Underserved Men's Understanding of Androgen Deprivation Therapy Related Risks

描述(申请人提供)：雄激素剥夺疗法(ADT)越来越多地被用于治疗前列腺癌，包括在放射治疗(RT)的新辅助和辅助情况下，用于通过手术或放射进行初步治疗后复发的前列腺癌，或者当前列腺癌处于晚期，不再需要局部治疗、手术或放射治疗的时候。这一点意义重大，因为前列腺癌是美国男性最常见的非皮肤癌。尤其令人担忧的是服务不足的男性。拉美裔是美国增长最快的少数民族，他们的医疗保险覆盖率较低。非洲裔美国人(AA)的发病率几乎是其他种族男性的两倍，并且患有晚期侵袭性疾病。为了这项研究的目的，我们将服务不足定义为低收入、未参保或公共参保。低收入家庭收入将是联邦贫困水平(FPL)的300%或更低。尽管与前列腺癌相比，服用ADT已被证明对生存有好处，但研究表明，服用ADT的男性患血管运动症状、抑郁、疲劳、与健康相关的生活质量(HRQOL)降低、骨密度(BMD)降低、性功能障碍、代谢综合征、脂肪量增加、瘦肌肉质量减少、血脂增加和动脉顺应性降低的风险增加，所有这些都使他们患心血管疾病(CVD)、骨质疏松和II型糖尿病的风险更高。拉丁裔和再障患者通常都有代谢综合征、肥胖、血脂异常、心血管适合度低和糖尿病，这使他们患心血管疾病的风险更高。然而，人们对这些男性如何理解ADT及其相关风险与他们自己的健康和福祉知之甚少。因此，我们的目标是：1.从以前收集的数据中，探索男性对ADT的解释、ADT的目的、效果和风险，以便制定针对ADT相关问题的访谈指南2.从ADT服务不足的男性那里获得深入的叙述，重点是他们对ADT的理解和经验；3.建立男性对ADT及其相关风险的理解和反应的描述性框架，以指导制定干预措施，以降低与ADT相关风险的发病率和死亡率。我们将使用两个阶段的定性方法来实现这些目标。首先，我们将对现有的定性数据进行新的、深入的分析，这些数据侧重于在采访时接受ADT的男性。根据这一分析，我们将开发有针对性的面试指南，以更全面地探索男性对ADT相关的理解和管理，以及新的服务不足的男性队列。这是必要的形成性工作，为开发和测试干预措施奠定基础，以最大限度地减少高度脆弱、服务不足的男子中与抗逆转录病毒治疗相关的风险。这些干预措施有可能改善接受ADT治疗的未得到充分服务的男性的发病率和死亡率，从而减少与ADT相关的一些保健和人力成本。 公共卫生相关性：虽然雄激素剥夺疗法(ADT)对晚期前列腺癌复发的男性患者有生存益处，但它也有与心血管疾病、骨碎片、代谢综合征和性功能障碍相关的多个相关风险。服务不足的男性面临的风险尤其大。我们的目标是了解接受ADT治疗的前列腺癌患者如何了解他们的治疗方法及其相关风险。为此，我们将分两个阶段进行研究。在第一阶段，我们将在两项研究中使用对服务不足的男性进行的采访记录；一项是关于低收入非裔美国人和拉丁裔男性中前列腺癌治疗相关失禁和阳萎的意义，另一项是前列腺癌治疗相关症状对低收入拉丁裔夫妇的影响。我们将选择服用ADT的男性的成绩单，并重新分析它们，以了解ADT及其风险，以及他们对相关症状的处理。我们将利用这一点来开发一份面试指南，以深入采访ADT的理解和风险。我们将利用对这些数据的分析来帮助制定干预措施，将ADT相关风险降至最低。

DESCRIPTION (provided by applicant): Androgen deprivation therapy (ADT) is increasingly being used to treat prostate cancer in the neoadjuvant and adjuvant contexts with radiation therapy (RT), for recurrence following primary treatment with surgery or radiation, or when the prostate cancer is at an advanced stage such that local treatments, surgery or radiation, are no longer indicated. This is significant because prostate cancer is the most commonly diagnosed noncutaneous cancer in American men. Of particular concern are underserved men. Latinos are the fastest growing minority in the United States (US) and have lower rates of health insurance coverage. African American (AA men) have almost twice the incidence as men of other ethnicities, and have advanced, aggressive disease. For purposes of this study, we will define underserved as low-income and uninsured or publically insured. Low-income will be household income 300% of the Federal Poverty Level (FPL) or less. Despite the proven survival benefit of ADT relative to prostate cancer, studies have shown that men on ADT are at increased risk for vasomotor symptoms, depression, fatigue, diminished health-related quality of life (HRQOL), decreased bone mineral density (BMD), sexual dysfunction, metabolic syndrome, increased fat mass, along with decreased lean muscle mass, increased serum lipids, and decreased arterial compliance all of which places them at higher risk for cardiovascular disease (CVD), osteoporosis, and type II diabetes. Both Latinos and AA more often have components of metabolic syndrome, obesity, dyslipidemia, low cardiovascular fitness, and diabetes placing them at higher risk for CVD. However, little is known about how these men understand ADT and its associated risks relative to their own health and well-being. Therefore, we aim to: 1. From previously collected data explore men's explanations of ADT, its purpose, effects, and risks among underserved men on ADT in order to develop interview guides focused on issues related to 2 Elicit in-depth narratives from underserved men on ADT focused on their understanding and experience of ADT and 3. Develop a descriptive framework of men's understanding of and response to ADT and its associated risks to guide development of interventions to decrease morbidity and mortality related to ADT-associated risks. We will use a two-stage qualitative approach to meet these aims. First we will conduct a new, in-depth analysis of existing qualitative data focused on men who were receiving ADT at the time of their interviews. From this analysis we will develop focused interview guides to more completely explore men's understanding and management of ADT-related with a new cohort of underserved men. This is necessary formative work to lay the foundation for the development and testing of interventions to minimize ADT-associated risks among highly vulnerable underserved men. These interventions have the potential to improve morbidity and mortality of underserved men on ADT thereby decreasing some of the health care and human costs that can be associated with ADT. PUBLIC HEALTH RELEVANCE: While androgen deprivation therapy (ADT) has survival benefit for men with recurrent of advanced prostate cancer, it has multiple associated risks related to cardiovascular disease, bone fraction, metabolic syndrome, and sexual dysfunction. Underserved men are at particular risk. Our goal is to understand how underserved men treated for prostate cancer with ADT understand their treatment and the risks associated with it. To do this, we will conduct the study in two phases. In the first phase we will use transcripts of interviews conducted with underserved men in two studies; one on the meaning of prostate cancer treatment-related incontinence and impotence among low-income African American and Latino men and the second on the impact for prostate cancer treatment-related symptoms on low-income Latino couples. We will select the transcripts of the men who were on ADT and re-analyze them for understanding of ADT and its risks and for their management of related symptoms. We will use this to develop an interview guide to do in-depth interviews focused on ADT understanding and risks. We will use the analysis of this data to help develop interventions to minimize ADT-related risks.