Prostate Cancer among Black Men
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03 May, 2017
Introduction
The goal of this essay is to critically assess prostate cancer among black men as a key public health issue affecting the population in nursing practice. To realise this goal, the essay endeavours to explore and discuss the determinants of prostate cancer among the chosen population. Additionally, the inequalities and policies that impact prostate cancer among Black men will also be analysed. Thereafter, the essay shall seek to identify and discuss the role of the nurse in terms of assessing the public health needs of black men and promoting their health and wellbeing. The reason for choosing to focus on prostate cancer among black men is based on the wealth of evidence available in existing literature, which indicates that Black men, when compared to other ethnic groups, have a higher risk of being diagnosed with prostate cancer (Jones and Chinegwundoh, 2014). A number of studies on the prevalence of prostate cancer in the UK (for example, Kheirandish and Chinegwundoh, 2011) indicate that black men have a 30% higher mortality rate due to prostate cancer compared to Caucasian men, and their risk of being diagnosed with prostate cancer is 2-3 times that of their Caucasian counterparts. It is therefore important to examine the burden of prostate cancer as if faced by Black men in order to enhance understanding and awareness of the diseases among this vulnerable population.
Rationale
Prostrate cancer remains a disease of increasing public health concern globally. In such industrialised countries as the UK, prostate cancer is the fourth most common type of cancer and a leading cause of death due to cancer (Cancer Research UK, 2015). The prevalence, incidence, and mortality of prostate cancer in developing countries have also been on the rise in recent decades (Haas et al., 2008).
Black men are characterized by higher health disparities compared to men from other ethnic groups. These health disparities are evident with respect to prevalence, incidence, burden of diseases, and mortality. Prostate cancer health disparities, as evident among Black men, are the result of complex, albeit interrelated, factors. According to the National Cancer Institute (2008), socio-economic status and limited health care coverage are two of the most common factors that contribute to prostate cancer health disparities. According to Zimmerman (2015), prostate cancer remains one of the most commonly diagnosed types of cancer among men. In 2015 alone, some estimated 220,800 new cases of prostate cancer were diagnosed in the U.S., while approximately 27,540 deaths due to prostate cancer were also reported. However, Black men are more likely to delay undergoing prostrate screening compared to men of other races, thereby placing them at a higher risk of morbidity and mortality due to prostate cancer (Zimmerman, 2015). Woods et al. (2004) report that Black men do not participate in screening for prostate cancer in as high a number as men from other ethnic groups owing to several cultural factors, including health barriers, beliefs, knowledge, and relationships with the primary healthcare providers (Woods et al., 2004). This could also explain why black men across the globe have a higher incidence of prostate cancer than all other male ethnic groups. There is therefore a need to raise awareness about the health disparities facing Black men as far as prostate cancer is concerned so that the relevant health care providers can take remedial action.
Discussion
- Exploration of the size of the health problem
According to Prostate Cancer UK (2014), for every four Black men living in the UK, one of them will be diagnosed with prostate cancer at some point in their lives. This is in comparison with 1 out of every 8 men in the general population. The double average risk facing black men in terms of being diagnosed with prostate cancer compared to their colleagues from other ethnic groups is largely due to the fact that Black communities are characterised by low awareness of prostate cancer (Prostate Cancer UK, 2014). The mortality rate of prostate cancer among black men in the UK is also higher relative to that of other men in the general population. For example, in 2014, prostate cancer accounted for 13% of all the cancer deaths reported among UK men (Cancer Research UK., 2015). On the other hand, prostate cancer is responsible for 22% of all deaths due to cancer in black men in the UK, and it accounts for about 8% of the annual deaths reported among black men in the UK. Statistics by Prostate Cancer UK (2014) show that each year, nearly 37,000 men in the UK are diagnosed with prostate cancer. At the same time, prostate cancer causes an estimated 9,000 deaths among men in the UK each year. As can be seen, prostate cancer is a public health care issue of concern to health care providers in the UK. A study by the UK National Screening Committee reveals that screening of prostrates is associated with a 21% reduction in death due to prostate cancer (UK NSC., 2016).
Deprivation also plays a contributing role in the health inequality gap, and poorer health outcomes are evident among Black men regarding prostate cancer. Health inequalities as a result of deprivation are inextricably associated with ethnicity. Between 2009 and 2011, Black men of working age in the UK had an unemployment rate of 18% (Office for National Statistics, 2014). This was by far the highest rate of unemployment recorded among all the various ethnicities in the UK. Considering that men classified as being most deprived are also characterised by the poorest cancer outcomes, this could explain why the diverse socio-economic inequalities that Black men face are having such a huge impact on their health.
- b. Determinants of health
Determinants of health refer to a host of social, economic, personal, and environmental factors that impact health status. According to the World Health Organisation (WHO), various factors collectively influence the health of individuals and communities. Therefore, the environment and circumstances under which people live determine whether they will be healthy or not (WHO, 2017). Two of the common determinants of health include the socio-economic environment and an individual's behaviours and characteristics. Socio-economic factors account for a considerable portion of the total burden of prostate cancer in the general population (Merletti, Galassi, and Spadea, 2011). Cheng et al. (2009) indicate that socio-economic status is associated with various factors that could generally impact the burden of prostate cancer. Some of the factors linked to socio-economic status include environmental and lifestyle factors, along with access, utilisation, and quality of health care services and screening (Cheng et al., 2009). Towards this end, various studies point towards an elevated risk of men from higher socio-economic groups being diagnosed with prostate cancer. This could be the case because men with higher income, education, and health-seeking behaviours are more likely to undergo prostate cancer screening (Smith, 2014).
