ABSTRACT
BACKGROUND/PURPOSE: Little is known about primary care physicians' (PCPs) beliefs about prostate cancer screening efficacy, evidence uncertainty, and their actual screening behaviors. We examined factors associated with PCP beliefs about screening efficacy and uncertainty and whether beliefs were associated with prostate specific-antigen (PSA) test use. METHODS: The 2008 National Survey of Primary Care Physicians' Practices Regarding Prostate Cancer Screening collected information on physicians' attitudes, beliefs, and practices related to prostate cancer and screening (n=1,256). Two factors were constructed that measured belief in certainty of evidence for PSA testing and belief in screening efficacy. These factors, along with PCP sociodemographic and practice-related factors, were used to examine associations with offering the PSA test. RESULTS: Most PCPs were male (70%), Caucasian (76%), under age 50 (56%), and practiced in communities with more than 50,000 residents (54%). In bivariate analysis, variables associated with PCP belief in evidence uncertainty included female gender, younger age, and lower patient volume. Variables associated with belief in screening efficacy included older age and general and family practice specialty. After adjustment, PCPs with high belief in evidence uncertainty were less likely (OR=0.19, 95% CI=0.06, 0.62) to offer PSA and more likely to practice shared decision making (OR=1.80, 95% CI=1.22-2.67). PCPs with high belief in screening efficacy were more likely (OR=2.99, 95% CI=1.15, 7.77) to offer PSA and less likely to practice shared decision making (OR=0.47, 95% CI=0.32-0.70). CONCLUSION: Our data indicate that belief patterns about evidence uncertainty and the efficacy of using PSA may play a role in whether PCPs offer PSA.
Subject(s)
Attitude of Health Personnel , Early Detection of Cancer , Physicians, Primary Care , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , Age Factors , Attitude of Health Personnel/ethnology , Decision Making , Early Detection of Cancer/statistics & numerical data , Humans , Male , Practice Patterns, Physicians'/statistics & numerical data , Sex Factors , Uncertainty , United StatesABSTRACT
BACKGROUND: Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored. METHODS: Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when they entered the North Carolina Central Cancer Registry during the years 2007 and 2008. Our dependent variable was the amount of months that had passed between first diagnosis and treatment. Our main independent variable was self-reported race. Covariates included age, income, level of education, insurance status, treatment received, Gleason score, and level of medical mistrust. We used negative binomial regression analysis to determine the association between the amount of time that lapsed between a diagnosis of prostate cancer and treatment by race. RESULTS: Compared with white men, black men were more likely to experience a longer wait time between diagnosis and treatment of prostate cancer (incidence rate ratio [IRR] 1.19; 95% confidence interval [CI], 1.04-1.36). Controls for demographical, clinical, and psychosocial variables (IRR 1.24; 95% CI, 1.04-1.43) did not explain this difference between the races. CONCLUSIONS: These results suggest that the amount of time that lapses between first diagnosis and treatment of prostate cancer is longer for black men compared with white men. Our findings have identified an underreported racial disparity in the disease continuum of prostate cancer.
Subject(s)
Healthcare Disparities/ethnology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Time-to-Treatment , Adult , Age Factors , Aged , Aged, 80 and over , Black People , Humans , Male , Middle Aged , Neoplasm Grading , North Carolina , Self Report , Waiting Lists , White PeopleABSTRACT
The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007-2008 and asked to participate in a telephone interview covering several measures about their initial prostate cancer treatment. Logistic regression was used to assess demographic, psychosocial, and clinical factors on whether they felt that they had chosen the best treatment for the disease. Respondents were majority White (52.7 %), married (75.9 %), and had surgery (67.9 %) as their initial treatment. At the bivariate level, factors associated with the belief that the treatment chosen was best were as follows: White race/ethnicity, higher levels of education, a more recent treatment date, having health insurance coverage, type of treatment received, higher levels of bother from side effects, greater contentment with their quality of life, and doctor discussions of the various treatment options. Similarly, the multivariate analysis showed increased odds of belief that the treatment chosen was the best among demographic (i.e., race/ethnicity, level of education, and health insurance coverage) as well as psychosocial and clinical variables (i.e., greater bother from side effects, greater contentment with their quality of life, and initial treatment received). Results suggest that demographic, psychosocial, and clinical factors play an important role for men in assessing their treatment choices for prostate cancer.
