Page 125 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

One multivariable analysis reported that men in higher socioeconomic strata (versus lower strata)
had a decreased probability of receiving AS/WW versus active treatments. 77,159

Education. Five multivariable analyses examined education level with respect to
AS/WW. 66,161,166,167,177 Three reported that education was not a significant factor in predicting
men receiving AS/WW. 66,161,177 One reported that men who resided in census tracts with fewer
residents who had a high school education (versus more) had an increased probability of
receiving AS/WW versus other treatments. 166 One reported that college graduates (versus non-
college graduates) had an increased probability of interrupting AS/WW to seek active
treatments. 167

Race. Ten multivariable analyses examined race/ethnicity with respect to AS/WW. 77,159,164,166,168-
170,176,177,180 Six found that race/ethnicity was not a significant factor in selecting AS/WW or in
the decision to interrupt AS/WW and seek definitive treatments. 77,164,168-170,176 Four analyses
reported that blacks were more likely than whites to receive AS/WW versus active
treatments. 159,166,177,180
One survey of 231 men with prostate cancer in North Carolina reported that there was no
significant difference between blacks and whites as to whether the option of WW was discussed
with their physicians (48.7 percent versus 56.1 percent). 190

Delivery System

Economic Incentives and Disincentives
Offer of AS. No study or survey specifically addressed how economic incentives and
disincentives might affect the offer of AS.

Acceptance of AS

Insurance Type (HMO, Military, Private). Two multivariable analyses reported that having
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Medicare (versus private insurance, or private or Veterans Administration (VA) insurance 160 )
increased the probability of receiving AS/WW (versus active treatments). One analysis reported
that having Medicare plus supplement (versus private) also increased the probability of AS/WW
(versus RP). 179 One analysis reported that having preferred provider organization (PPO) or health
maintenance organization (HMO) coverage decreased, and that having VA insurance increased,
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the probability of receiving AS/WW versus RP. It also reported that Medicare supplemented
with fee-for-service, HMO, or PPO coverage decreased the probability of receiving AS/WW
versus RP.

Adherence to AS. One multivariable analysis reported that insurance status was not a significant
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factor in predicting interruption of AS/WW.

Availability of Technology
No study or survey specifically addressed how the availability of technology might affect the
offer or acceptance of, or adherence to, AS.

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