Low-income cancer patients are less informed

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Higher-income individuals with prostate cancer feel more informed about the disease and more satisfied with their treatment decisions than do their lower-income peers, new survey findings show.

“A more focused effort must be made to improve the education and available information for prostate cancer patients from lower income levels,” according to study author Peter Grimm of the Swedish Medical Center in Seattle and his colleagues.

Their survey findings were presented Sunday in Atlanta, during the 46th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

A recent report from the Prostate Cancer Foundation indicated that doctors do not agree on the best way to screen for or treat prostate cancer. Patients are usually advised to choose their preferred treatment, in consultation with their urologist, who may or may not be a cancer specialist. In most cases, men choose to be treated with radiation or a hormone-based treatment or to have their prostate removed.

Grimm and his colleagues conducted an online survey of 4,587 prostate cancer patients and caregivers in September 2003. Participants were asked about their treatment history, awareness of various treatment options and satisfaction with their treatment decisions.

Overall, 95 percent of respondents with yearly incomes of $120,000 or more said they generally felt informed about their disease, while only 69 percent of those whose annual income fell below $20,000 said the same.

When deciding how to treat the prostate cancer, less than half of those in the lowest income group said they sought a second opinion before making a decision, compared with nearly 80 percent of those in the highest income group.

Also, more higher-income than lower-income patients said they were “pleased” with the decisions they made about their treatment. And if given a second chance to make those decisions, 92 percent of respondents from the highest income group said they would make the same choices. The same was true for 77 percent of those who earned less than $20,000 each year.

These findings show that doctors are not reaching all patients “as well as we could,” Grimm said. He noted, however, a tendency for low-income patients to ask fewer questions.

In his practice as a radiation oncologist Grimm said he has encountered patients who tend to “clam up” and to seem intimidated. This may be one reason why lower-income patients get less information and are less satisfied, he said.

Patients “need to be comfortable asking questions,” Grimm said. To increase their comfort level, they should read all the information they can find about their disease and write their questions down before going to the doctor, he advised.

And, he added, physicians should recognize that some patients require a “very individualized” approach.

“Physicians need to be aware that there is a difference in understanding at certain income levels,” Grimm said. Doctors should develop materials and information that their patients can comprehend and make themselves available to answer any questions that come up, he added.

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