Impact of Social Determinants of Health on Quality of Life and Treatment-Related Decision-Making in Advanced Prostate Cancer
Abstract
Prostate cancer is the most common cancer diagnosis among U.S. men. Advances in treatments have contributed to the improvements in prostate cancer survival rates of close to 100%, but these treatments can also produce side effects—such as loss of bladder control and painful urination—that can affect a man’s quality of life. Given the increasing number of men who are living with or who are surviving prostate cancer, there is a critical need to understand the quality of survival experienced and the risk factors that ultimately impact their experience so that men can make better treatment decisions for their long-term health. Few risk indicators, beyond older age and Black race, are associated with worse survival outcomes. Our prior work suggests that social determinants of health (SDOH; e.g., social, economic, cultural, health care, or transportation circumstances) likely play a role in racial disparities and poor prostate cancer outcomes. In our work, we have developed methods that allow us to look at thousands of SDOH variables and narrow it down to only a few that are most associated with an advanced prostate cancer diagnosis. However, a comprehensive analysis of SDOH and their effects on treatment-related PCa decision-making and quality of life post-diagnosis have not been studied. By identifying specific SDOH variables most associated with decision-making and reports of lower quality of life, we can potentially improve risk assessment for these outcomes. Specifically, we can use findings to adapt existing SDOH screening tools that can be implemented during treatment planning in the clinic to identify men at risk of poor decision-making and quality of life concerns post-diagnosis. Thus, to address the DOD health equity focus areas related to sociocultural factors and access to care and the PCRP overarching challenges related to identification of vulnerable groups at risk for quality of life and decision-making detriments, the main objective of our study is to (1) apply complex computer algorithms that can identify from many SDOH variables, the ones that best predict poor decision-making outcomes and quality of life in approximately 1400 men with locally advanced prostate cancer, and (2) interview 36 men from different race and SDOH backgrounds, along with 15 clinical stakeholders (e.g., physicians, nurses, social workers), to learn more about the SDOH we identified from our algorithms and to get patient and stakeholder input on how to organize and improve an existing SDOH screening tool, e.g., evaluate the tool’s acceptability. This screening tool then can be used to identify at risk individuals in need of additional, but often limited, resources and link them to additional services during their cancer care. Thus, this study dually provides insight into how SDOH considerations can impact quality of life and decision-making outcomes, while also serving to improve the identification of populations placed at risk for poor PCa outcomes who are in need of intervention. In this study, we focus on men with locally advanced prostate cancer because the majority of quality of life studies have focused mostly on low stage prostate cancer patients who are often good candidates for active surveillance (i.e., their cancer is at such a low risk that they can monitor instead of actively treat their disease). Patients with locally advanced disease undergo more complex treatments and related decision-making, and the impact of their selected treatment on quality of life is largely unknown, particularly more than 5 years from diagnosis. At the end of 3 years, this study will result in a risk profile that includes SDOH, race, clinical factors, decision-making and quality of life reports that might help clinicians identify men with locally advanced prostate cancer, who are at risk for poor patient outcomes, make better treatment choices in line with their desired quality of life. Additionally, the study will produce an adap
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210368
Entities
People
- Shannon M Lynch
Organizations
- United States Army