African-American Prostate Cancer Survivors' Treatment Decision-Making and Quality of Life

• Published in: Psycho-oncology (Chichester, England) Vol. 21; p. 18
• Main Authors: Palmer, N, Turner, A, Xu, J, Avis, N
• Format: Journal Article
• Language: English
• Published: Chichester Wiley Subscription Services, Inc 01.02.2012
• Subjects: African Americans; Decision making; Medical treatment; Prostate cancer; Quality of life; Variance analysis; United States > US
• ISSN: 1057-9249; 1099-1611

African-American men are disproportionately affected by prostate cancer (PCa) and report poorer quality of life (QOL). Little is known about treatment decision-making (TDM) among African-American men with PCa. Therefore, this study examines the association between TDM and QOL in a sample of African-American PCa survivors. One-hundred ninety African-American PCa survivors were recruited from the North Carolina Central Cancer Registry, as part of a larger study on genetic risks of PCa. Patients completed a one-time, face-to-face survey that asked about their chosen cancer treatment, aspects of TDM, and PCa-specific QOL (using the Expanded Prostate Cancer Index Composite - EPIC). Analysis of variance was conducted to determine if TDM was associated with QOL. The majority of patients (44%) preferred to be active participants (patient makes final decision) in their TDM, while 39% preferred a collaborative role (patient and physician share responsibility) and 16% preferred a passive role (physician makes final decision). These percentages were similar regarding the actual role played in TDM. Almost 95% of patients matched in their desired TDM role and the actual role played. Patients who were more passive in their TDM reported better QOL compared to patients who were more active. Significant differences were found in the following QOL domains: urinary summary (p = 0.005), urinary function (p = 0.009), urinary bother (p = 0.016), urinary incontinence (p = 0.018), sexual bother (p = 0.033), and hormonal bother (p = 0.015). African-American PCa survivors indicated they preferred to and actually played an active or collaborative role in TDM. However passive patients reported better PCa-specific QOL compared to active patients. African- American passive men may be less symptomatic while active men may report more symptoms and want to be proactive in resolving them. Although TDM involvement did not vary by treatment or age in this sample, other studies suggest there may be some interaction. There may be additional intervening factors that merit investigation, such as prognosis and cultural or socio-economic beliefs. Providers should be attentive to patients' desired involvement in TDM. However, regardless of patients' TDM preference, providers should be engaging in effective patient-provider communication that promotes information sharing to ensure patients are properly informed before TDM. The original study was funded by the Department of Defense Congressionally Directed Medical Research Program (Grant#: DOD-PC051143). Dr. Palmer is supported by the Wake Forest School of Medicine Cancer Prevention and Control Training Program (NCI/NIH Grant #5R25CA122061).