Subject(s)
Choice Behavior , Health Knowledge, Attitudes, Practice , Prostatic Neoplasms/psychology , Prostatic Neoplasms/therapy , Quality of Life , Adult , Aged , Aged, 80 and over , Attitude to Health , Cross-Sectional Studies , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Socioeconomic FactorsABSTRACT
BACKGROUND: Limited information exists on primary care physicians' (PCPs) use of the prostate-specific antigen (PSA) test by patient risk category. We describe PCP responses to hypothetical patient scenario (PS) involving PSA testing among high-risk asymptomatic men. METHODS: Data were from the 2007 to 2008 National Survey of Primary Care Physicians' Practices Regarding Prostate Cancer Screening. PS#1: healthy 55-year-old white male with no family history of prostate cancer; PS#2: healthy 45-year-old African American male with no family history of prostate cancer; and PS#3: healthy 50-year-old male with a family history of prostate cancer. Data were analyzed in SAS/SUDAAN. RESULTS: Most PCPs indicated that they generally discuss the possible benefits/risks of PSA testing with the patient and then recommend the test (PS#1-PS#3 range, 53.4%-68.7%; P < .001); only about 1% reported discussing and then recommending against the test. For PS#3, compared to PS#1 and #2, PCPs were more likely to discuss and recommend the test or attempt to persuade the patient who initially declines the test. For PS#3, all clinicians generally would order/discuss the PSA test and not rely on the patient to ask. CONCLUSION: Clinicians treat family history as an important reason to recommend, persuade, and initiate PSA testing.
ABSTRACT
INTRODUCTION: Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States. African American (AA) men have greater prostate cancer burden than other men. Little is known about AA primary care physicians' (PCPs) practices regarding prostate cancer screening. METHODS: We analyzed data from the 2007-2008 National Survey of Primary Care Physicians' Practices Regarding Prostate Cancer Screening. The current study included 604 AA PCPs. Outcomes assessed were (a) offering screening using the prostate-specific antigen (PSA) test, (b) use of screening discussions to involve patients in the decision to screen, and (c) having a discussion policy to try to talk the patient into getting the screening tests. RESULTS: Most AA PCPs were male (52%), younger than 50 years (61%), and had 21% to 100% AA patients in their practices (74%). The majority (94%) of AA PCPs offered prostate cancer screening using PSA, discussed the tests with their male patients to involve them in the decision to screen (83%), and had a policy to try to talk the patient into getting the screening tests (77%). Multivariate analysis showed that offering screening, use of discussions, and a usual policy to encourage taking the screening tests varied mainly by practice-related factors, including practice type, practice location, and percentage of AA patients in the practice. CONCLUSION: Data from this study indicate that most AA PCPs reported high proscreening behaviors for all 3 outcomes. Additionally, practice- and screening-related factors may be important when examining AA PCP screening behaviors.
Subject(s)
Black or African American , Family Practice/statistics & numerical data , Mass Screening , Practice Patterns, Physicians'/statistics & numerical data , Prostatic Neoplasms/diagnosis , Adult , Decision Making , Female , Humans , Male , Mass Screening/methods , Middle Aged , Multivariate Analysis , Patient Participation , Physician-Patient Relations , Referral and Consultation/statistics & numerical data , United StatesABSTRACT
Metastasis, which remains incompletely characterized at the molecular and biochemical levels, is a highly specific process. Despite the ability of disseminated cancer cells to intravasate into distant tissues, it has been long recognized that only a limited subset of target organs develop clinically overt metastases. Therefore, subsequent adaptation of disseminated cancer cells to foreign tissue microenvironment determines the metastatic latency and tissue tropism of these cells. As a result, studying interactions between the disseminated cancer cells and the adjacent stromal cells will provide a better understanding of what constitutes a favorable or unfavorable microenvironment for disseminated cancer cells in a tissue-specific manner. Previously, we reported a protein signature of brain metastasis showing increased ability of brain metastatic breast cancer cells to counteract oxidative stress. In this study, we showed that another protein from the brain metastatic protein signature, neurotrophin-3 (NT-3), has a dual function of regulating the metastatic growth of metastatic breast cancer cells and reducing the activation of immune response in the brain. More importantly, increased NT-3 secretion in metastatic breast cancer cells results in a reversion of mesenchymal-like (EMT) state to epithelial-like (MET) state and vice versa. Ectopic expression of NT-3 in EMT-like breast cancer cells reduces their migratory ability and increases the expression of HER2 (human epidermal growth factor receptor 2) and E-cadherin at the cell-cell junction. In addition, both endogenous and ectopic expression of NT-3 reduced the number of fully activated cytotoxic microglia. In summary, NT-3 appears to promote growth of metastatic breast cancer cells in the brain by facilitating the re-epithelialization of metastatic breast cancer cells and downmodulating the cytotoxic response of microglia. Most importantly, our results provide new insights into the latency and development of central nervous system macrometastases in patients with HER2-positive breast tumors and provide mechanistic rationale to target HER2 signaling for HER2-positive breast cancer brain metastasis.
