Active surveillance and patient reported outcomes in a diverse population of prostate cancer patients

项目总结/摘要 越来越多的低级别和低进展潜力的前列腺癌被诊断出来 每年.大多数患有这些肿瘤的男性预计与其他同龄男性的生存率相当 没有前列腺癌。因此，积极监测，或密切监测疾病的进程与 鉴于癌症进展的证据，普遍建议进行治疗性干预 作为一种可行的管理选择，为男性肿瘤分类为"非常低风险"或"低风险"，特别是 考虑到严重的发病率，包括大小便失禁和性功能障碍， 手术和放疗研究表明，男性可能没有充分了解他们的治疗情况， 更令人担忧的是，有证据表明，对积极监视选项的讨论是 少数民族男性和社会经济地位较低的男性较少。此外，实际上 没有关于患者报告结果的研究（例如，身体、精神、社会心理健康）和健康相关的 不同种族/族裔和社会经济群体的生活质量。在以人口为基础的 在一个由不同种族/族裔和社会经济水平组成的环境中，建议的具体目标如下： 1）检查提供者对患者种族/民族的看法和对活性药物的偏好 （2）研究极低和低收入人群中主动监测的流行率和决定因素， 按种族/民族和社会经济地位的前列腺癌患者的风险;和3）比较患者的变化， 按治疗、种族/民族和社会经济地位报告的结局，以及 社会人口统计学、临床和背景（家庭、社交网络、机构/提供者、邻里）因素 患者报告的结果变化。这些目标将使用混合方法研究解决， 定性提供者和患者访谈、提供者调查以及纵向患者调查， 在基线（诊断后2 - 3个月）和基线后12和24个月进行访谈。所有少数民族患者 20%的非西班牙裔白人随机样本将使用早期病例确定 这是大湾区癌症登记处和当地退伍军人事务部卫生系统的一个流程。多级 治疗决策过程和患者报告结局的决定因素包括患者的 社会人口、文化、社会心理和背景因素。这项基于人群的研究， 在包括一系列医疗保健环境的多样化人群中，将使我们能够了解 在多个层面上的促成因素，导致在接受积极监测方面存在差距。该信息 需要确定谁和如何最好地针对干预措施，以确保所有男子充分知情 了解他们的治疗方案，并提供机会，参与知情的决定， 治疗。

PROJECT SUMMARY/ABSTRACT An increasing proportion of prostate cancers of low grade and low potential for progression are diagnosed each year. Most men with these tumors are expected to have comparable survival as other men their age without prostate cancer. Thus, active surveillance, or closely monitoring the course of disease with the expectation to intervene with curative intent given evidence of cancer progression, is universally recommended as a viable management option for men with tumors categorized as “very low risk” or “low risk”, particularly given significant morbidities including urinary and bowel incontinence and sexual dysfunction associated with surgery and radiation. Research suggests that men may not be adequately informed about their treatment options and, even more concerning, there is evidence that discussion of the option of active surveillance is done less often for minority men and men of low socioeconomic status. Furthermore, there has been virtually no research on patient-reported outcomes (e.g., physical, mental, psychosocial well-being) and health related quality of life among different racial/ethnic and socioeconomic groups. Conducted within a population-based setting comprising a diverse mix of races/ethnicities and socioeconomic level, the proposed specific aims are to: 1) Examine provider perspectives on patient racial/ethnic perceptions and preferences regarding active surveillance; 2) Examine the prevalence of and determinants of active surveillance among very low and low risk prostate cancer patients by race/ethnicity and socioeconomic status; and 3) Compare changes in patient- reported outcomes by treatment, race/ethnicity, and socioeconomic status, and the contributions of sociodemographic, clinical, and contextual (family, social networks, institutional/provider, neighborhood) factors on patient-reported outcome changes. These aims will be addressed using a mixed methods study integrating qualitative provider and patient interviews, a survey of providers, and a longitudinal patient survey with interviews at baseline (2-3 months after diagnosis) and 12 and 24 months after baseline. All minority patients and a 20% random sample of non-Hispanic Whites will be identified using an early-case ascertainment process from the Greater Bay Area Cancer Registry and the local Veteran's Affairs health system. Multilevel determinants of treatment decision-making process and patient-reported outcomes will include patients' sociodemographic, cultural, psychosocial, and contextual factors. This population-based study, conducted within a diverse population inclusive of a range of medical care settings, will enable us to understand the contributing factors at multiple levels that drive the gaps in receipt of active surveillance. This information is needed to determine who and how best to target interventions to ensure that all men are adequately informed about their treatment options and provided the opportunity to engage in informed decisions regarding their treatments.