Prostate cancer (PCa) is the most common cancer among American men, with a 10-year survival rate of 98%. As more men survive PCa, they and their partners must contend with the psychological, physical, and social implications of PCa survivorship and the impact these factors have on quality of life (QoL). Regrettably, many PCa survivors report that they experience various unmet supportive care needs and psychosocial issues such as depressive symptoms and anxiety. In particular, African American PCa survivors report lower QoL, lower satisfaction with treatment outcome, and higher stress compared with non-African American PCa survivors. The reasons for their lower QoL are complex and require consideration of individual, social, and environmental factors. The proposed research examines multi-level factors at the patient-, partner-, and healthcare provider levels to increase QoL among African American PCa survivors, which is one of the FY18 Prostate Cancer Research Program (PCRP) Overarching Challenges.

Cancer is often considered a “we-disease,” as survivors’ QoL is often tied to their partners’ QoL and vice versa. However, few studies have examined this relationship between African American PCa survivors and their partners. In addition, there is a gap between PCa survivors’ and partners’ needs and the care they receive: PCa survivors report a significant desire for more information and better communication with their physicians. Also, the partners of PCa survivors often feel neglected and relegated to the sideline by healthcare providers, suggesting that providers likely do not consider the PCa survivor-partner as a single unit of care. Accordingly, the objective of this proposed research is to bridge this gap between PCa QoL research and clinical care. At the completion of this study, I expect to identify patient-, partner-, and healthcare provider-level factors that impact African American PCa survivors’ QoL and establish intervention strategies.

The proposed couple-based research has the potential to have a higher impact on QoL and health outcomes than research targeting single individuals (either PCa survivors or their partners); results from this study will be helpful for enhancing both PCa survivors’ and their partners’ QoL. Also, if the focus of cancer care is expanded to the couple and targets joint QoL, African American PCa survivors’ QoL may be more easily enhanced. Importantly, the National Coalition for Cancer Survivorship already defines survivors to include family members, friends, and caregivers of individuals with cancer. This expanded definition may spur more inclusive clinical practices to better meet the needs of PCa survivors and their partners. The proposed research is directly related to a large health disparity, given that its target population is African American men, who have the highest PCa burden. Results of the present study will be available at the end of 2021 and will be shared, not only with researchers, but also with African American churches and PCa support groups (e.g., Tex Us Too) with which our research teams have strong and long-standing relationships. The information gained from this research can be used to develop programs that address PCa survivors, their partners, and healthcare providers and are practicable for survivors to undertake and clinics or community facilities to offer.

My career goal is to obtain a tenure-track faculty position in an academic setting where I will conduct research in PCa disparities. My training goals during the fellowship are to (1) define the complex PCa disparities across biological, psychological, social, and environmental factors; (2) identify how PCa survivors and partners influence each other’s QoL; and (3) become proficient in couple-based data analysis and interpretation. These goals will be achieved through coursework, seminars, workshops, summer institutes, readings, conferences, and meetings with mentors. The Health Disparity Fellowship will provide opportunities to receive intensive training in PCa disparities from highly dedicated mentors with expertise in PCa disparities (Drs. Gomez, McNeill, and Ma), cancer survivorship (Drs. Lu and Milbury), qualitative analysis (Dr. Lu), and couple relationships/analysis (Dr. Milbury). With the support of the Fellowship, I will be able to attend national and local PCa and cancer health disparities conferences to present my research, learn research methods, and expand my professional network. Furthermore, data derived from the Fellowship will increase my competitiveness for future career development and research awards. Given the high impact of the proposed research, strong mentoring team, rigorous training plans, and evidence of my high productivity, I have significant capacity and potential for future success as an independent investigator who advances PCa disparities research and improves QoL and survivorship for underserved populations.