Subject(s)
Brain Neoplasms/secondary , Breast Neoplasms/pathology , Neurotrophin 3/physiology , Tumor Microenvironment , Animals , Cell Line, Tumor , Cell Proliferation , Epithelial-Mesenchymal Transition , Female , Humans , Immune Evasion , Mice , Mice, SCID , Neurotrophin 3/analysis , Receptor, ErbB-2/physiology , Receptor, trkA/analysisABSTRACT
PURPOSE: We explored whether African-American (AA) primary care physicians (PCPs) have different prostate cancer screening practices compared to non-AA PCPs, after adjustment for potential confounding factors such as the proportion of AA patients in PCP practices. METHODS: We used SAS/SUDAAN to compare weighted responses from AA PCPs (n = 604) with those from non-AA PCPs (n = 647) in the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. We used multivariate logistic regression to calculate the weighted odds ratios (OR) and 95% confidence intervals (CI). RESULTS: We found that AA PCPs had higher odds of working in practices with above-the-median (≥ 21%) proportions of AA male patients (OR, 9.02; 95% CI: 5.85-13.91). A higher proportion of AA PCPs (53.5%; 95% CI: 49.5-57.4) reported an above-the-median proportion (≥ 91%) of PSA testing during health maintenance exams as compared to non-AA PCPs (39.4%; 95% CI: 35.5-43.4; P < 0.0002). After adjusting for the proportion of AA patients and other factors, we found that AA PCPs had higher odds of using PSA tests to screen men (OR, 1.74; 95% CI: 1.11-2.73). CONCLUSION: This study quantifies the magnitude of the differences reported in previous focus group studies. Our results may be helpful in hypothesis generation and in planning future research studies.
ABSTRACT
Complementary and alternative medicine (CAM) has been commonly used among Americans; however, less is known about its use among men with a history of prostate cancer. This study used the 2002 National Health Interview Survey (NHIS) to explore the amount and type of CAM use among 218 Black and White men with a history of prostate cancer. Over 90% of men reported having ever used any form of CAM and most men used biologically-based and mind-body therapies. Nurses are in a unique position to discuss, to assess needs and practices, and perhaps, to act as intermediaries for physicians and other healthcare professionals and prostate cancer survivors who use CAM.
