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Botelho F, Lopes R, Pina F, Silva C, Pacheco-Figueiredo L, Lunet N. Prostate cancer treatment in Portugal: a nationwide analysis. Sci Rep 2023; 13:19362. [PMID: 37938598 PMCID: PMC10632360 DOI: 10.1038/s41598-023-46591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
Different treatment options exist for localized prostate cancer. Treatments performed in high-volume hospitals are associated with better results. Our objective was to describe time trends in prostate cancer treatments in Portugal and case volume per hospital. We used the national database of diagnosis-related group of the Portuguese Central Administration of the Health System to describe the number of radical prostatectomy (RP), brachytherapy (BT) and external radiotherapy (eRT) treatments performed in all National Health System hospitals. There was a rapid increase in the annual number of RP until 2006 and then a deceleration; BT treatments augmented significantly until 2011. The utilization of eRT also increased, surpassing RP after 2010. From the 46 hospitals performing RP, only eight had a case-volume > 50 treatments/year, and from the nine hospitals performing BT, only four accomplished > 15 treatments/year. In the 11 hospitals with eRT, nine performed > 50/year. Regarding RP, there was negative correlation between the hospital volume and length of stay (r = - 0.303; p = 0.041). In the Portuguese National Health Service there was a steep increase in the number of prostate cancer treatments, and there is an ample margin for concentration of RP and BT treatments, for improvement of the hospitals case volume.
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Affiliation(s)
- Francisco Botelho
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.
- Instituto de Investigação em Ciências da Vida e Saúde - ICVS/3B's Laboratório Associado, Escola de Medicina, Universidade do Minho, Braga, Portugal.
| | - Rui Lopes
- Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Francisco Pina
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
- Departamento de Urologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carlos Silva
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
- Departamento de Urologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Luís Pacheco-Figueiredo
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
- Instituto de Investigação em Ciências da Vida e Saúde - ICVS/3B's Laboratório Associado, Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Urban-rural prostate cancer disparities in a regional state of Australia. Sci Rep 2022; 12:3022. [PMID: 35194109 PMCID: PMC8863814 DOI: 10.1038/s41598-022-06958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/03/2022] [Indexed: 11/09/2022] Open
Abstract
Men living in regional and remote areas experience disparities in prostate cancer (PrCa) diagnosis, clinical characteristics and treatment modalities. We sought to determine whether such disparities exist in PrCa patients from Tasmania; a regional state of Australia with the second-highest rate of diagnosis and where over a third of residents live in outer regional and remote areas. Our study included clinicopathological data from 1526 patients enrolled in the Prostate Cancer Outcomes Registry-Tasmania. Regression analyses were undertaken to determine whether demographic, clinical and treatment variables differed between inner regional and outer regional/remote patients. Men from outer regional/remote areas were significantly more likely to reside in lower socio-economic areas, be diagnosed at a later age and with more clinically aggressive features. However, in contrast to previous studies, there were no overall differences in diagnostic or treatment method, although men from outer regional/remote areas took longer to commence active treatment and travelled further to do so. This study is the first to investigate PrCa disparities in a wholly regional Australian state and highlights the need to develop systematic interventions at the patient and healthcare level to improve outcomes in outer regional and remote populations in Australia and across the globe.
