The burden of prostate cancer (PCa) is substantial, and racial disparities in PCa are the largest in all of oncology. Disparities in PCa screening, diagnosis and treatment have been well-documented; however, while PCa is often slow-growing and patients face a long journey after diagnosis, prior disparities research has largely neglected the vast majority of this journey in the 3.3 million PCa survivors in the US. To optimize overall health and survival, PCa survivors need longitudinal, guideline-recommended healthcare during survivorship. The two most common causes of mortality in men with PCa are 1) cardiovascular disease (CVD) and 2) prostate cancer. There is an urgent need to study disparities in survivorship care, and it is likely that disparities in receipt of guideline-recommended care in PCa survivors directly contribute to the known disparities in mortality in this population. The National Academy of Medicine and American Society of Clinical Oncology have both called for more cancer survivorship research, a high-priority but understudied research area. This study breaks new ground in disparities research by examining survivorship care specific to CVD care and PCa monitoring. It leverages a unique, population-based, and diverse cohort of 1,455 PCa survivors enrolled at diagnosis from 2011-2013 and followed longitudinally with yearly surveys and medical records, with an innovative linkage to administrative and claims data from multiple insurance plans and health care systems, allowing unique insight into disparities in survivorship care by race, insurance/system type (Medicare/Medicaid/private/VA/uninsured), and urban/rural residence. This novel, comprehensive dataset with 3 data sources to measure survivorship care (patient report, medical records, claims) will allow the study team to achieve these specific aims: (1) To examine guideline-recommended PCa-specific survivorship care, including monitoring for PCa recurrence by race, insurance type, and patient rurality; (2) To examine guideline- recommended primary and preventive care ? emphasizing cardiovascular disease management and prevention ? by race, insurance type, and patient rurality; and (3) To examine data source concordance ? patient-report vs medical records vs claims ? for guideline-recommended survivorship care, to inform the research methodology for future studies in this area. The anticipated outcomes of this study are to provide novel insight regarding disparities in cancer survivorship care that are directly amenable to intervention; and address fundamental methodologic questions in disparities research on cancer survivorship, made possible by this study's unique dataset.
All specific aims directly address known current knowledge gaps in this research area. The research team has extensive experience and expertise with cancer disparities research, analysis of large datasets (including cancer registry and claims data), and designing interventions to reduce disparities and improve the healthcare and overall health of cancer survivors. We will leverage this expertise and findings from this study to design and test interventions targeting disparities in survivorship care as the next step.
This study addresses a major public health problem ?racial disparities in prostate cancer mortality? through a novel examination of the healthcare received by survivors specifically related to the two most common causes of mortality in this patient population: cardiovascular disease and prostate cancer. With 3.3 million prostate cancer survivors in the US, and the high prevalence, morbidity and mortality burden from prostate cancer and cardiovascular disease especially affecting racial minority and rural patients, this study will reveal novel potential targets for intervention to reduce disparities and improve the health and survival of cancer survivors.
