Twenty-five years of the IMPACT men’s health study: Survivorship, health behaviors, and social determinants of health among uninsured and underrepresented prostate cancer patients.

Abstract

e13586 Background: The UCLA Men’s Health Study (MHS) was initiated 25 years ago to address critical gaps in prostate cancer (PCa) survivorship, quality of life(QOL), and health outcomes among uninsured and underrepresented men. MHS has collected patient-reported data across sociodemographic, physical, emotional, behavioral, and cancer-specific domains, providing an unparalleled view of survivorship patterns in a diverse, low-income, multi-ethnic PCa population. We conducted a systematic review of MHS findings to characterize long-term survivorship trends, identify determinants of QOL, and inform health-equity–focused interventions. Methods: The cohort included 1,328 participants enrolled in a program providing free PCa-related care to uninsured men in California across three periods: 2000–2008, 2009–2018, and 2019–2025, reflecting evolving treatment practices, health policy (including the Affordable Care Act), and external influences such as the COVID-19 pandemic. We evaluated longitudinal trends in patient-reported physical health, emotional well-being, and cancer-specific outcomes by enrollment period. Results: Participants included 771 enrolled PCa patients in 2000–2008, 529 in 2009–2018, and 28 in 2019–2025. Participants were predominantly < 65 years (86%), Hispanic (60%), and married/partnered (59%), and had low educational attainment (46%). Daily alcohol use declined over time (25% to 10%, p < 0.0001), and comorbidity burden decreased, with the proportion of participants with Charlson Comorbidity Index = 0 increasing from 36% to > 60% (p < 0.0001). Disease characteristics shifted, with earlier cohorts having a higher proportion of T1 disease and later cohorts showing more T2 disease, (p = 0.0004), Gleason grade distribution (p = 0.026),in later cohorts reflecting a higher proportion of intermediate/high-grade disease (GG 2–4), and pretreatment PSA levels (p < 0.0001). In multivariable analyses, current smoking was associated with worse survivorship outcomes, including lower physical functioning (β = −7.7, p = 0.028), lower SF-12 physical component scores (β = −3.2, p = 0.009), and greater bowel bother (β = −6.8, p = 0.037). Comorbidity burden was associated with poorer physical functioning (β = −5.5, p < 0.05) and worse mental health outcomes (β = −3.1, p < 0.05). Mental health outcomes were less strongly associated with age but were consistently influenced by behavioral and comorbidity factors. Conclusions: Across 25 years of follow-up, modifiable health behaviors, particularly smoking and comorbidity burden emerged as the strongest drivers of survivorship disparities among uninsured and underrepresented PCa patients These findings highlight the importance of integrating behavioral risk reduction and comorbidity management into survivorship care models to advance health equity.