Bringing men in primarily Black neighborhoods together in convenient settings can provide an effective way to educate them about prostate cancer, according to a recent report.
Using data from the Pennsylvania Cancer Registry, investigators identified 4 neighborhoods in Philadelphia with the highest prostate cancer burden (combined incidence, mortality and stage at diagnosis). They trained peer educators to deliver educational sessions and lead discussions in neighborhood settings. Their efforts improved prostate cancer knowledge and intent to talk to a doctor about prostate cancer screening.
“Urologists should care about these findings because we showed that there are community-based methods that may be used to connect at-risk men with health providers so that clinical interventions can be more successful,” according to study investigator Charnita Zeigler-Johnson, PhD, MPH, a prostate cancer researcher at Sidney Kimmel Cancer Center-Jefferson Health and assistant professor of medical oncology at Thomas Jefferson University in Philadelphia, Pennsylvania.
The investigators held their sessions in recreation centers, churches and synagogues, transitional housing sites, public libraries, and civic neighborhood organizations. They administered surveys at baseline, immediately post-session, and at 1 and 4 months post-session to assess 3 main measures: knowledge about prostate cancer, concern/fear about prostate cancer, and a patient’s intention to get screened for prostate cancer. At baseline, the intervention and control groups did not differ in any of these measures.
Prostate cancer knowledge and intention to screen increased significantly in both study arms at a 4-month follow-up evaluation. The change in level of prostate cancer concern, however, was significant only for the intervention group immediately post-session and at a 1-month follow-up evaluation.
“We concluded that convening men in familiar and convenient settings in their neighborhoods and giving them an opportunity to learn from their peers made them more receptive to health education,” Dr Zeigler-Johnson said.
She added that the findings “speak to the power of these [neighborhood] spaces that enabled the men to learn from a trusted peer-educator but also from each other. So, even though men in the control group weren’t directly talking about prostate cancer, there was clearly a beneficial effect of having these open conversations about health in general.”
The study, which was published in the Journal of Racial and Ethnic Health Disparities, included 239 men with a median age of 53 years (range 27-83 years). The investigators assigned 121 men from 2 of the neighborhoods (89% Black) to an intervention arm, which received education on prostate health and prostate cancer screening, symptoms, detection, staging, and treatment. From the other 2 neighborhoods, investigators recruited 118 men (95% Black) to serve as controls. They received general education on men’s health issues and the benefits of a healthy lifestyle.
The study involved a multidisciplinary research team along with prostate cancer survivors and peer educators from the targeted neighborhoods. Dr Zeigler-Johnson and colleagues partnered with trusted community members who lived in the selected neighborhoods and trained them to deliver the educational sessions to the control group and intervention group. “Our interventions were informed by not only the cancer registry data, but also by focus groups conducted in each of the neighborhoods so that we knew the information that we needed to convey and the best way to deliver culturally tailored educational interventions,” Dr Zeigler-Johnson said.
Combining this approach of epidemiological mapping and community outreach could become an important model for health disparities research, according to the investigators. They have follow-up studies planned.
Julio Pow-Sang, MD, chair of the Genitourinary Oncology Program at Moffitt Cancer Center in Tampa, Florida, said these findings confirm previous observations regarding prostate cancer awareness in the Black community. The study reinforces the need for sustainable educational programs that reach Black men regarding the racial disparities with prostate cancer. Dr Pow-Sang said early detection of aggressive prostate cancer could decrease morbidity and mortality. “Specifically, these men are at increased risk of having prostate cancer and dying of cancer as compared to other ethnic groups. African-American men appear to have limited knowledge regarding prostate cancer,” Dr Pow-Sang said. “Reaching out to these men would require state and local funding to provide for education programs at these men’s local communities.”
Greg Hall, MD, medical director at University Hospitals (UH) Cutler Center for Men in Cleveland, Ohio, said going to high-risk areas populated with predominantly Black citizens and having targeted discussions with trusted advisors regarding the disease process is a great start. “However, while initiatives such as this may have a tremendous initial impact, a sustained presence is necessary for lasting change. As in almost all educational experiences, research has shown a significant decline in knowledge retention over time,” Dr Hall said.
“The medical community has a bad track record of exploiting disadvantaged communities, specifically the Black community,” Randy Vince, MD, incoming director of Minority Men’s Health at the center. “Coming for 1 event does not go far enough in rebuilding trust in the medical profession. However, a continued presence goes a long way by demonstrating a commitment to individual communities, which helps rebuild trust.” For many reasons, prostate cancer in Black men is more aggressive, metastasizes earlier, and more frequently results in death, he noted. “The good news is that the causes of these disparities are reversible. This study highlights how targeted interventions can be a significant first step in addressing the racial disparities in prostate cancer,” Dr Vince said.
Lee Ponsky, MD, executive director of the center and chair of the UH Urology Institute, agrees, and said repeated learning sessions are warranted. “Having just 1 discussion about almost anything will not lead to predominate and lasting behavior changes. In fact, their outcomes data are very encouraging because they suggest education from a trusted advisor is impactful, so repeated interventions of the same quality should change outcomes more significantly over time,” Dr Ponsky said.
Zeigler‑Johnson C, Madsen R, Keith SW, et al. Testing a prostate cancer educational intervention in high‑burden neighborhoods. J Racial Ethn Health Disparities. Published online November 8, 2021. doi:10.1007/s40615-011-01183-5