease among African Americans. Cancer 1998;83:320‐330. © 1998 American Cancer Society.
Results of a telephone survey completed by 117 African American and 114 white men with prostate carcinoma revealed that measures related to treatment (i.e., treatment options discussed by patients with their physicians, treatment(s) received, factors influencing treatment, and satisfaction with treatments discussed and options given) were consistently associated with stage of disease at diagnosis (P < 0.001) rather than other variables measured (i.e., race, age, income, comorbidity, education, and residential status).