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3
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Winter M, Patel MI. Difficulties of delivering urological care to remote areas. ANZ J Surg 2021; 91:483-484. [PMID: 33847058 DOI: 10.1111/ans.16688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia.,Department of Urology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Manish I Patel
- Specialty of Surgery, Sydney Medical School, Sydney, New South Wales, Australia.,Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
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Andkhoie M, Szafron M. The Impact of Geographic Location on Saskatchewan Prostate Cancer Patient Treatment Choices: A Multilevel and Spatial Analysis. J Rural Health 2020; 36:564-576. [PMID: 32510662 DOI: 10.1111/jrh.12471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate the relationship between remoteness and the initial chosen treatment (active surveillance/watchful waiting (AS/WW), radiation therapy (RT), surgery, chemotherapy (CT), or hormonal therapy (HT) for prostate cancer (PCa). METHODS This study built 2 multilevel generalized linear models via a binomial link for each treatment type (one with only covariates and one with 2 additional study variables to the covariate model). The study also used cluster analysis using the Global and local Moran's I spatial statistics to find any complementary results to the above models. RESULTS This study found that patients living in the rural areas have lower odds (OR = 0.59; 95% CI, 0.45-0.77; P < .001) of having surgery compared to patients living in the greater urban areas. Among patients whose closest PCa assessment center is Regina, patients living in the greater urban areas have higher odds (OR = 1.66; 95% CI, 1.03-2.68; P = .039) of choosing RT compared to patients living in the rural areas. There was no statistically significant effect of remoteness on whether one chose HT or AS/WW. CONCLUSIONS There are regional disparities to PCa treatment utilization. Living in rural areas affects choosing surgery and, in certain localized geographical regions, affects choosing RT. For non-curative treatments (ie, AS/WW and HT), we did not find any association with geographical remoteness.
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Affiliation(s)
- Mustafa Andkhoie
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael Szafron
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Mahumud RA, Alam K, Dunn J, Gow J. Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 - 2014: an incidence-based approach in terms of trends, determinants and inequality. BMJ Open 2019; 9:e031874. [PMID: 31843834 PMCID: PMC6924826 DOI: 10.1136/bmjopen-2019-031874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Cancer is a leading killer worldwide, including Australia. Cancer diagnosis leads to a substantial burden on the individual, their family and society. The main aim of this study is to understand the trends, determinants and inequalities associated with cancer incidence, hospitalisation, mortality and its burden over the period 1982 to 2014 in Australia. SETTINGS The study was conducted in Australia. STUDY DESIGN An incidence-based study design was used. METHODS Data came from the publicly accessible Australian Institute of Health and Welfare database. This contained 2 784 148 registered cancer cases over the study period for all types of cancer. Erreygers' concentration index was used to examine the magnitude of socioeconomic inequality with regards to cancer outcomes. Furthermore, a generalised linear model was constructed to identify the influential factors on the overall burden of cancer. RESULTS The results showed that cancer incidence (annual average percentage change, AAPC=1.33%), hospitalisation (AAPC=1.27%), cancer-related mortality (AAPC=0.76%) and burden of cancer (AAPC=0.84%) all increased significantly over the period. The same-day (AAPC=1.35%) and overnight (AAPC=1.19%) hospitalisation rates also showed an increasing trend. Further, the ratio (least-most advantaged economic resources ratio, LMR of mortality (M) and LMR of incidence (I)) was especially high for cervix (M/I=1.802), prostate (M/I=1.514), melanoma (M/I=1.325), non-Hodgkin's lymphoma (M/I=1.325) and breast (M/I=1.318), suggesting that survival inequality was most pronounced for these cancers. Socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality and death. CONCLUSIONS Significant differences in the burden of cancer persist across socioeconomic strata in Australia. Policymakers should therefore introduce appropriate cancer policies to provide universal cancer care, which could reduce this burden by ensuring curable and preventive cancer care services are made available to all people.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Health and Epidemiology Research, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Prostate Cancer Foundation of Australia, St Leonards, New South Wales, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Dasgupta P, Baade PD, Aitken JF, Ralph N, Chambers SK, Dunn J. Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence. Front Oncol 2019; 9:238. [PMID: 31024842 PMCID: PMC6463763 DOI: 10.3389/fonc.2019.00238] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.
