Racial disparities in cancer treatment are well described but poorly understood. Although most experts believe that access to care contributes to these disparities, access for vulnerable populations is a complex, multidimensional process that is inadequately captured by measures of insurance coverage or travel time. In this application, we propose to build upon our prior researching racial disparities, prostate cancer treatment and access to care to investigate the contribution of a multidimensional picture of health care access to racial differences in prostate cancer treatment. We will collect primary data on a population based sample of men diagnosed with localized prostate cancer (N=3,000) in 8 counties in the Greater Philadelphia area and on the urologists and radiation oncologists who form their access to prostate cancer treatment. We will focus on this area as it is the primary focus of the proposed center and because the multiple dimensions of cancer care in urban populations are poorly understood. Building on the access framework of Penchansky and Thomas, we will assess the accessibility /availability, accommodation, affordability, &acceptability of prostate cancer care, using data from a patient survey, administrative records, &a provider inventory. Following the framework of Aday &Andersen, we will create spatial measures of potential access &individual measures of experienced access (a form of realized access). We will incorporate information about the characteristics of providers using data from patients about their experiences, as well as data from the AMA masterfile about provider board certification and training. We will then examine the relationships between potential access, experienced access, &differences in treatment as well as the degree to which these effects are mediated by insurance coverage, socioeconomic status &neighborhood deprivation. To our knowledge, this will be the first study to construct a comprehensive, multi-dimensional picture of access to cancer care by collecting information from patients, providers &administrative sources &to use this picture to improve our understanding of a racial difference in cancer treatment.

Public Health Relevance

Disparities in prostate cancer outcomes may be related to access to care, yet the parameters that determine this access are not well understood. This project will explore aspects of access to care using data collected from patients, providers and administrative sources to better understand disparities in cancer treatment.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
Project #
Application #
Study Section
Special Emphasis Panel (ZMD1-RN)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
United States
Zip Code
Wong, Michelle S; Grande, David T; Mitra, Nandita et al. (2017) Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems. Med Care 55:817-822
Rebbeck, Timothy R (2017) Prostate Cancer Genetics: Variation by Race, Ethnicity, and Geography. Semin Radiat Oncol 27:3-10
Jiang, Tammy; Stillson, Christian H; Pollack, Craig Evan et al. (2017) How Men with Prostate Cancer Choose Specialists: A Qualitative Study. J Am Board Fam Med 30:220-229
Radhakrishnan, Archana; Grande, David; Mitra, Nandita et al. (2017) Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment. Cancer 123:1027-1034
Lynch, Shannon M; Mitra, Nandita; Ravichandran, Krithika et al. (2017) Telomere Length and Neighborhood Circumstances: Evaluating Biological Response to Unfavorable Exposures. Cancer Epidemiol Biomarkers Prev 26:553-560
Pollack, Craig Evan; Armstrong, Katrina A; Mitra, Nandita et al. (2017) A multidimensional view of racial differences in access to prostate cancer care. Cancer 123:4449-4457
Radhakrishnan, Archana; Grande, David; Ross, Michelle et al. (2017) When Primary Care Providers (PCPs) Help Patients Choose Prostate Cancer Treatment. J Am Board Fam Med 30:298-307
Yamoah, Kosj; Zeigler-Johnson, Charnita M; Jeffers, Abra et al. (2016) The impact of body mass index on treatment outcomes for patients with low-intermediate risk prostate cancer. BMC Cancer 16:557
Yamoah, Kosj; Deville, Curtiland; Vapiwala, Neha et al. (2015) African American men with low-grade prostate cancer have increased disease recurrence after prostatectomy compared with Caucasian men. Urol Oncol 33:70.e15-22
Zeigler-Johnson, Charnita; Morales, Knashawn H; Glanz, Karen et al. (2015) Individual- and neighborhood-level education influences the effect of obesity on prostate cancer treatment failure after prostatectomy. Cancer Causes Control 26:1329-37

Showing the most recent 10 out of 14 publications