Underserved Men's Understanding of Androgen Deprivation Therapy Related Risks

服务不足的男性对雄激素剥夺疗法相关风险的了解

• 批准号: 8258702
• 负责人: SALLY L Maliski
• 金额: $ 18.61万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-18 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8258702
• 关键词: Address; Adjuvant; African American; American; Androgen Therapy; Androgens; Bone Density; Cardiovascular Diseases; Cardiovascular system; Caucasians; Caucasoid Race; Couples; Data; Data Analyses; Databases; Development; Diabetes Mellitus; Diagnosis; Disease; Dyslipidemias; Ethnic Origin; Fatigue; Fatty acid glycerol esters; Foundations; General Population; Goals; Health; Health Insurance; Healthcare; Household; Human; Impotence; Incidence; Income; Incontinence; Insurance Coverage; Intervention; Interview; Latino; Life; Lipids; Low income; Malignant Neoplasms; Malignant neoplasm of prostate; Metabolic syndrome; Minority; Morbidity - disease rate; Neoadjuvant Therapy; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Operative Surgical Procedures; Osteoporosis; Personal Satisfaction; Phase; Prostate Cancer therapy; Radiation; Radiation therapy; Recurrence; Relative (related person); Relative Risks; Risk; Serum; Sexual Dysfunction; Staging; Symptoms; Testing; Time; Transcript; Uninsured; United States; Vasomotor; Work; base; bone; cancer therapy; cohort; cost; depressive symptoms; deprivation; experience; federal poverty level; fitness; health related quality of life; high risk; improved; meetings; men; mortality; muscle form; public health relevance; response; theories; therapy development

DESCRIPTION (provided by applicant): Androgen deprivation therapy (ADT) is increasingly being used to treat prostate cancer in the neoadjuvant and adjuvant contexts with radiation therapy (RT), for recurrence following primary treatment with surgery or radiation, or when the prostate cancer is at an advanced stage such that local treatments, surgery or radiation, are no longer indicated. This is significant because prostate cancer is the most commonly diagnosed noncutaneous cancer in American men. Of particular concern are underserved men. Latinos are the fastest growing minority in the United States (US) and have lower rates of health insurance coverage. African American (AA men) have almost twice the incidence as men of other ethnicities, and have advanced, aggressive disease. For purposes of this study, we will define underserved as low-income and uninsured or publically insured. Low-income will be household income 300% of the Federal Poverty Level (FPL) or less. Despite the proven survival benefit of ADT relative to prostate cancer, studies have shown that men on ADT are at increased risk for vasomotor symptoms, depression, fatigue, diminished health-related quality of life (HRQOL), decreased bone mineral density (BMD), sexual dysfunction, metabolic syndrome, increased fat mass, along with decreased lean muscle mass, increased serum lipids, and decreased arterial compliance all of which places them at higher risk for cardiovascular disease (CVD), osteoporosis, and type II diabetes. Both Latinos and AA more often have components of metabolic syndrome, obesity, dyslipidemia, low cardiovascular fitness, and diabetes placing them at higher risk for CVD. However, little is known about how these men understand ADT and its associated risks relative to their own health and well-being. Therefore, we aim to: 1. From previously collected data explore men's explanations of ADT, its purpose, effects, and risks among underserved men on ADT in order to develop interview guides focused on issues related to 2 Elicit in-depth narratives from underserved men on ADT focused on their understanding and experience of ADT and 3. Develop a descriptive framework of men's understanding of and response to ADT and its associated risks to guide development of interventions to decrease morbidity and mortality related to ADT-associated risks. We will use a two-stage qualitative approach to meet these aims. First we will conduct a new, in-depth analysis of existing qualitative data focused on men who were receiving ADT at the time of their interviews. From this analysis we will develop focused interview guides to more completely explore men's understanding and management of ADT-related with a new cohort of underserved men. This is necessary formative work to lay the foundation for the development and testing of interventions to minimize ADT-associated risks among highly vulnerable underserved men. These interventions have the potential to improve morbidity and mortality of underserved men on ADT thereby decreasing some of the health care and human costs that can be associated with ADT. PUBLIC HEALTH RELEVANCE: While androgen deprivation therapy (ADT) has survival benefit for men with recurrent of advanced prostate cancer, it has multiple associated risks related to cardiovascular disease, bone fraction, metabolic syndrome, and sexual dysfunction. Underserved men are at particular risk. Our goal is to understand how underserved men treated for prostate cancer with ADT understand their treatment and the risks associated with it. To do this, we will conduct the study in two phases. In the first phase we will use transcripts of interviews conducted with underserved men in two studies; one on the meaning of prostate cancer treatment-related incontinence and impotence among low-income African American and Latino men and the second on the impact for prostate cancer treatment-related symptoms on low-income Latino couples. We will select the transcripts of the men who were on ADT and re-analyze them for understanding of ADT and its risks and for their management of related symptoms. We will use this to develop an interview guide to do in-depth interviews focused on ADT understanding and risks. We will use the analysis of this data to help develop interventions to minimize ADT-related risks.

