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

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.