Differences in patterns of care of prostate cancer, New South Wales, 1991

Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology

OBJECTIVE

To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil.

MATERIALS AND METHODS

A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice.

RESULTS

One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA.

CONCLUSIONS

A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.

Frontiers of cancer care in Asia-Pacific region: cancer care in Australia

Cancer has a significant impact on the Australian community. One in three men and one in four women will develop cancer by the age of 75. The estimated annual health expenditure due to cancer in 2000-1 in Australia was $2.7 billion, representing 5.5% of the country’s total healthcare expenditure. An historical overview of the national cancer control strategies in Australia is provided. In males, the five most common cancers in order of decreasing incidence are: prostate cancer, colorectal cancer, lung cancer, melanoma and lymphoma, while for Australian women, breast cancer is the most common cancer. Key epidemiologic information about these common cancers, current management issues and comprehensive national clinical practice guidelines (where available) are highlighted. Aspects of skin cancer, a particularly common cancer in the Australian environment – with a focus on melanoma – are also included.

Cancer outcomes in Australia, measured by selected outcomes, are among the best in the world. However, there is still evidence of health inequalities, especially among patients residing in regional and remote areas, the indigenous population and people from lower socio-economic classes. Limitations of current cancer care practices in Australia, including provision of oncology services, resources and other access issues, as well as suggested improvements for future cancer care, are summarised. Ongoing implementation of national and state cancer control plans and evaluation of their effectiveness will be needed to pursue the goal of optimal cancer care in Australia.

Ultrasound image transmission via camera phones for overreading

Emergency physicians using ultrasound frequently encounter unfamiliar findings during routine ultrasound examination. This is especially common for less experienced practitioners.

OBJECTIVE

To compare high-resolution thermal printer ultrasound images and images recorded and transmitted via commercial camera cell phones.

METHODS

This was a study comparing randomly selected images of actual ultrasound examinations performed in an academic level I ED with hospital-based emergency ultrasound credentialing. Two hospital credentialed emergency sonologists with extensive experience were asked to review 50 randomly selected images from actual patients as seen on a camera cell phone screen after being captured from a high-resolution thermal printout and sent to a similar phone. Reviewers recorded initial impression of the image and identified structures, measurements, and pathology. After hearing a brief clinical vignette, reviewer rated the images for image quality, detail, resolution, as previously defined, on a 10-point Likert scale. This process was then repeated with the original thermal printouts. Data were analyzed using descriptive statistics, agreement analysis, and the Student t test.

RESULTS

Reviewers showed good interrater agreement for pathology and structure detection between phone and thermal printer images. There was no statistically significant difference in image quality, resolution, and detail between phone images and thermal printer images. However, there was statistically significantly increase in confidence in diagnosis for reviewers when using thermal printer images as compared with phone images, P = .003 and P = .02. Several phone images were felt to be suboptimal, and there was moderate agreement on these between reviewers.

CONCLUSIONS

Ultrasound pictures recorded by one phone and then sent to another yielded images that showed no statistically significant differences from traditional high-resolution thermal printouts in image quality, detail, and resolution. Measurements were too small to be read on the camera phones, and reviewers had statistically significantly lower confidence in their diagnosis when using the camera phones to review images.

Urban–rural differences in prostate cancer mortality, radical prostatectomy and prostate‐specific antigen testing in Australia

OBJECTIVE

To assess differences in trends for prostate cancer mortality, radical prostatectomy and prostate-specific antigen (PSA) testing for Australian men aged 50-79 years living in capital cities compared with regional and rural areas.

DESIGN

Descriptive, population-based study based on data from official sources from 1985 to the 2002/03 financial year (depending on data availability).

MAIN OUTCOME MEASURES

Age-standardised rates per 100,000 men aged 50-79 years of mortality from prostate cancer, incidence of prostate cancer, PSA tests and radical prostatectomy.

RESULTS

We found a statistically significant and increasing (age-standardised) mortality excess for prostate cancer in regional and rural areas. In 2000-2002 the excess (compared with capital cities) was 21% (95% CI, 14%-29%). Rates of radical prostatectomy in rural and regional Australia were 29% lower (95% CI, 23% lower to 35% lower) than in capital cities. Although PSA testing is common across the whole of Australia, age-standardised rates in 2002/03 were 16% lower (95% CI, 15% lower to 17% lower) in regional and rural areas than in capital cities.

CONCLUSIONS

Our results show that the probability of a man having a PSA test and the management of his prostate cancer depend on where he lives. The cause or causes of the prostate cancer mortality excess in regional/rural areas cannot be established in a descriptive study, but fewer radical prostatectomies in regional and rural areas, perhaps associated with less PSA screening, remain among the several competing hypotheses. Other possibilities are related to other differences in management, perhaps associated with access to urologists. Governments and other budget holders need good evidence about the effectiveness of prostate cancer screening and early treatment, but also about the best strategies for providing equitable access to cancer services in both urban and rural areas.

Rural inequalities in cancer care and outcome

We need improved primary care, access to expert multidisciplinary services, and appropriate coordination of the two.

Trends in the curative treatment of localized prostate cancer after the introduction of prostate-specific antigen: data from the Rotterdam Cancer Registry

OBJECTIVE

To investigate changes in the incidence and treatment of prostate cancer over the period in which new diagnostic tools were introduced and the attitude towards treatment was changing.

PATIENTS AND METHODS

Information on the extent of disease and treatment of patients diagnosed with prostate cancer within the Rotterdam region was retrieved from the Rotterdam Cancer Registry.

RESULTS

In the period 1989-95, 4344 patients were diagnosed with prostate cancer and the age-standardized incidence increased from 62 to 125 per 100 000 men. This increase mainly comprised tumours localized to the prostate, while the incidence of advanced cancers remained stable. The proportion of poorly differentiated tumours decreased from 33% in 1989 to 24% in 1995. In the same period the number of patients receiving radiotherapy increased from 80 to 258, while the annual number of radical prostatectomies rose from 17 to 159. Radiotherapy was the preferred type of treatment in patients over 70 years of age, whereas radical prostatectomy was used more frequently in younger patients with localized tumours.

CONCLUSION

While the value of screening for prostate cancer remains in debate, incidence and treatment patterns are changing rapidly. Information on patterns of care is needed to interpret future mortality data and to plan resources for adequate health care.

Systematic review of cancer treatment programmes in remote and rural areas

In an attempt to ensure high quality cancer treatment for all patients in the UK, care is being centralized in specialist centres and units. For patients in outlying areas, however, access problems may adversely affect treatment. In an attempt to assess alternative methods of delivering cancer care, this paper reviews published evidence about programmes that have set out to provide oncology services in remote and rural areas in order to identify evidence of effectiveness and problems. Keyword and textword searches of on-line databases (MEDLINE, EMBASE, HEALTHSTAR and CINAHL) from 1978 to 1997 and manual searches of references were conducted. Fifteen papers reported evaluations of oncology outreach programmes, tele-oncology programmes and rural hospital initiatives. All studies were small and only two were controlled, so evidence was suggestive rather than conclusive. There were some indications that shared outreach care was safe and could make specialist care more accessible to outlying patients. Tele-oncology, by which some consultations are conducted using televideo, may be an acceptable adjunct. Larger and more methodologically robust studies are justified and should be conducted.