Subject(s)
Attitude to Health/ethnology , Black or African American/statistics & numerical data , Complementary Therapies/statistics & numerical data , Prostatic Neoplasms/therapy , Survivors/statistics & numerical data , White People/statistics & numerical data , Adult , Aged , Health Behavior , Humans , Male , Middle Aged , Patient Acceptance of Health Care/ethnology , Prostatic Neoplasms/ethnology , Self Care/statistics & numerical data , Socioeconomic Factors , United States/epidemiologyABSTRACT
OBJECTIVE: This study examined prostate-specific antigen (PSA) test use among men and identified sociodemographic and health-related characteristics associated with its use over time. METHODS: The National Health Interview Survey collected information on PSA test use among 16,058 men > or = 40 years of age in 2000 and 2005. We examined two outcomes: (1) having had a recent (within two years) screening PSA test and (2) having had three or more PSA tests in the past five years (to indicate frequent use). RESULTS: Marital status, family history of prostate cancer, and having seen a doctor in the past year differed over time in the unadjusted model. In the adjusted model, recent PSA screening decreased from 2000 to 2005 for single, never-married men, but increased for men with chronic diseases. Frequent PSA test use increased for men with a family history of prostate cancer, men with chronic diseases, and men who had seen a physician in the past year. Significant correlates of higher recent PSA test use included being older, married, and of black race/ethnicity; having higher levels of education and income, health-care coverage, and a usual place of health care; and increased comorbidity. CONCLUSION: Major organizations are not in agreement about the efficacy of prostate cancer screening; however, men > or = 40 years of age continue to use the PSA test. Both recent screening and frequent testing showed variability during the study period and may have implications for the ongoing randomized clinical trials that are expected to clarify whether early detection of prostate cancer with PSA testing increases survival.
Subject(s)
Early Detection of Cancer/trends , Prostate-Specific Antigen/blood , Adult , Age Factors , Aged , Aged, 80 and over , Body Mass Index , Genetic Predisposition to Disease , Health Behavior , Health Care Surveys , Humans , Male , Middle Aged , Socioeconomic FactorsABSTRACT
OBJECTIVE: This study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior. METHODS: We analyzed data from the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression. RESULTS: Eighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31-40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice. CONCLUSIONS: Both individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S.
Subject(s)
Mass Screening/methods , Patient Education as Topic/methods , Physician-Patient Relations , Physicians, Primary Care , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiology , Adult , Female , Follow-Up Studies , Humans , Male , Mass Screening/trends , Middle Aged , Patient Education as Topic/trends , Physicians, Primary Care/trends , Prostatic Neoplasms/prevention & control , United States/epidemiologyABSTRACT
BACKGROUND: Major health organizations recommend that physicians discuss the risks and benefits of prostate cancer screening with men before ordering tests. The length of time that health care providers spend discussing prostate cancer screening-related issues with patients has been given little attention. The purpose of this study was to determine the amount of time that primary care physicians (PCP) in the United States reported spending in discussions about prostate cancer screening with patients by selected PCP individual, practice-related, and screening-related factors. METHODS: Data were obtained from the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. We determined whether PCP characteristics were associated with amount of time spent with patients. RESULTS: Results showed that female, African American or other race, and older PCP spend more time (above the median) with patients compared to their referents. Also, more time spent with male patients was more often associated with PCP having practices in urban inner city areas as well as when the screening decision was shared between the PCP and the patient/family. CONCLUSION: Results from this study offer some insight into the amount of time that PCP report spending with patients in discussing prostate cancer screening-related issues specifically, and confirms the involvement of individual as well as practice-level factors.
ABSTRACT
OBJECTIVES: This study examined PSA screening interval of black and white men aged 65 or older and its association with prostate cancer stage at diagnosis. METHODS: SEER-Medicare data were examined for 18,067 black and white men diagnosed with prostate cancer between 1994 and 2002. Logistic regression was used to assess the association between race, PSA screening interval, and stage at diagnosis. Analysis also controlled for age, marital status, comorbidity, diagnosis year, geographic region, income, and receipt of surgery. RESULTS: Compared to whites, blacks diagnosed with prostate cancer were more likely to have had a longer PSA screening interval prior to diagnosis, including a greater likelihood of no pre-diagnosis use of PSA screening. Controlling for PSA screening interval was associated with a reduction in blacks' relative odds of being diagnosed with advanced (stage III or IV) prostate cancer, to a point that the stage at diagnosis was not statistically different from that of whites (OR=1.12, 95% CI=0.98-1.29). Longer intra-PSA intervals were systematically associated with greater odds of diagnosis with advanced disease. CONCLUSIONS: More frequent or systematic PSA screening may be a pathway to reducing racial differences in prostate cancer stage at diagnosis, and, by extension, mortality.