描述（由申请人提供）：雄激素剥夺疗法 (ADT) 越来越多地用于在新辅助和辅助放疗 (RT) 背景下治疗前列腺癌，用于治疗手术或放疗初次治疗后的复发，或者前列腺癌在处于晚期阶段，不再需要局部治疗、手术或放射治疗。这很重要，因为前列腺癌是美国男性中最常诊断出的非皮肤癌。尤其值得关注的是服务不足的男性。拉丁裔是美国增长最快的少数族裔，健康保险覆盖率较低。非裔美国人（AA 男性）的发病率几乎是其他种族男性的两倍，并且患有晚期、侵袭性疾病。出于本研究的目的，我们将服务不足的人群定义为低收入且无保险或公共保险的人群。低收入是指家庭收入为联邦贫困线 (FPL) 的 300% 或更低。 尽管已证明 ADT 相对于前列腺癌具有生存益处，但研究表明，接受 ADT 的男性出现血管舒缩症状、抑郁、疲劳、健康相关生活质量 (HRQOL) 下降、骨矿物质密度 (BMD) 下降、性功能障碍、代谢综合征、脂肪量增加、瘦肌肉量减少、血脂增加和动脉顺应性降低，所有这些都使他们患心血管疾病 (CVD)、骨质疏松症和 II 型糖尿病的风险更高。拉丁裔和 AA 都更常患有代谢综合征、肥胖、血脂异常、心血管健康水平较低和糖尿病，这使得他们患 CVD 的风险更高。然而，人们对这些男性如何理解 ADT 及其对自身健康和福祉的相关风险知之甚少。因此，我们的目标是： 1. 根据之前收集的数据，探索男性对 ADT 的解释、其目的、影响以及服务不足男性对 ADT 的风险，以制定针对以下相关问题的访谈指南 2 引出服务不足男性的深入叙述3. 制定男性对 ADT 及其相关风险的理解和应对的描述性框架，以指导制定干预措施，以降低相关发病率和死亡率ADT 相关风险。 我们将使用两阶段定性方法来实现这些目标。首先，我们将对现有定性数据进行新的深入分析，重点关注在访谈时接受 ADT 的男性。根据这一分析，我们将制定有针对性的访谈指南，以更全面地探讨男性对新的服务不足男性群体对 ADT 相关的理解和管理。这是必要的形成性工作，为制定和测试干预措施奠定基础，以最大限度地减少高度脆弱的服务不足男性中与 ADT 相关的风险。这些干预措施有可能改善接受 ADT 服务不足的男性的发病率和死亡率，从而减少与 ADT 相关的一些医疗保健和人力成本。 公共健康相关性：虽然雄激素剥夺疗法 (ADT) 对晚期前列腺癌复发的男性具有生存益处，但它也具有与心血管疾病、骨分数、代谢综合征和性功能障碍相关的多种相关风险。服务不足的男性面临的风险尤其大。我们的目标是了解接受 ADT 治疗的前列腺癌服务不足的男性如何了解他们的治疗方法以及与之相关的风险。为此，我们将分两个阶段进行研究。在第一阶段，我们将在两项研究中使用对服务不足的男性进行的采访记录；第一篇关于低收入非裔美国人和拉丁裔男性中前列腺癌治疗相关的尿失禁和阳痿的含义，第二篇关于前列腺癌治疗相关症状对低收入拉丁裔夫妇的影响。我们将选择接受 ADT 的男性的记录并重新分析它们，以了解 ADT 及其风险并管理相关症状。我们将用它来开发一个采访指南，以进行专注于 ADT 理解和风险的深度采访。我们将利用这些数据的分析来帮助制定干预措施，以尽量减少 ADT 相关风险。