MP19-11 RACIAL AND ETHNIC DISPARITIES IN VALUATION OF LIFE EXPECTANCY IN PROSTATE CANCER TREATMENT DECISION MAKING

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP19-11 RACIAL AND ETHNIC DISPARITIES IN VALUATION OF LIFE EXPECTANCY IN PROSTATE CANCER TREATMENT DECISION MAKING John M. Masterson, Michael Luu, Rebecca Gale, Brennan Spiegel, Stephen J. Freedland, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Michael LuuMichael Luu More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the indolent nature of prostate cancer (PC), life expectancy (LE) is essential in triage between aggressive local therapy and conservative management for all tumor risk subtypes. Black men are more likely to be overtreated for low-risk PC. We sought to investigate racial or ethnic disparities in how Black and Hispanic men value LE in PC treatment decision making. METHODS: We used targeted crowdsourcing to query a group of men reflecting sociodemographics of a typical US PC population. Subjects completed a conjoint analysis exercise in which they iteratively chose between aggressive treatment vs conservative management across varying levels of 4 tradeoffs: tumor risk; risk of erectile dysfunction; risk of incontinence; and risk of irritative urinary symptoms. Subjects were asked to consider their LE when making decisions, which was calculated using the Prostate Cancer Comorbidity Index. Multinomial conditional logistic regression compared the odds of choosing aggressive vs conservative treatment across LEs ranging from 0 to 20 years by racial and ethnic subgroups. We calculated the interaction between LE and race/ethnicity in predicting treatment choice overall and across levels of tumor risk. RESULTS: Of 2,046 men, 435 (22%) were Black and 230 (11%) were Hispanic. Across all men, the odds of aggressive treatment choice increased by 17% for every 5 years of additional LE (OR 1.17, 95%CI 1.12-1.22), with men more likely to choose aggressive treatment at LE of >13 years and non-aggressive treatment at LE of £10 years. However, among Black men, LE was not associated with treatment choice (OR 0.97, 95%CI 0.90–1.05) (Figure 1A). Black men were more likely to choose aggressive treatment overall, regardless of LE or tumor risk. Among Hispanic men, LE was associated with treatment choice, akin to the non-Hispanic population (OR 1.14, 95%CI 1.02–1.27) (Figure 1B). While Hispanic men were more likely to choose aggressive treatment overall, their choices differed by both LE and tumor risk. Healthy literacy was equivalent by race/ ethnicity. CONCLUSIONS: Black men did not take LE into account when making treatment decisions, in stark contrast to other races and ethnicities. Culturally sensitive approaches to communication of competing risks of mortality may be needed to improve decision making in these men. Source of Funding: © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e269 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Luu More articles by this author Rebecca Gale More articles by this author Brennan Spiegel More articles by this author Stephen J. Freedland More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...