Subject(s)
Black or African American/statistics & numerical data , Prostate-Specific Antigen/analysis , Prostatic Neoplasms/diagnosis , White People/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Male , Mass Screening , Medicare/statistics & numerical data , Neoplasm Staging , Prostatic Neoplasms/ethnology , SEER Program/statistics & numerical data , Time Factors , United States/epidemiologyABSTRACT
African-American men experience greater incidence and mortality from prostate cancer compared to White men as well as men from other groups. Few studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use in African-American men. This study examined use of the PSA test and DRE among African-American men over time and identified correlates associated with the use of these procedures. Overall trends for years 2002-2006 showed a significant decrease in recent PSA test use and DRE among African-American men in 2004 and 2006 compared to year 2002. Recent PSA test use and DRE were associated with several factors including older ages, being married, higher levels of education and income, and overweight and obese body mass index (BMI). PSA test use and DRE among African-American men should be monitored over time to find out if this pattern continues.
Subject(s)
Black People , Physical Examination , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , Rectum , Adult , Aged , Humans , Male , Mass Screening , Middle Aged , Prostatic Neoplasms/blood , Prostatic Neoplasms/ethnology , Risk FactorsABSTRACT
BACKGROUND: Studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use among men; however, few have examined use of these procedures together over time. This study examined use of the PSA test and DRE among men over time and identified correlates associated with test use for the PSA test only, the DRE only, and both procedures combined. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) collected information on prostate cancer test use among 229,574 men aged 40 or older over 3 years (2002, 2004, and 2006). Patterns of PSA test and DRE use were examined overall and by selected demographic and health-related characteristics. Correlates of recent PSA test and DRE use were determined using logistic regression. RESULTS: Overall trends for years 2002-2006 were a significant increase for PSA use only and a significant decrease of PSA and DRE use combined. Having had a recent PSA test (within 2 years) only; a recent DRE only; or both tests varied by sociodemographic and health-related variables, including age, race/ethnicity, marital status, levels of education and income, body mass index, health insurance status, and having a personal doctor or health care provider. CONCLUSION: Although major organizations are not in agreement about the efficacy of prostate cancer screening, the PSA test and DRE continue to be utilized regularly by a majority of American men over age 40. PSA test and DRE use in this population provide a basis for addressing issues related to screening.
Subject(s)
Digital Rectal Examination , Mass Screening/statistics & numerical data , Population Surveillance , Prostate-Specific Antigen/blood , Prostate/pathology , Prostatic Neoplasms/diagnosis , Adult , Aged , Confidence Intervals , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Prostatic Neoplasms/epidemiology , Risk Factors , Surveys and Questionnaires , United States/epidemiologyABSTRACT
The purpose of this study was to assess the repeatability of a dual gradient-recalled echo (GRE) muscle functional MRI technique. On 2 days, subjects (n = 8) performed 10 s isometric dorsiflexion contractions under conditions of: (1) maximal voluntary contraction (MVC), (2) 50% MVC (50% MVC), or (3) 50% MVC with concurrent proximal arterial cuff occlusion (50% MVC(cuff)). Functional MRI data were acquired using single-slice dual GRE (TR/TE = 1000/6, 46 ms)-echo planar imaging for 20 s before, during, and for 180 s after each contraction. The mean signal intensity (SI) time courses at each TE (SI(6) and SI(46), reflecting variations in blood volume and %HbO(2), respectively) from the tibialis anterior (TA) and extensor digitorum longus (EDL) muscles were characterized with the post-contraction change in SI and the time-to-peak SI (DeltaSI and TTP, respectively). DeltaSI(6) following an MVC was 36% higher than that obtained after a 50% MVC (p = 0.048). For DeltaSI(6), the highest intraclass correlation coefficients (ICCs) were observed for the TA muscle in the 50% MVC and MVC conditions, with values of 0.83 (p = 0.01) and 0.88 (p = 0.005), respectively. Bland-Altman plots revealed repeatability coefficients (RCs) for the 50% MVC and MVC conditions in the TA muscle of 1.9 and 1.4, respectively. The most repeatable measures for DeltaSI(46) were obtained for the 50% MVC and MVC conditions in the EDL muscle (p = 0.01 and p = 0.04, respectively). Bland-Altman plots revealed RC's for 50% MVC and MVC conditions in the EDL muscle of 3.9 and 5.7, respectively. DeltaSI(6) and DeltaSI(46) increased as a function of the contraction intensity. The repeatability of the method depends on the muscle and contraction condition being evaluated, and in general, is higher following an MVC.
