Social support and its impact on treatment choice in patients with prostate cancer: An often omitted variable

The decision to pursue radical prostatectomy as a treatment option for patients with prostate cancer is often influenced by factors outside the realm of tumor risk. The support system at home can often impact treatment decision beyond the severity of disease. In order to determine whether social support impacted treatment type, we performed a retrospective cohort study of 418 low-income men enrolled in California's IMPACT Program who were diagnosed with non-metastatic prostate cancer. IMPACT provides free prostate cancer treatment to low-income, uninsured men. Study participants underwent definitive treatment with either surgery or radiation therapy. Social support members were defined as individuals identified by the participant and who assisted IMPACT staff with facilitating the participant's care while enrolled in the Program. Univariate and non-linear mixed effects regression analysis were performed with the outcome variable being treatment type. Confidence intervals for the predicted probabilities, predictive margins and relative risks were derived using bias-corrected bootstrapping with 1000 repetitions. In this cohort, married subjects with less than two members in their social network were more likely to have undergone surgery. While marital status is often used as a proxy for social support, we find that subjects in a relationship and with two or more members in their social network were no more likely to have undergone surgery than subjects who were not in a relationship. Hence, marital status and social support may not be interchangeable variables.