Race/ethnicity and the intensity of medical monitoring under 'watchful waiting' for prostate cancer.
BACKGROUND
Previous studies have found that racial/ethnic minority patients with prostate cancer are more frequently managed with "watchful waiting." Little, however, is known about the medical care received among men managed with watchful waiting. We examine the type and intensity of medical monitoring received by African American, Hispanic, and white patients with prostate cancer managed with "watchful waiting" in fee-for-service systems.


METHODS
Surveillance Epidemiology and End Results-Medicare data for men diagnosed with prostate cancer 1994-1996 were used in this study. Men were determined to have initially received watchful waiting if they did not receive surgery, radiation, or hormone treatment within the first 7 months of diagnosis. Crosstabulations, multivariate logistic, and Cox regressions were used to examine the association between clinical and sociodemographic variables and the receipt of a primary care, urology visit, prostate-specific antigen test, or bone scan.


RESULTS
In general, Hispanic and African American men received less medical monitoring and had longer median times from diagnosis to receipt of a medical monitoring visit or procedure than white men. Furthermore, nearly 6% of African American, 5% of Hispanic, and 1% of white men did not have any medical monitoring visits or procedures during the 60-month follow-up period (P<0.001). Differences in observed clinical or sociodemographic characteristics did not explain variations in medical monitoring.


CONCLUSIONS
Regular medical monitoring is considered by most medical authorities to be a necessary component of management with watchful waiting. The disproportionately low receipt of medical monitoring visits and procedures observed for African American and Hispanic men managed with watchful waiting in this study suggest that there are racial/ethnic disparities in the receipt of appropriate prostate cancer management.
Shavers
Vickie L
VL
Applied Research Program, Health Services and Economics Branch, National Cancer Institute, Bethesda, MD 20892-7344, USA. shaversv@mail.nih.gov
Brown
Martin
M
Klabunde
Carrie N
CN
Potosky
Arnold L
AL
Davis
William
W
Moul
Judd
J
Fahey
Angela
A
D001741:Black or African American / Q000706:statistics & numerical data*; D000359:Aftercare / Q000379:methods / Q000706:statistics & numerical data; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015897:Comorbidity; D005500:Follow-Up Studies; D006302:Health Services Research; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D012042:Registries; D018426:SEER Program; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D017430:Prostate-Specific Antigen