Subject(s)
Blood Volume/physiology , Echo-Planar Imaging/methods , Isometric Contraction/physiology , Oxygen/metabolism , Adult , Biomechanical Phenomena , Humans , Male , Muscles/physiology , Regression Analysis , Reproducibility of Results , Time FactorsABSTRACT
BACKGROUND: There are limited population-based studies of benign prostate hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in men, and most studies examined to date have been restricted to predominately white populations. This study examines treatment and all-cause mortality among a cohort of African-American and white men aged > or =65 with BPH/LUTS symptoms over time. METHODS: Data were collected from the Piedmont Health Survey of the Elderly-Established Populations for the Epidemiological Study of the Elderly for 5 North Carolina counties from 1994 (N=502) to 1998 (N=322). RESULTS: From 1994-1998, there were no significant racial differences in treatment by catheter insertion, prostate surgery or drug therapy for BPH/LUTS. However, overall use of the 3 treatments increased from 1994-1998, with drug therapy showing the largest increase. Adjusted analyses revealed racial differences in prostate surgery only, with African-American men nearly 40% more likely to receive prostate surgery than white men. Men with comorbid conditions were less likely to receive drug therapy, whereas those with poor self-reported health or cancer were more likely to receive prostate surgery. Catheter insertion was more likely for those who had resided in a nursing home. Men who received drug therapy treatment or had regular rectal exams showed decreased risk of mortality. CONCLUSION: Findings suggest that healthcare providers should direct more attention to the management of LUTS in white and African-American elderly men. Data also demon-strate the need for studies that focus on treatment modalities as well as important correlates of LUTS.
Subject(s)
Black or African American , Prostatic Hyperplasia/therapy , Prostatic Neoplasms/therapy , Aged , Humans , Male , Prostatic Hyperplasia/mortality , Prostatic Neoplasms/mortality , United States , Urologic Diseases/diagnosis , White PeopleABSTRACT
OBJECTIVES: At least 10.8 million living Americans have been diagnosed with cancer, and about 1.5 million new cancer cases are expected to be diagnosed in 2008. The purpose of this study was to examine prayer for health and self-reported health among a sample of men and women with a personal history of cancer. METHODS: We used data from the 2002 National Health Interview Survey, which collected information on complementary and alternative medicine practices. RESULTS: Among 2262 men and women with a history of cancer, 68.5% reported having prayed for their own health and 72% reported good or better health status. Among cancer survivors, praying for one's own health was associated with several sociodemographic variables including being female, non-Hispanic black, and married. Compared to persons with a history of skin cancer, persons with a history of breast cancer, colorectal cancer, a cancer with a short survival period (e.g., pancreatic cancer), or other cancers were more likely to pray for their health. Persons who reported good or better health were more likely to be female, younger, have higher levels of education and income, and have no history of additional chronic disease. Overall, praying for one's own health was inversely associated with good or better health status. CONCLUSIONS: Data from this nationally representative sample indicate that prayer for health is commonly used among people with a history of cancer and that use of prayer varies by cancer site. The findings should add to the current body of literature that debates issues around spirituality, decision-making about treatment, and physician care.
