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

项目摘要/摘要 越来越多的低级别和低进展可能性的前列腺癌被诊断出来 每年。大多数患有这些肿瘤的男性的存活率预计与其他同龄男性相当。 没有前列腺癌。因此，积极监测，或密切监测病程与 普遍推荐在有癌症进展证据的情况下，期望以治疗意图进行干预 作为一种可行的治疗方案，对于那些被归类为“极低风险”或“低风险”的男性，尤其是 考虑到明显的发病率，包括尿失禁和性功能障碍 手术和放射治疗。研究表明，男性可能没有充分了解自己的治疗方法 选项，更令人关切的是，有证据表明，关于主动监视选项的讨论 少数族裔男性和社会经济地位较低的男性较少这样做。此外，实际上已经有 没有关于患者报告的结果(例如，身体、精神、心理社会健康)和与健康有关的研究 不同种族/民族和社会经济群体之间的生活质量。在以人口为基础的 背景包括不同的种族/民族和社会经济水平，拟议的具体目标是 到：1)检查提供者对患者种族/民族的看法和对Active的偏好 监测；2)审查在极低和低水平人群中积极监测的流行率和决定因素 按种族/民族和社会经济地位对前列腺癌患者的风险；以及3)比较患者- 按治疗、种族/族裔和社会经济地位报告的结果，以及 社会人口、临床和环境(家庭、社会网络、机构/提供者、社区)因素 根据患者报告的结果变化。这些目标将使用一种混合方法研究来解决 定性的提供者和患者访谈、提供者调查和纵向患者调查 在基线(确诊后2-3个月)以及基线后12个月和24个月进行访谈。所有少数族裔患者 20%的非西班牙裔白人随机样本将通过早期病例确定进行鉴定 大湾区癌症登记处和当地退伍军人事务健康系统的流程。多层次 治疗决策过程和患者报告的结果的决定因素将包括患者的 社会人口、文化、心理社会和背景因素。这项基于人群的研究，进行了 在包括一系列医疗保健环境在内的不同人群中，将使我们能够理解 造成主动监测接收差距的多个层面的促成因素。此信息是 需要确定谁和如何最好地针对干预措施，以确保所有男子都得到充分的信息 关于他们的治疗选择，并提供了机会参与关于他们的 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.