Ethnicity & Determinants of QoL Following PCa Treatment

描述（由申请人提供）：尽管前列腺癌（PCa）仍然是西班牙裔（H）和非洲裔美国人（AA）男性癌症相关死亡的第二大原因，但这些少数民族参与生活质量（QoL）结局研究的人数通常很少，其中H的代表性明显不足。患有PCa的少数民族男性在诊断时的教育和财政资源较少，疾病负担的指标较多（例如，更晚期的疾病，更高的前列腺特异性抗原[PSA]），以及降低的生活质量和治疗后的生存率，即使在控制了社会人口统计学和疾病变量后。此外，AA中的PCa死亡率是非西班牙裔白色（NHW）男性的两倍。尽管受小样本的限制，但现有研究表明，少数民族男性持续报告较低的QoL（例如，身体功能下降和更多疾病特异性下降，如泌尿/肠道和性功能障碍），治疗满意度较低，治疗后恢复较差;然而，种族可能影响QoL的机制仍有待探索。这些先前的研究也缺乏种族的多维概念化，以及将种族与健康结果联系起来的理论框架。本修订申请包括一项为期5年的前瞻性观察性研究，旨在评估种族组成员资格对一般和疾病特异性QoL结局和疾病状态的影响（即，PSA）诊断和治疗PCa的男性。我们将招募690名不同种族的男性（230名NHW; 230名H; 230名AA）诊断为PCa，并在基线（治疗前）、治疗后3个月以及治疗后24个月随访期内每6个月进行一次心理社会和身体健康评估。我们的具体目标是在24个月的随访中确定：（目标1）种族群体成员资格与（a）一般（即，身体和精神健康功能）和疾病特异性生活质量（QoL），和（B）疾病状态（即，PSA）由PCa知识和态度、心理社会资源（即，乐观，社会支持，应对和家庭环境），坚持治疗和获得医疗保健超过两年的随访期的男性治疗PCa;（目标2）是否种族的特定组成部分（即，文化价值[例如，家庭主义、宗教信仰、癌症宿命论]、种族认同、文化适应、少数民族地位和社会经济地位）与前列腺癌知识和态度、心理社会资源、获得医疗保健的机会以及在接受前列腺癌治疗的男性中两年随访期间的治疗依从性相关;以及（目标3）族裔群体成员的具体组成部分之间的关系，生活质量和疾病状态的解释PCa的知识和态度，心理社会资源，获得医疗保健和坚持治疗超过两年的随访期的男性治疗PCa。研究基线评分和QoL随时间变化的轨迹是否存在种族差异，以及这些差异的潜在决定因素（例如，种族、心理社会资源等组成部分），将在结构方程模型框架内进行潜在增长曲线建模。我们还将测试种族群体成员，假定介质的生活质量和疾病状态，以及它们的联合作用，同时将相关的社会人口和医学因素的假设模型的组成部分之间的关系。

DESCRIPTION (provided by applicant): Despite the fact that prostate cancer (PCa) continues to be the second leading cause of cancer-related death among Hispanic (H) and African American (AA) men, participation of these ethnic minorities in quality of life (QoL) outcome research is often minimal with Hs being significantly underrepresented. Ethnic minority men with PCa have less educational and financial resources at diagnosis, more indicators of disease burden (e.g., more advanced disease, higher prostate specific antigen [PSA]), and reduced QoL and survival following treatment even after controlling for sociodemographic and disease variables. Furthermore, PCa mortality rates among AAs are twice as high as in non-Hispanic white (NHW) men. Although limited by small samples, available studies indicate that there are differential outcomes by ethnicity with minority men consistently reporting lower QoL (e.g., reduced physical functioning and more disease-specific decrements such as urinary/bowel and sexual dysfunction), lower treatment satisfaction and poorer recovery after treatment; however, the mechanisms by which ethnicity may impact QoL remain to be explored. These prior studies are also lacking in a multidimensional conceptualization of ethnicity, as well as a theoretical framework that links ethnicity to health outcomes. This revised application consists of a 5-year prospective observational study designed to assess the effect of ethnic group membership on general and disease- specific QoL outcomes and disease status (i.e., PSA) in men diagnosed and treated for PCa. We will recruit 690 ethnically diverse men (230 NHW; 230 H; 230 AA) at diagnosis for PCa and conduct psychosocial and physical health assessments at baseline (pre-treatment), at 3-months post-treatment, and every 6 months over a 24-month post-treatment follow-up period. Our Specific Aims are to determine over a 24-month follow-up: (Aim 1) whether the relationship between ethnic group membership and (a) general (i.e., physical and mental health functioning) and disease-specific quality of life (QoL), and (b) disease status (i.e., PSA) is explained by PCa knowledge and attitudes, psychosocial resources (i.e., optimism, social support, coping and family environment), adherence to treatment and access to health care over a two-year follow-up period in men treated for PCa; (Aim 2) whether specific components of ethnicity (i.e., cultural values [e.g., familism, religiosity, cancer fatalism], ethnic identity, acculturation, minority status & SES) are associated with PCa knowledge and attitudes, psychosocial resources, access to health care & adherence to treatment over a two-year follow-up period in men treated for PCa; and (Aim 3) whether the relationship between specific components of ethnic group membership, and QoL and disease status are explained by PCa knowledge and attitudes, psychosocial resources, access to health care & adherence to treatment over a two-year follow-up period in men treated for PCa. To investigate if there are ethnic differences in baseline scores and the trajectory of change in QoL over time and the potential determinants of these differences (e.g., components of ethnicity, psychosocial resources), latent growth curve modeling in the framework of structural equation modeling will be performed. We will also test the relationships among components of ethnic group membership, postulated mediators of QoL and disease status, and their joint effects, while incorporating relevant socio-demographic and medical factors in the hypothesized models.