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Race/Ethnicity and the Intensity of Medical Monitoring Under ‘Watchful Waiting’ for Prostate Cancer

Shavers, Vickie L. PhD*; Brown, Martin PhD*; Klabunde, Carrie N. PhD*; Potosky, Arnold L. PhD*; Davis, William PhD; Moul, Judd MD; Fahey, Angela BS*†‡

doi: 10.1097/01.mlr.0000117361.61444.71
Original Article

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.

Conclusion 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.

*Applied Research Program, Health Services and Economics Branch, National Cancer Institute, Bethesda, Maryland;

†Surveillance Research Program, Statistical Research and Applications Branch, National Cancer Institute, Bethesda, Maryland;

the ‡Department of Surgery/DoD Center for Prostate Disease Research/Uniformed Services University and Walter Reed Army Medical Center, Bethesda, Maryland; and Information Management Systems, Silver Spring, Maryland.

The opinions and assertions are the views of the authors and are not to be construed as reflective of the views of the National Cancer Institute or the U.S Army Department of Defense.

Reprints: Vickie L. Shavers, PhD, National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program/HSEB, 6130 Executive Blvd. EPN 4005 MSC 7344, Bethesda, MD 20892–7344. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.