Race and decision-making in prostate cancer management

An article in Oncology Nurse Advisor notes that “Black and white men prioritize certain treatment-related factors differently when considering prostate cancer treatment options.”

Really? This should hardly come as a surprise to the US healthcare community by now! There has been years of research into the differences between ways that white and black patients (female and male) think about issues related to healthcare — and for all sorts of very good reasons.

The current study is based on data presented by Gordon et al. at the recent annual meeting of the American Society of Clinical Oncology (ASCO).

The core findings reported by Gordon et al., based on their survey of > 1,100 newly-daignosed prostate cancer patients in North Carolina were that:

  • The two most important issues for both groups were getting the cancer cured and preserving quality of life, in that order, but …
  • African-American men with intermediate- and high-risk disease were more concerned than white men with intermediate- and high-risk disease about such factors as
    • Impact of treatment on daily activities
      • Very important for 74 percent of African Americans and for 58 percent of Caucasians
    • Recovery time post-treatment
      • Very important for 81 percent of African Americans compared to 50 percent of Caucasians
    • Treatment time
      • Very important for 76 percent of African Americans compared to 39 percent of Caucasians

Cost was also a more critical issue for African Americans than it was for Caucasian patients. Now there’s a real shock!

Also, African Americans were less influenced by their physicians’ recommendations than Caucasians (50 vs 61 percent) and more influenced by their family and friends (19 vs. 7 percent).

These data correspond very well with all sorts of other data available on the sociocultural issues that affect healthcare decision-making among different racial groups.

One would really have hoped that by now physicians who see a meaningful percentage of African-American patients (and their support staff) would have come to realize that African Americans aren’t likely to be applying exactly the same healthcare decision-making processes as the average white person. There are all sorts of major social and cultural issues at play here, including things like the Tuskegee experiments at one end and the importance of women in decision-making about healthcare among African-American families at the other.

7 Responses

  1. Bullet points 2 to 4 are consistent with high awareness in the AA community of higher incidence and mortality (though now the gap is quite narrow for mortality considering all patients, not just those with distant metastases at diagnosis). For years the Virginia Prostate Cancer Coalition group saw a considerably higher interest in receiving our handouts and talking to us among AA attendees at Marine Corps Marathon and Half Marathon Health Expos at which we manned an information booth in conjunction with the Foundation for Cancer Research and Education.

    Regarding social and cultural issues, a fellow survivor and I who were manning our booth years ago were amused and saddened by the reaction of an elderly African American woman who was stunned (gobsmacked) by our presence. She was wide-eyed with a disapproving scowl, clearly signaling that our presence was not appropriate for a gathering of decent people! To her, we were presenting something good people just did not discuss. However, hers was a unique reaction, with almost all other African Americans quite interested in our information and thankful we were there.

    My own family’s handling of the disease was not all that different in years past, about 40 years ago. I knew my grandfather died of cancer, but no one said it was prostate cancer, a piece of information that would have been useful to me in later years. It’s good that society is now a lot more open about cancer.

  2. The results are not really surprising.

    Type and time of treatment as well as recovery time are all related to financial aspects; no surprise that African-Americans are more concerned about this than Caucasians. I assume this also means that African-Americans are more likely going to chose prostatectomy over radiation, correct?

    African-Americans are less likely to see a doctor, thus they have less confidence in what the doctor is recommending. Well, if you listen less to your doctor, you are going to listen more to family and friends.

  3. Wolfram:

    Actually (unless it has changed recently) African American men are much more likely to choose radiation therapy over surgery.

  4. If that is the case (I don’t have the data, but somebody should), then you are saying that they choose the more expensive and more time consuming treatment; confused!

  5. Dear Wolfram:

    I don’t make this stuff up; please see this link. I don’t have any type of perfect explanation for why the effect occurs. Like the authors of the article referred to, I am sure that a lot of African American men are diagnosed with more advanced prostate cancer than the average Caucasian, and thus would probably not be good candidates for surgery. However, it is my understanding that there is a sociocultural component to this as well in that many African Americans simply prefer to try to avoid surgery.

  6. I know you don’t make this stuff up and I have seen similar references. All I am saying is that the apparent fact that African-American men seem to prefer radiation treatment seems to be conflicting with some of the findings in this new article.

  7. Dear Wolfram:

    I would need a lot more information about this study before I could tell you whether there was any real conflict between the data presented here and the other data suggesting that African Americans tend to elect radiation therapy over surgery if possible.

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