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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Comprehensive Center (P60)
Project #
5P60MD006900-03
Application #
8624550
Study Section
Special Emphasis Panel (ZMD1-RN)
Project Start
2014-03-01
Project End
2017-02-28
Budget Start
2014-03-01
Budget End
2015-02-28
Support Year
3
Fiscal Year
2014
Total Cost
$171,491
Indirect Cost
$59,505
Name
University of Pennsylvania
Department
Type
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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
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
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
Yamoah, Kosj; Walker, Amy; Spangler, Elaine et al. (2015) African-american race is a predictor of seminal vesicle invasion after radical prostatectomy. Clin Genitourin Cancer 13:e65-72
Yamoah, Kosj; Johnson, Michael H; Choeurng, Voleak et al. (2015) Novel Biomarker Signature That May Predict Aggressive Disease in African American Men With Prostate Cancer. J Clin Oncol 33:2789-96
Rebbeck, Timothy R; Haas, Gabriel P (2014) Temporal trends and racial disparities in global prostate cancer prevalence. Can J Urol 21:7496-506
Lynch, Shannon M; Rebbeck, Timothy R (2013) Bridging the gap between biologic, individual, and macroenvironmental factors in cancer: a multilevel approach. Cancer Epidemiol Biomarkers Prev 22:485-95