Session
Cancer in Men's Health
APHA 2022 Annual Meeting and Expo
Abstract
Shared-decision making preferences in prostate cancer patients between a quaternary care institution and a safety net hospital
APHA 2022 Annual Meeting and Expo
Decision aids have been long advocated as tools to promote shared decision-making (SDM) between physicians and patients. The goal of our research is to evaluate whether patient preferences for outcomes of localized prostate cancer vary by patient socioeconomic status. “WiserCare, is a SDM tool implemented in two different populations. A total of 245 patients at UCLA, a quaternary care institution, and 53 patients at Olive View-UCLA Medical Center (OVMC), a safety net hospital, completed the tool. Most participants at UCLA completed the tool online with minimal assistance from study staff while OVMC participants completed it via telephone and in-person, with the assistance of study personnel. OVMC participants were more likely to be non-white, complete the module in Spanish, and have comorbidities. UCLA participants had higher concerns about side effects of bowel control and frequent urination compared to OVMC participants (16% vs 12% and 14% vs 12%, respectively). However, OVMC participants cared more about surgical complications (12% vs 9%) and had stronger preference for treatments that involved outpatient surgery and shorter recovery time (7% vs 5% and 9% vs 6%, respectively) than UCLA patients. UCLA patients had higher preferences for quality of life-related outcomes while OVMC patients displayed higher preferences for treatment intensity-related outcomes. These preferences may reflect the ability to take time from work or other economic considerations. Given the stark differences between patient population and preferences, it is imperative to consider patients’ racial/ethnic background, socioeconomic status, English fluency, and general health when counseling men with localized prostate cancer.
Abstract
Objective and subjective socioeconomic status and colorectal cancer screening uptake among U.S. men
APHA 2022 Annual Meeting and Expo
Background: Socioeconomic status (SES) is fundamentally related to the underutilization of colorectal cancer (CRC) screening, yet little is known about the role of subjective SES. This study investigated if subjective indicators of SES were associated with CRC screening uptake among U.S. men aged 45-75. It was hypothesized that men with lower perceptions of their social status and greater perceived economic strain would have decreased odds of CRC screening uptake.
Methodology: Cross-sectional study of 499 U.S. men between 45-75 years. Study outcomes were ever completing a stool-based CRC screening test, ever completing an exam-based CRC screening test, and being current with CRC screening. Predictors were objective (household income, educational attainment) and subjective (subjective social status, economic strain) SES. Unadjusted and adjusted logistic regression models were conducted.
Results: Men with greater economic strain had decreased odds of being current with CRC screening (OR = 0.72, 95% CI: 0.54, 0.96). Household income modified the association between economic strain and ever completing a stool-based test (est. = 0.33, p = .038); greater economic strain decreased the odds of completing a stool-based test more strongly for men from lower, compared to higher, income households. Subjective social status was unrelated to CRC screening uptake.
Conclusions: Evidence from this study suggests that experiencing economic strain may interfere with men’s decisions to get screened for CRC and to stay current with their screening. Therefore, subjective indicators of SES can offer information about the barriers to CRC screening uptake beyond that captured by household income or educational attainment.
Abstract
The Association Between Testicular Self-Examination and Early Stage Testicular Cancer Diagnosis: The Missing Data Link
APHA 2022 Annual Meeting and Expo
Testicular cancer (TCa) is the most prevalent tumor diagnosed in men 15-40 years of age. However, advances in treatment makes TCa treatment a highly survivable disease, even in later stages of discovery. With survivorship comes growing concerns over quality of life (QoL) issues. Those males diagnosed in later stages, on average, have a reduced survivability and an increase in the likelihood of future complications.
Testicular self-examination (TSE) is a diagnostic method used to discover early stage tumor incidence. A TSE is done by palpating the testicles and scrotum to check for abnormal lumps. Arguably, a lack of participation in TSE may predispose an individual to a late-stage diagnosis. However, there is a lack of direct data linking these variables. This study aimed to fill in this research gap by examining the relationship between practicing TSE and stage of diagnosis for TCa survivors.
A cross-sectional study design was used to assess TCa survivors attitudes, perceptions, and behaviors pertaining to their diagnosis and TSE. Participants were sampled using a 41-question nationwide survey administered through the Testicular Cancer Society. In total, 390 men were recruited for participation in this study. Primary bivariate analysis consisted of a Spearman Rho correlation analysis of all primary and descriptive variables with stage diagnosis of TCa.
A multivariate analysis was done using an ordered logistic regression. Bivariate analysis showed that performance of TSE is associated with a less advanced stage diagnosis (20%, p-value= 0.05). Multivariate ordered logistic regression models exhibited that those who perform TSE prior to diagnosis are less likely to have a more advanced stage diagnosis (28%, p-value= 0.037). TSE performance after diagnosis also showed statistical significance (p-value= 0.005).
Although there are perceived benefits of TSE, the United States Preventive Services Task Force (USPSTF) still gives it a “D rating, recommending against the use of TSE in adolescent and adult men. In contrast, it is recommended monthly by the American Medical Association and the American Urological Association. The USPSTF argues that TSE could potentially lead to unnecessary diagnostic procedures. However, they fail to take into account the quality of life complications for men diagnosed with TCa. This is the first study to add empirical evidence exemplifying the benefits of TSE and adding discourse to the recommendation of the USPSTF.
Abstract
Testicular cancer symptom recognition and stage of diagnosis
APHA 2022 Annual Meeting and Expo
Purpose: Despite generally favorable testicular cancer treatment outcomes, the substantial contrast in survivorship and quality of life between early- and late-stage cases warrants the need for interventions that promote early detection of TC. A critical component to this process includes registration of disease symptoms. Therefore, there is a need to further explore the relationship between symptom reporting and stage diagnosis to help develop a spectrum of TC symptoms that could assist physicians diagnosis the disease earlier.
Methods: A cross-sectional study was employed to explore possible associations between TC symptom presentation and stage of diagnosis. An original 40-item survey was distributed among TC survivors to determine the potential impact of several risk factors and behaviors upon diagnosis. This analysis aimed to explore how certain patient-driven experiences could serve as catalysts for seeking medical care for testicular health concerns.
Results: Correlation analyses indicated the strength/significance of relationship between reported symptoms and stage diagnosis. The only non-significant association was self-reported testicular pain. Experiencing hot flashes and having no symptoms had positive associations with later-stage diagnosis. Change in shape had a significant negative association with later-stage diagnosis. Logistic regression explained relatively low variance in the data (r2=0.1415), it was statistically significant (Chi2 probability<0.001). Pain (OR=1.6524, p<0.05), Hot Flashes (OR=5.7893, p<0.01), and No Symptoms Experienced (OR=12.4836, p<0.01) were all significant predictors of a more advanced stage diagnosis.
Conclusion: The concern around uncommon or atypical symptoms are that they are inexact and indistinct. In short, they are not very clear and/or obvious signs that TC is present. However, perhaps in tandem with other more overt symptoms they can serve as more confirmatory variables for a suspect case or, if observed with other uncommonly reported symptoms that it could serve as a viable option for the diagnostic process to consider TC as a possible prognosis.