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.

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(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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