Ethnicity & Determinants of QoL Following PCa Treatment

描述(申请人提供)：尽管前列腺癌(PCA)仍然是西班牙裔(H)和非裔美国人(AA)男性癌症相关死亡的第二大原因，但这些少数族裔在生活质量(QOL)结果研究中的参与往往很少，HS的比例明显偏低。患有前列腺癌的少数民族男性在诊断时的教育和财政资源较少，疾病负担的指标更多(例如，疾病更晚期，前列腺特异性抗原[PSA]更高)，即使在控制了社会人口和疾病变量后，治疗后的生活质量和存活率也会降低。此外，AAA中的PCA死亡率是非西班牙裔白人(NHW)男性的两倍。虽然样本有限，但现有的研究表明，不同种族的结果不同，少数族裔男性始终报告生活质量较低(例如，身体功能下降和更具体的疾病，如尿便/肠道功能障碍和性功能障碍)，治疗满意度较低，治疗后恢复较差；然而，种族影响生活质量的机制仍有待探索。这些先前的研究也缺乏对族裔的多维概念化，以及将族裔与健康结果联系起来的理论框架。这项修订后的申请包括一项为期5年的前瞻性观察研究，旨在评估种族群体成员对诊断和治疗前列腺癌的男性总体和特定疾病的生活质量结果和疾病状况(即PSA)的影响。我们将在诊断为前列腺癌时招募690名不同种族的男性(230名nhw；230名H；230名aa)，并在基线(治疗前)、治疗后3个月和治疗后24个月内每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)种族群体成员与(A)一般(即身心健康功能)和特定疾病的生活质量(QOL)之间的关系，以及(B)疾病状况(即PSA)是否由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)、坚持治疗和获得卫生保健之间的关系来解释，接受PCA治疗的男性在两年的随访期内；(目的2)种族的特定组成部分(即文化价值观[例如，家族主义、宗教信仰、癌症宿命论]、族裔认同、文化适应、少数群体地位和社会地位)是否与接受PCA治疗的男性在两年随访期内获得卫生保健和坚持治疗有关；(目的3)接受PCA治疗的男性在两年随访期内，是否通过PCA知识和态度、心理社会资源、获得保健的机会和坚持治疗来解释特定族裔组成部分与生活质量和疾病状况之间的关系。为了调查基线得分和生活质量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(例如种族成分、心理社会资源)，将在结构方程建模的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构成因素、假设的生活质量和疾病状况中介因素之间的关系，以及它们的联合影响，同时在假设的模型中纳入相关的社会人口和医疗因素。

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.