Racial disparities in advanced prostate cancer care: An analysis of treatment patterns and patient experience

项目总结/摘要 前列腺癌是一个重大的公共卫生负担，临床结局具有很大的异质性， 巨大的种族差异：美国黑人男性被诊断患有前列腺的可能性是男性的1.6倍 与白色男性相比，死于前列腺癌的可能性高出两倍。晚期 前列腺癌（APC）的死亡风险最高，生活质量受到最严重的影响， 疾病本身及其相关疗法的影响。尽管如此，晚期前列腺癌是 替补演员在过去的10年里，APC的治疗前景随着FDA的发展而迅速变化。 美国批准了11种新疗法，但这些疗法的实际应用和男性的经验 使用这些疗法是未知的。此外，尽管在获得治疗和生活质量方面存在差距， 已经在局限性前列腺癌患者中显示，这些结果尚未在患者中进行研究 与APC;这是令人担忧的，因为有限的治疗机会和较差的生活质量与较高的 癌症的死亡率。关于APC患者的治疗模式或经验知之甚少， 迄今为止，在这一人群中的大多数研究主要招募了非西班牙裔白色男性。目前迫切 需要将前列腺癌种族差异的调查扩大到APC患者，并使用特定的 关注以患者为中心的结局，以突出潜在的干预领域，以降低APC的死亡率。 拟议工作的总体目标是量化治疗模式中的种族差异， 美国APC患者的医疗保健系统经验和生活质量 和联合王国。我将调查这些领域的病人的经验，使用数据约 1500名患者参加了国际男性晚期前列腺癌登记处（IRONMAN）， 新诊断为APC的男性的全球前瞻性队列。具体地说，我将比较自认为 美国和英国的黑人和白色男人的种族。在目标1中，我将使用医疗记录和医生 描述观察到的治疗模式差异和停药原因的问卷数据 治疗。在目标2中，我将使用澳大利亚的国家癌症控制指标来评估基线的差异 病人与医疗保健系统的经验，强调沟通和融入护理。在Aim中 3.我将使用来自EORTC QLQ-C30生活质量调查的患者报告结局指标数据， 评估生活质量基线和纵向领域的种族差异，包括总体生活质量， 功能状态和症状状态。该项目将提供真实世界的信息，可以直接 通过识别和量化患者接受的护理范围内的种族差异来翻译， APC，建议医疗保健提供者进行干预的潜在领域，以确保人人享有公平的医疗保健 APC患者

PROJECT SUMMARY/ABSTRACT Prostate cancer is a significant public health burden with substantial heterogeneity in clinical outcomes and large racial disparities: Black men in the United States are 1.6 times more likely to be diagnosed with prostate cancer and two times more likely to die from prostate cancer compared to white men. Patients with advanced prostate cancer (APC) experience the highest risk of death and the most severely impacted quality of life due to the disease itself as well as its associated therapies. Despite this, advanced prostate cancer is understudied. The treatment landscape for APC has changed rapidly over the past 10 years with the FDA approval of 11 new therapies in the US, yet the real-world uptake of these therapies and experience of men using these therapies is unknown. Additionally, though disparities in access to treatment and quality of life have been shown in patients with localized prostate cancer, these outcomes have not been studied in patients with APC; this is concerning as limited access to treatment and poorer quality of life have been linked to higher mortality in cancer broadly. Little is known about the treatment patterns for or experience of patients with APC, and most studies to date in this population have enrolled primarily non-Hispanic white men. There is an urgent need to expand the investigation of prostate cancer racial disparities into patients with APC, and with a specific focus on patient-centric outcomes, to highlight potential areas for intervention to decrease mortality from APC. The overarching goal of the proposed work is to quantify racial differences in the treatment patterns, experience with the health care system, and quality of life for patients with APC in the United States and United Kingdom. I will investigate these domains of the patient experience using data from approximately 1500 patients enrolled in the International Registry for Men with Advanced Prostate Cancer (IRONMAN), a global prospective cohort of men newly diagnosed with APC. Specifically, I will compare the self-identified races of Black and white men in the US and UK. In Aim 1, I will use medical record and physician questionnaire data to characterize differences in observed treatment patterns and reasons for discontinuing treatments. In Aim 2, I will use Australia’s National Cancer Control Indicators to assess differences in baseline patient experience with the health care system, emphasizing communication and integration into care. In Aim 3, I will use patient-reported outcome measures data from the EORTC QLQ-C30 Quality of Life Survey to assess racial differences in baseline and longitudinal domains of quality of life, including overall quality of life, functional status, and symptom status. This project will provide real-world information that can be directly translated by identifying and quantifying racial disparities across the spectrum of care received by patients with APC, suggesting potential areas for intervention by healthcare providers to ensure equitable care for all patients with APC.