Poor health literacy can discourage men from choosing to actively monitor for prostate cancer
Tumor gene profiling is a tool that helps patients diagnosed with cancer to make informed decisions about treatment. In predominantly white populations, in low risk men with early prostate cancer, these tools have been shown to increase patient acceptance of active surveillance. A common, evidence-based approach to monitoring the tumor prior to more aggressive treatment such as surgery or radiation.
However, a new study by researchers from the University of Illinois at Chicago and Northwestern University shows that in a predominantly black, urban patient population with significant social disadvantages, tumor profiling in men with clinically similar prostate cancers had the opposite effect. it reduced patient acceptance of active monitoring. In fact, men with low health literacy were more than seven times less likely to accept active surveillance when their tumors were profiled than men with high health literacy.
“The data presented in this study provides important evidence that tumor profiling has different effects in high-risk populations and in populations with less access to health services and education,” said Dr. Peter Gann, Professor of Pathology at the UIC College of Medicine and corresponding author of the study.
The results are published today in the Journal of Clinical Oncology.
We generally consider the acceptance of active surveillance to be a good thing as it can result in an improved quality of life and a longer time without treatment side effects. Knowing that poor health literacy can discourage men from opting for active surveillance, efforts should be made to provide low-risk prostate cancer men with active, surveillance-based education so that they can be informed Treatment decisions. “
Dr. Adam Murphy, Study Fifirst A.uthor and Assistant Professor of Urology at the Feinberg School of Medicine at Northwestern University
“It will be years before we can assess whether the results vary based on these decisions. However, it is important to understand how differently communities are affected by these test results so that we can support safe and informed decision-making,” said Gann. Who is a member of the University of Illinois Cancer Center at UIC.
The study was conducted as part of a clinical trial called ENACT, which taught newly diagnosed men about cancer treatment options. The study is the first to use a randomized design to assess the impact of a genome test on treatment choice.
In the study, the researchers enrolled 200 men from three Chicago public hospitals, whose clinical results placed them in the very low to low middle class prostate cancer risk category, meaning that all participants were considered candidates for active surveillance. Participants were randomly selected at diagnosis for standard or standard counseling, as well as a discussion of test results for tumor gene creation.
The Oncotype DX Genomic Prostate Score (GPS) was used for the intervention group. GPS analyzes tumor cells and measures the activity of certain genes and then “evaluates” the aggressiveness of the cancer. The results are presented as the probabilities of bad results.
“Because the GPS test was validated in predominantly white patient populations, we particularly wanted to know how the test would affect the decision-making process of black patients in choosing a low-risk approach to diagnosing prostate cancer,” said Gann.
Of the participants, 70% were black, 16% had a university degree, 46% were classified as having little health literacy and 16% were not insured. Health literacy was measured by a person’s ability to understand information about their health.
Overall, the vast majority (82%) of the participants in the study opted for active monitoring, while the others opted for immediate treatment with surgery or radiation. However, the acceptance of active monitoring was lower in the group that received GPS results (74%) than in the group that did not receive GPS results (88%). Participants with low health literacy who received GPS results were seven times less likely to choose active monitoring.
In addition, Gann and Murphy found that men with a positive family history of prostate cancer were significantly more likely to choose surveillance. “That was surprising. It may be that these men are more familiar with the increased adoption of a surveillance approach and the risk of treatment-related morbidity,” said Gann.
Insurance is also an important factor in helping patients choose active monitoring, according to Murphy. “The coverage will encourage compliance with the serial visits for PSA tests, prostate exams, and prostate biopsies that are part of active surveillance,” said Murphy, a member of the Robert H. Lurie Comprehensive Cancer Center, Northwestern University.
A follow-up study is planned to investigate whether tumor profiling with GPS and prostate MRI can improve the safety of active surveillance in high-risk men thanks to the refinancing of the ENACT clinical trial.
University of Illinois at Chicago