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Pretreatment Education and Counseling
As part of the counseling of men diagnosed with prostate cancer, healthcare practitioners (physicians, practice nurses and health educators/navigators) need to provide good information about the relative benefits and risks of the treatments advocated, including their likely influence on subsequent QOL, and then incorporate patient preferences into the therapeutic decision. In doing so, it should be appreciated that whereas some patients will want to maximize their chances for a “cure” and will accept the risk of post-treatment complications, such as urinary and sexual dysfunction, others will opt for a higher risk of prostate cancer recurrences to retain their present urinary and sexual function. It also needs to be realized that patients may receive conflicting information about the benefits and risks of treatment from different sources and that there may be considerable uncertainty regarding cure rates, the likelihood of complications occurring and the degree to which their lives will be affected by these complications. Although it might be assumed that a patient’s treatment decision will be based on a rational assessment of the available information, this may not be the case as his interpretation of potential outcomes may be based on the personal context of a particular complication. Generic Zithromax 500mg

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Although earlier studies (reviewed in Haas and Sakr) of the association between socioeconomic status and prostate cancer incidence reported inconsistent findings, a more recent epidemiological study has suggested that the advent of widespread PSA testing in the United States has changed the relationship, due largely to the greater use of PSA screening among men of higher socioeconomic status. Analysis of the relationship between socioeconomic status (defined by income and educational attainment) and prostate cancer incidence during the period 1972-1997 indicated no relationship in any racial or ethnic group prior to 1987; after this time, however, a strongly positive relationship was found for all racial/ethnic populations except Asians. Men of higher socioeconomic status were diagnosed with localized disease more frequently but with distant (metastatic) disease less frequently than men of low socioeconomic status.23 Other studies have indicated that stage at diagnosis is inversely correlated with health insurance status among African Americans, in that only 50% of those with distant disease had health insurance as compared with 100% of those with localized disease,24 and that men with Medicare only or no health insurance have a worse health-related QOL over time following treatment of prostate cancer than those with HMO insurance. canadian prescription drugs

These findings suggest that men of lower socioeconomic status and with poorer health insurance coverage for prostate cancer screening services are diagnosed and treated later and, hence, have worse outcomes. However, where access to healthcare is equivalent among men of different socioeconomic status, as in the U.S. military, no association between socioeconomic status and either the stage of the disease at diagnosis or five-year survival is observed. healthcare pharmacy

Low literacy may also be a significant barrier to the diagnosis of early-stage prostate cancer. This has important influences on the complex interaction between patients and physicians and on patients’
understanding of the recommended treatments and, ultimately, their decision-making process. Data from the CaPSURE program have suggested that educational level is predictive of the primary treatment received by US. patients with newly diagnosed prostate cancer. Those with a lower educational level exhibited higher usage of primary hormonal therapy and decreased rates of radical prostatectomy compared with those who have a higher education level, and this was evident in both African Americans and whites (Figure l). However, among older men (>75 years of age), those with higher educational levels received more radiotherapy and less primary hormonal therapy than those with lower educational levels, suggesting that the impact of education on primary treatment is different depending on patient age. canadian antibiotics

Other CaPSURE data have shown that among men for whom “watchful waiting” was the initial management, educational level was among the factors (others included age, PSA level and Gleason grade) predicting eventual active treatment. Men with a low educational level were less likely to receive active treatments than those with higher levels of education. However, in predicting primary treatment, educational level appears to be less influential than clinical variables such as stage, grade and pretreatment symptoms. Clinical factors have such a strong influence on the physician’s decision that the patient’s educational level may become less important in determining what treatment is recommended and what the patient ultimately receives. Canadian Pharmacy mall