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Show Disease-Specific Survival Among Prostate Cancer Patients In Utah According to Religion and Religiosity Ray M. Merrill Ph. D., M.P.H.; Charles L. Wiggins; Sterling C. Hilton; Emily Allen Purpose: To determine if religion or religious activity influence disease-specific survival among incident cases of prostate cancer diagnosed among Utah residents during the time period 1985-99. Methods: Population-based records for incident prostate cancer cases were linked with membership records from the Church of Jesus Christ of Latter-day Saints (LDS) to determine religious affiliation and, for LDS Church members, level of religious activity. Prostate cancer-specific survival was calculated according to the method of Kaplan and Meier for religiously active LDS, less-active LDS, and non-LDS men with prostate cancer. The Cox proportional hazards model was used to compare survival among these three groups with simultaneous adjustment for prognostic factors (age, race, marital status, summary stage, histologic grade, radiation therapy, surgery, and year of diagnosis). Analyses were restricted to individuals whose only cancer diagnosis was of the prostate gland or whose prostate cancer was the first of two or more diagnoses. Results: Crude prostate cancer-specific survival curves differed among active LDS, less active LDS, and non-LDS men (Log-rankp = 0.001). By the Cox model with active LDS cases as the reference group, the death hazard for less religiously active LDS was then 1.28 (95% CI: 1.13 - 1.45) and for non-LDS 1.00 (0.87 - 1.14), with simultaneous adjustment for established prognostic factors. Conclusions: Modest differences in prostate cancer-specific survival between active LDS and non-LDS prostate cancer cases were explained by well-established prognostic factors. These same factors did not fully account for differences in survival between religiously active and less active members of the LDS Church. Comparatively poor prostate cancer survival has been associated with certain demographic factors (aged less than 50 or greater than 80 years, black, not married), tumor characteristics (advanced stage and grade), co-morbid conditions, and less aggressive treatment.1"9 Smoking has also been associated with poorer survival in prostate cancer patients.10"11 Because of the association that may exist between religiosity within religious groups and factors associated with disease-specific survival among prostate cancer patients, such as marriage and smoking, it seems reasonable that religion-religiosity would have an affect on prostate cancer survival. Also, religion may provide a social support structure that directly affects survival. The relationship between religion and religiosity with prostate cancer survival has not previously been investigated. In this paper, we explore whether membership and religiosity in the LDS Church, whose doctrine discourages use of tobacco, alcohol, coffee, and tea, and encourages a nutritious diet, marriage, and family, is associated with prostate disease-specific survival in prostate cancer patients in Utah. METHOD Utah Cancer Registry (UCR) data were linked to LDS Church membership records to estimate prostate cancer survival according to LDS and non-LDS populations in Utah, and to estimate religiosity among LDS during the period 1985-99. Utah Cancer Registry The UCR, established in 1966, has continuously participated in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program since 1973. UCR staff members and local cancer registrars identify incident cases of cancer among Utah residents through routine and systematic review of pathology reports, medical records, radiation therapy records, hospital discharge lists, and vital records. Tumor characteristics including histology, grade, and primary site are coded according to the International Classification of Disease for Oncology-Second Edition (ICDO-2).12 Prostate cancer-specific death is coded according to the International Classification of Diseases, 9th Revision, Clinical Modification-Third Edition (ICD-9-CM).13 This code remained the same in the International Classification of Diseases, 10th Revision.14 Categories of stage of disease at diagnosis are documented in the Summary Staging Guide of the Surveillance. Epidemiology, and End Results Program of the National Cancer Institute.15 Registry records also include information regarding treatment, survival, and patient characteristics such as age at diagnosis, gender, race/ethnicity, and place of residence at diagnosis. Such information is ascertained from specific statements in medical records, reports from private pathology laboratories and radiotherapy units, and death certificates. Cancer surveillance in Utah is conducted in accordance with standards instituted by the SEER Program and the North American Association of Central Cancer Registries.1617 hi order to provide valid estimates of cancer survival, a high percentage of cancer cases must be routinely followed to ascertain both vital status and date of last contact. UCR records are linked four times each year with records of death certificates from the Office of Vital Records and Health Statistics from the Utah Department of Health. Results from these routine linkages identify cancer patients who have died, regardless of their cause of death. Registry staff members work closely with cancer registrars in local hospitals to document, through systematic review of medical records, the date of last contact for those cancer patients not known as being deceased. Records for these patients are also linked annually with administrative databases, including Medi-caid reimbursement claims, Utah driver license records, and 14 Utah's Health: An Annual Review Volume LX |
