Managing the Low-Socioeconomic-Status Prostate Cancer Patient: INTRODUCTION
Management of patients with prostate cancer may include “watchful waiting,” hormonal (androgen ablative) therapy, radical prostatectomy, cryosurgery, chemotherapy or radiation therapy in the form of external-beam radiotherapy, high-dose radiotherapy or brachytherapy. While clinical variables, such as age, disease stage, prostate-specific antigen (PSA) level, Gleason score, comorbidities and symptoms, are important considerations in the physicians’ selection of treatment(s), patient participation in the decision-making process is desirable and generally encouraged. Therefore, provision of adequate information to patients is vital as they need to understand the benefits and risks of the treatment alternatives, the costs and follow-up procedures involved, and the likely survival and quality-of-life (QOL) outcomes. canadian antibiotics
Data to indicate a clear superiority of one treatment choice over another are, however, lacking, and this uncertainty can affect the decision-making process—particularly when patients are faced with several options. In addition to clinical variables, numerous other factors may influence an individual patient’s decision concerning treatment, including income, insurance status, educational level, ethnicity, personality, lifestyle, philosophy/beliefs, previous life experiences and current health status. The interrelationships between these clinical and social variables can be very complex. An important consideration in patients’ participation in the decision-making process is how they access information and use it. This may not be fully appreciated by physicians, as information sources—ranging from the electronic media and specific literature to advice from friends—can vary widely in the way the benefits and risks of the various treatment options are portrayed. In addition, there may be limitations to physicians’ understanding of patient outcome preferences, which can adversely affect the patient-physician relationship. canadian pharmacy online
Socioeconomic status, literacy and educational levels have important implications for patients’ access to healthcare, ability to manage the bureaucracy of medical insurance and healthcare institutions, ability to attend clinics for follow-up visits, and their understanding of information provided to them on prostate cancer and its treatment. Lack of health insurance by many Americans is a major barrier to receipt of optimal healthcare; about 16% <65 years of age have no insurance coverage, while one-third of people ^65 years of age have Medicare coverage only. In 2002, 18% of Americans aged 18-64 years reported having no regular source of healthcare, and for 6% cost had been a barrier to obtaining needed healthcare during the previous year. Percentages of the population among the various racial and ethnic groups of the U.S. population who have no healthcare coverage or no regular source of medical care are shown in Table 1 (American Cancer Society statistics). generic sildenafil citrate
This article outlines the treatment options for patients with newly diagnosed prostate cancer and discusses how a low socioeconomic status and educational level can adversely influence therapeutic decision-making and, consequently, satisfaction with treatment outcomes. It also discusses measures designed to increase patients’ informed participation in the shared decision-making process and to enhance their posttreatment QOL. Cefdinir antibiotics