Genetics is also a key determinant of the health of an individual and the possibility of such an individual developing certain illnesses. A growing body of evidence points toward the crucial role of androgen metabolism genes in prostate cancer aetiology (Zeigler-Johnson et al., 2008). Black men, who have been shown to be at a higher risk of being diagnosed with prostate cancer, are also reported to have higher circulating levels of androgen compared to men of other races, such as the Chinese, who have a reduced risk of prostate cancer (Bunker et al., 2002).
- Relevant health policies
One of the most effective strategies for tackling prostate cancer is to have individuals in the population undergo screening and detect prostate cancer early enough. So far, the PSA (prostate-specific antigen) test remains the best strategy for achieving early detection of this disease among men without any symptoms in the UK, and more so for those who have been shown to be at a higher risk of prostate cancer (Prostate Cancer UK, 2016). According to Public Health England (2015), any man in the UK aged 50 and above who wishes to undergo a PSA test ought to have access to it. Towards this end, primary health professionals are encouraged to follow this national guidance in ensuring that no man aged 50 and above who is in need of a PSA test is denied such a test. However, the PSA test has not been applied as a population-wide screening programme in the UK based on evidence that it could end up offering more harm than good to the general population (UK National Screening Committee, 2016). However, men aged 45 and above who are at a higher risk of prostate cancer (for example, Black men) should also have access to a PSA test.
The NICE (National Institute for Health and Care Excellence) recommends that men with prostate cancer, along with their families and caregivers, should have access to information and decision support. Specifically, such information and decision support should be tailored to the individual needs of the patients (NICE, 2014). As a means of helping men make the crucial decision to undergo a prostate biopsy, NICE (2014) recommends that health care professionals should discuss with their patients their PSA level, DRE (digital risk examination), and risk factors such as genetics, age, and ethnicity. This is important in order to create awareness among patients and also in order to inform their decision-making process.
- Role of the nurse
Prostate cancer patients are characterised by diverse requirements based on the stage at which the cancer has been diagnosed, as well as their individual lifestyles and circumstances. Supporting such diverse needs calls for high levels of experience, sensitivity, and skill. Specialist nurses attending to prostate cancer patients therefore need good training and support in order to fulfil this unique role (Tarrant et al., 2008). One of the key roles played by nurses attending to patients newly diagnosed with prostate cancer is that of identifying their learning needs and those of their partners. In addition, the nurse is also charged with the respectability of offering the prostate cancer patient targeted information that suits their knowledge gaps, level of evacuation, and health literacy. Moreover, nurses have to be alert so that they can easily identify prostate cancer patients who might be experiencing distress, especially following diagnosis, and assist them in dealing with their psychosocial needs (Paterson et al., 2013).
Given that nurses tend to interact more with patients than any other health care professionals, they are therefore in a vantage position to encourage men diagnosed with prostate cancer to join prostate cancer support groups (PCSGs), as these have been shown to play a vital role in reducing levels of anxiety among newly diagnosed patients, in addition to aiding in knowledge dissemination and information sharing, thereby providing reassurance to the patients (Yo Ko et al., 2016). Nurses could also be involved in outreach programmes on prostate cancer awareness through educational programmes aimed at sensitising the vulnerable population so that they can get tested. Even among those diagnosed with prostate cancer, nurses play an essential role in educating the patient on what to expect, in addition to teaching them how to manage the late and chronic effects of the illness. While the nurses are offering direct care to prostate cancer patients, they are best placed to start a conversation with their patients regarding their fears, expectations, and concerns, in addition to offering them the support that they require following the diagnosis of prostate cancer (Oncology Nursing Society, 2017).
Conclusion
Black men are more predisposed to prostate cancer than men from other ethnic groups, owing to a combination of genetic, socio-economic, and behavioural factors. Prostate cancer is the 4th most common type of cancer and a leading cause of death, hence increasing public health concern worldwide. The high health disparities faced by Black men call for enhanced awareness by relevant health care providers. Some of the policies implemented to tackle prostate cancer include conducting PSA tests to detect the disease. The NICE also recommends that health care professionals tailor the information and decision support given to prostate cancer patients to their individual needs. Nurses play a crucial role in supporting the diverse requirements of prostate cancer patients. This calls for good training and support in order to fulfil this unique role. Nurses are also best placed to encourage individuals in the community to undergo PSA tests and to disseminate knowledge and information about the diseases. This is best achieved through education programmes at the community level. Towards this end, the following recommendations are made:
- i) There is a need to organise more outreach programmes aimed at creating awareness about prostate cancer, risk factors, and the importance of screening in communities where individuals most at risk, such as Black men, are to be found.
- ii) National guidelines on prostate cancer that permit men at risk of the disease due to age, ethnicity, or socio-economic status should be implemented so that they can have enhanced access to affordable screening services.
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