Underserved Men's Understanding of Androgen Deprivation Therapy Related Risks

描述（由申请人提供）：雄激素剥夺疗法（ADT）越来越多地用于治疗前列腺癌的新辅助治疗和放射疗法（RT）辅助治疗，用于手术或放射初步治疗后的复发，或当前列腺癌处于晚期时，不再需要局部治疗、手术或放射。这是重要的，因为前列腺癌是美国男性中最常见的非皮肤癌。特别令人关切的是得不到充分服务的男子。拉丁裔是美国增长最快的少数民族，医疗保险覆盖率较低。非裔美国人（AA男性）的发病率几乎是其他种族男性的两倍，并且患有晚期侵袭性疾病。在本研究中，我们将服务不足定义为低收入和无保险或无保险。低收入将是家庭收入为联邦贫困水平（FPL）的300%或更低。尽管ADT相对于前列腺癌的生存益处已被证明，但研究表明，接受ADT的男性发生血管扩张症状、抑郁、疲劳、健康相关生活质量（HRQOL）下降、骨矿物质密度（BMD）降低、性功能障碍、代谢综合征、脂肪量增加、沿着瘦肌肉质量降低、血脂升高和动脉顺应性降低，所有这些都使他们处于心血管疾病（CVD）、骨质疏松症和II型糖尿病的更高风险中。拉丁美洲人和AA更经常有代谢综合征，肥胖，血脂异常，心血管健康水平低和糖尿病的组成部分，使他们有更高的心血管疾病风险。然而，人们对这些男性如何理解ADT及其与自身健康和福祉相关的风险知之甚少。因此，我们的目标是：1.根据先前收集的数据，探索男性对ADT的解释，其目的，影响和ADT服务不足男性中的风险，以制定访谈指南，重点关注与ADT服务不足男性的深入叙述相关的问题，重点关注他们对ADT的理解和经验，以及3。制定男性对ADT及其相关风险的理解和反应的描述性框架，以指导干预措施的制定，以降低与ADT相关风险相关的发病率和死亡率。 我们将采用两个阶段的定性方法来实现这些目标。首先，我们将对现有的定性数据进行新的深入分析，重点关注在访谈时接受ADT的男性。从这个分析中，我们将制定重点访谈指南，以更全面地探讨男性的理解和管理ADT相关的一个新的队列服务不足的男人。这是必要的形成性工作，为制定和测试干预措施奠定基础，以尽量减少高度脆弱的服务不足的男性中与ADT相关的风险。这些干预措施有可能改善ADT治疗不足男性的发病率和死亡率，从而降低与ADT相关的一些医疗保健和人力成本。 公共卫生相关性：虽然雄激素剥夺治疗（ADT）对复发性晚期前列腺癌男性具有生存益处，但它具有与心血管疾病、骨分数、代谢综合征和性功能障碍相关的多种相关风险。得不到充分服务的男子面临的风险特别大。我们的目标是了解接受ADT治疗的前列腺癌患者如何理解他们的治疗以及与之相关的风险。为此，我们将分两个阶段进行研究。在第一阶段，我们将使用两项研究中与服务不足的男性进行的访谈记录;一项研究是关于低收入非洲裔美国人和拉丁裔男性中前列腺癌治疗相关的尿失禁和阳痿的意义，第二项研究是关于前列腺癌治疗相关症状对低收入拉丁裔夫妇的影响。我们将选择接受ADT治疗的男性的成绩单，并重新分析它们，以了解ADT及其风险，以及他们对相关症状的管理。我们将利用这一点来制定一个访谈指南，以进行深入访谈，重点是ADT的理解和风险。我们将利用这些数据的分析来帮助制定干预措施，以最大限度地减少ADT相关风险。

DESCRIPTION (provided by applicant): Androgen deprivation therapy (ADT) is increasingly being used to treat prostate cancer in the neoadjuvant and adjuvant contexts with radiation therapy (RT), for recurrence following primary treatment with surgery or radiation, or when the prostate cancer is at an advanced stage such that local treatments, surgery or radiation, are no longer indicated. This is significant because prostate cancer is the most commonly diagnosed noncutaneous cancer in American men. Of particular concern are underserved men. Latinos are the fastest growing minority in the United States (US) and have lower rates of health insurance coverage. African American (AA men) have almost twice the incidence as men of other ethnicities, and have advanced, aggressive disease. For purposes of this study, we will define underserved as low-income and uninsured or publically insured. Low-income will be household income 300% of the Federal Poverty Level (FPL) or less. Despite the proven survival benefit of ADT relative to prostate cancer, studies have shown that men on ADT are at increased risk for vasomotor symptoms, depression, fatigue, diminished health-related quality of life (HRQOL), decreased bone mineral density (BMD), sexual dysfunction, metabolic syndrome, increased fat mass, along with decreased lean muscle mass, increased serum lipids, and decreased arterial compliance all of which places them at higher risk for cardiovascular disease (CVD), osteoporosis, and type II diabetes. Both Latinos and AA more often have components of metabolic syndrome, obesity, dyslipidemia, low cardiovascular fitness, and diabetes placing them at higher risk for CVD. However, little is known about how these men understand ADT and its associated risks relative to their own health and well-being. Therefore, we aim to: 1. From previously collected data explore men's explanations of ADT, its purpose, effects, and risks among underserved men on ADT in order to develop interview guides focused on issues related to 2 Elicit in-depth narratives from underserved men on ADT focused on their understanding and experience of ADT and 3. Develop a descriptive framework of men's understanding of and response to ADT and its associated risks to guide development of interventions to decrease morbidity and mortality related to ADT-associated risks. We will use a two-stage qualitative approach to meet these aims. First we will conduct a new, in-depth analysis of existing qualitative data focused on men who were receiving ADT at the time of their interviews. From this analysis we will develop focused interview guides to more completely explore men's understanding and management of ADT-related with a new cohort of underserved men. This is necessary formative work to lay the foundation for the development and testing of interventions to minimize ADT-associated risks among highly vulnerable underserved men. These interventions have the potential to improve morbidity and mortality of underserved men on ADT thereby decreasing some of the health care and human costs that can be associated with ADT. PUBLIC HEALTH RELEVANCE: While androgen deprivation therapy (ADT) has survival benefit for men with recurrent of advanced prostate cancer, it has multiple associated risks related to cardiovascular disease, bone fraction, metabolic syndrome, and sexual dysfunction. Underserved men are at particular risk. Our goal is to understand how underserved men treated for prostate cancer with ADT understand their treatment and the risks associated with it. To do this, we will conduct the study in two phases. In the first phase we will use transcripts of interviews conducted with underserved men in two studies; one on the meaning of prostate cancer treatment-related incontinence and impotence among low-income African American and Latino men and the second on the impact for prostate cancer treatment-related symptoms on low-income Latino couples. We will select the transcripts of the men who were on ADT and re-analyze them for understanding of ADT and its risks and for their management of related symptoms. We will use this to develop an interview guide to do in-depth interviews focused on ADT understanding and risks. We will use the analysis of this data to help develop interventions to minimize ADT-related risks.