Subject(s)
Faith Healing/statistics & numerical data , Neoplasms/epidemiology , Neoplasms/therapy , Religion , Self Care/statistics & numerical data , Survivors/statistics & numerical data , Attitude to Health , Faith Healing/psychology , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Self Care/psychology , Spirituality , Survivors/psychology , United States/epidemiologyABSTRACT
BACKGROUND: Although evidence that prostate cancer deaths are reduced by screening for elevated prostate-specific antigen (PSA) concentration coupled with early diagnosis and treatment is insufficient to advocate routine screening for prostate cancer, PSA testing has become more common in the past decade. We examined characteristics that might influence testing and compared test use between men ages 40 to 49 and 50 to 79 years. METHODS: We used data from 7,669 participants with no history of prostate cancer in the 2005 National Health Interview Survey. RESULTS: Among men reporting about PSA testing, an estimated 16% of 40- to 49-year-old men and 49% of 50- to 79-year-old men had a PSA test in the past 2 years. In multivariate analyses, among men ages 40 to 49 years, non-Hispanic Black men were more likely (P < 0.05) to have had a PSA test than non-Hispanic White men. We found no significant difference by race/ethnicity in men ages 50 to 79 years. Higher education, higher poverty threshold, usual source of medical care, family history of prostate cancer, and comorbid conditions were associated with increased PSA test use in both age groups. Additionally, men ages 50 to 79 years born in the United States, who were married, had private or military health insurance, and had been diagnosed with another cancer type were more likely to be tested. CONCLUSIONS: Findings from the multivariate analyses indicated significantly higher PSA test use among younger non-Hispanic Black men than among non-Hispanic White men. These findings may indicate that healthcare providers are getting and conveying the message of increased risk of prostate cancer among African American men.
Subject(s)
Mass Screening/statistics & numerical data , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/epidemiology , Black or African American/statistics & numerical data , Aged , Chi-Square Distribution , Genetic Predisposition to Disease , Health Surveys , Humans , Male , Middle Aged , Surveys and Questionnaires , United States/epidemiology , White People/statistics & numerical dataABSTRACT
Prostate cancer is the second leading cancer killer in men. Men in general and African American men in particular face crucial decisions regarding prostate cancer screening and perhaps treatment for this disease. Major health organizations agree that men should discuss prostate cancer screening with their physicians or other health care professionals. The purpose of the study was to examine sociodemographic and other correlates of physician-patient discussions regarding the advantages and disadvantages of the prostate-specific antigen (PSA) test among African American men aged 40 or older. A majority of African American men reported having discussed the advantages and disadvantages of prostate cancer screening and/or testing with their physicians before ordering it, and physician-patient discussions about the PSA test were associated with increased screening in African American men. Inasmuch as African American men have greater prostate cancer incidence and mortality over other groups, future attempts should be made to find meaningful correlates of PSA screening and test use to help reduce the burden of this disease.
Subject(s)
Black or African American/statistics & numerical data , Health Knowledge, Attitudes, Practice , Mass Screening/standards , Prostatic Neoplasms/ethnology , Prostatic Neoplasms/prevention & control , Adult , Age Factors , Aged , Communication , Confidence Intervals , Cross-Sectional Studies , Educational Status , Health Education/organization & administration , Humans , Male , Mass Screening/trends , Men's Health , Middle Aged , Multivariate Analysis , Odds Ratio , Physician-Patient Relations , Prostate-Specific Antigen/blood , Prostatic Neoplasms/mortality , Risk Assessment , Socioeconomic Factors , Survival Analysis , United States/epidemiologyABSTRACT
Many medical and professional organizations agree that men should discuss the advantages and disadvantages of testing for prostate-specific antigen (PSA) with their physicians before undergoing testing. In the 2000 National Health Interview Survey, men who had undergone a PSA test in the past were asked about their use of this test and discussions they had with physicians regarding its advantages and disadvantages. Among a group of 2,188 black and white men aged 40-79 years with no history of prostate cancer and a history of testing for PSA, we examined whether physician-patient discussions mediated the relationship between race and PSA testing. We specified that the test had to be their most recent one and part of a routine physical examination or screening test. We compared those tested within the past two years with those tested >2 years. Almost two-thirds of the men previously had discussions with their physicians about the advantages and disadvantages of the PSA test. Older men, college graduates, those living in the midwest and those with health insurance were more likely to have been tested recently. Discussion with a physician was found to mediate the relationship between race and PSA testing during the past two years. Black men were initially found to be more likely than white men to have been screened recently [odds ratio (OR)=1.45; 95% confidence interval (CI) 1.01-2.07], but in the full model race was no longer significant (OR=1.41; 95% Cl 0.98-2.03). Discussions about PSA testing were associated with more recent PSA screening (OR=1.38, 95% CI 1.05-1.82). These findings suggest that: 1) the relationships among race, physician discussions and PSA testing may need to be examined in more complex ways, and 2) the physician has an important role in men's decision to consider PSA testing.