84 POOR FOLLOW-UP AND LOW SOCIOECONOMIC STATUS PREDICT CANCER-SPECIFIC MORTALITY IN MEN WITH PROSTATE CANCER

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201284 POOR FOLLOW-UP AND LOW SOCIOECONOMIC STATUS PREDICT CANCER-SPECIFIC MORTALITY IN MEN WITH PROSTATE CANCER Mohummad Siddiqui, Alan Paciorek, Mark S. Litwin, and Aria F. Olumi Mohummad SiddiquiMohummad Siddiqui Boston, MA More articles by this author , Alan PaciorekAlan Paciorek San Francisco, CA More articles by this author , Mark S. LitwinMark S. Litwin Los Angeles, CA More articles by this author , and Aria F. OlumiAria F. Olumi Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.130AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies suggest that low socioeconomic status (SES) and disparities in prostate cancer care may be determinants of poor outcomes in underserved men. We hypothesize that differential utilization of healthcare resources, including maintaining regular follow-up appointments, may contribute to the poorer outcomes in men of low SES. METHODS We prospectively identified 3,643 men with prostate cancer diagnosed between 1998 and 2008 in the CaPSURE registry. Median follow-up was 53 months. Participants reported at study entry about household income; low (vs high) SES was set at $30,000 (133% of the federal poverty level for a family of four). We quantified follow-up as the percent of years after prostate cancer diagnosis that the individual had at least one prostate specific antigen (PSA) test checked. We used ordinal linear regression to perform multivariate analysis of follow-up as correlated with SES. We performed Cox proportional hazards models to assess the effects of income and follow-up on prostate cancer-specific mortality. Fifty men died from prostate cancer in the study period. RESULTS Higher rate of follow-up correlated positively with high SES (p=0.003) and prostatectomy (p<0.0001) but not with age, Gleason score, stage, or PSA at diagnosis. On univariate analysis, age, Gleason score, stage, PSA at diagnosis, follow-up, and SES were all significant hazards for death from prostate cancer. On multivariate analysis controlling for age, grade, stage, PSA at diagnosis, and treatment modality, low SES was a significant risk for death from prostate cancer (HR=2.03, p=0.02). When the model was additionally controlled for follow-up, the effect of income was attenuated somewhat by 9% (HR=1.89, p=0.03). Poor follow-up strongly correlated with prostate cancer-specific death (HR=5.6, p=0.003). CONCLUSIONS Men of higher SES maintained better follow-up for their prostate cancer care. Not maintaining regular followup appointments and being of low SES both predicted death from prostate cancer. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e36 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohummad Siddiqui Boston, MA More articles by this author Alan Paciorek San Francisco, CA More articles by this author Mark S. Litwin Los Angeles, CA More articles by this author Aria F. Olumi Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...