Graduation Year

2015

Document Type

Dissertation

Degree

Ph.D

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Environmental and Occupational Health

Major Professor

Thomas J. Mason, Ph.D.

Co-Major Professor

Jennifer Permuth-Wey, Ph.D.

Committee Member

Jennifer Permuth-Wey, Ph.D.

Committee Member

Hamisu Salihu, M.D., Ph.D, M.P.H.

Committee Member

Philippe Spiess, M.D., M.S.

Keywords

Adenocarcinoma, African American, First Course of Treatment, Non-Hispanic White, Radiation, Surgery

Abstract

Study Purpose: The purpose of this study was to examine whether there were differences in patterns of care between African American (AA) and Non-Hispanic White (NHW) men newly diagnosed with prostate cancer in Florida, and how the treatment patterns compare with the National Comprehensive Cancer Network (NCCN) initial treatment recommendations.

Materials and Methods: This retrospective cohort study utilized data from the Florida Cancer Data System (FCDS), to identify incident cases of prostate cancer diagnosed between 1982 and 2012. The variables of interest included: race/ethnicity, marital status, age at diagnosis, stage at diagnosis, tumor grade, year of diagnosis, and treatment modality (singular or multimodality). Adjusted odds ratios (AORs) and 95% confidence intervals were calculated to determine disparities in the receipt of treatment by age at diagnosis, stage at diagnosis and tumor grade between AA and NHW men.

Results: A total of 244,449 AA (30,556 cases or 12.5%) and NHW (213,893 cases or 87.5%) men met the study inclusion/exclusion criteria. AA men were significantly less likely to receive surgery only or surgery in combination with other treatment modalities compared to NHW men, localized disease (AOR=0.66, 95% CI (0.63-0.68), regional disease (AOR=0.63, 95% CI (0.57- 0.71), distant disease (AOR=0.50, 95% CI (0.34-0.75). Comparisons of adherence to the NCCN initial treatment recommendations indicate that AA men with <10 years of life expectancy had a lower NCCN initial treatment adherence percentage compared to NHW men (5% versus 13%). Moreover, AA men in the very high risk group had a higher NCCN initial treatment adherence percentage compared to NHW men (76% versus 70%).

Conclusion: After adjusting for potential demographic and clinical confounders, significant differences exist in the receipt of first course of treatment where AA men were more likely to receive radiation and/or hormone therapy and less likely to receive surgery compared to NHW men. Further research is needed to address this disparity.

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