227581 Access to Prostate Cancer Treatment: The Contribution of Race, Psychological Characteristics, and Cultural Factors

Wednesday, November 10, 2010

Chanita Hughes-Halbert, PhD , Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
Benita Weathers, MPH , Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
Brandon Mahler, BA , Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
Ernestine Delmoor, MPH , Health Educators for Cultural Diversity, Glenside, PA
James Coyne, PhD , Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
Thomas Ten Have, PhD , Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
David Lee, MD , Divison of Urology, University of Pennsylvania, Philadelphia, PA
Access to care is an important issue in cancer treatment decisions; reduced access is a primary cause of racial disparities. Geographic factors such as travel distance are increasingly being used to measure access to cancer care. However, empirical data are not available on how far men travel for prostate cancer treatment and the effects of socioeconomics, psychological, and cultural factors on travel distance are unknown. We evaluated these issues in 145 African American and white men who were newly diagnosed prostate cancer patients and had completed or initiated treatment. Overall, men traveled an average of 25 (SD=30) miles to their treatment facility. While white men (Mean=30 miles) traveled a significantly greater distance compared to African American men (Mean=10.4) (Kruskal-Wallis 2=27.8, p=0.001) and having greater socioeconomic resources (e.g., greater income) were associated significantly (p<0.01) with traveling a farther distance in bivariate analyses, only perceptions of stress had a significant independent association with how far men traveled (coefficient: increased distance =1.48 miles, SE=0.74, p=0.05) in multivariate analysis. Since there was a wide range for travel distance, we conducted a sensitivity analyses by excluding four men who traveled more than 100 miles. The effect for perceived stress (Coefficient=0.61) was attenuated and became non-significant (p=0.22). However, the effect for treatment facility became significant (p=0.01), primarily due to how far men traveled to obtain treatment at a practice that specialized in robotic prostatectomy (Coefficient=34.82, SE=12.57, p=0.01). Our findings suggest that psychological factors rather than race may be important determinants of access to prostate cancer treatment.

Learning Areas:
Diversity and culture
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
1. Identify factors that contribute to access to prostate cancer treatment. 2. Assess how far men travel to obtain prostate cancer treatment using GIS.

Keywords: Access to Health Care, Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an experienced researcher in racial disparities in cancer prevention and control and outcomes following diagnosis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.