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Affiliation(s)
- Paramita Dasgupta
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Nicholas Ralph
- Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,St Vincent's Private Hospital, Toowoomba, QLD, Australia.,School of Nursing & Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Suzanne Kathleen Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Jeff Dunn
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia
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Gilbert SM, Pow-Sang JM, Xiao H. Geographical Factors Associated with Health Disparities in Prostate Cancer. Cancer Control 2016; 23:401-408. [DOI: 10.1177/107327481602300411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Treatment variation in prostate cancer is common, and it is driven by clinical and clinician factors, patient preferences, availability of resources, and access to physicians and treating facilities. Most research on treatment disparities in men with prostate cancer has focused on race and socioeconomic factors. However, the geography of disparities — capturing racial and socioeconomic differences based on where patients live — can provide insight into barriers to care and help identify outlier areas in which access to care, health resources, or both are more pronounced. Methods Research regarding treatment patterns and disparities in prostate cancer using the Geographical Information System (GIS) was searched. Studies were limited to English-language articles and research focused on US populations. A total of 43 articles were found; of those, 30 provided information about or used spatial or geographical analyses to assess and describe differences or disparities in prostate cancer and its treatment. Two additional GIS resources were included. Results The research on geographical and spatial determinants of prostate cancer disparities was reviewed. We also examined geographical analyses at the state level, focusing on Florida. Overall, we described a geographical framework to disparities that affect men with prostate cancer and reviewed existing published evidence supporting the interplay of geographical factors and disparities in prostate cancer. Conclusions Disparities in prostate cancer are common and persistent, and notable differences in treatment are observable across racial and socioeconomic strata. Geographical analysis provides additional information about where disparate groups live and also helps to map access to care. This information can be used by public health officials, health-systems administrators, clinicians, and policymakers to better understand and respond to geographical barriers that contribute to disparities in care.
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Affiliation(s)
- Scott M. Gilbert
- Departments of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M. Pow-Sang
- Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Hong Xiao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
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8
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Chan BA, Larkins SL, Evans R, Watt K, Sabesan S. Do teleoncology models of care enable safe delivery of chemotherapy in rural towns? Med J Aust 2015; 203:406-6.e6. [PMID: 26561905 DOI: 10.5694/mja15.00190] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare the dose intensity and toxicity profiles for patients undergoing chemotherapy at the Townsville Cancer Centre (TCC), a tertiary cancer centre in northern Queensland, with those for patients treated in Mount Isa, supervised by the same medical oncologists via teleoncology. DESIGN A quasi-experimental design comparing two patient groups. SETTING TCC and Mount Isa Hospital, which both operate under the auspices of the Townsville Teleoncology Network (TTN). PARTICIPANTS Eligible patients who received chemotherapy at TCC or Mt Isa Hospital between 1 May 2007 and 30 April 2012. INTERVENTION Teleoncology model for managing cancer patients in rural towns. MAIN OUTCOME MEASURES Dose intensity (doses, number of cycles and lines of treatment) and toxicity rates (rate of serious side effects, hospital admissions and mortality). RESULTS Over 5 years, 89 patients received a total of 626 cycles of various chemotherapy regimens in Mount Isa. During the same period, 117 patients who received a total of 799 cycles of chemotherapy at TCC were eligible for inclusion in the comparison group. There were no significant differences between the Mount Isa and TCC patients in most demographic characteristics, mean numbers of treatment cycles, dose intensities, proportions of side effects, and hospital admissions. There were no toxicity-related deaths in either group. CONCLUSION It appears safe to administer chemotherapy in rural towns under the supervision of medical oncologists from larger centres via teleoncology, provided that rural health care resources and governance arrangements are adequate.
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Affiliation(s)
| | - Sarah L Larkins
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD
| | - Rebecca Evans
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Townsville, QLD
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10
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A population-based study of progression to metastatic prostate cancer in Australia. Cancer Epidemiol 2015; 39:617-22. [DOI: 10.1016/j.canep.2015.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/18/2022]
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11
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Socioeconomic inequalities in prostate cancer survival: A review of the evidence and explanatory factors. Soc Sci Med 2015; 142:9-18. [PMID: 26281022 DOI: 10.1016/j.socscimed.2015.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/05/2015] [Accepted: 07/07/2015] [Indexed: 02/01/2023]
Abstract
Although survival rates after prostate cancer diagnosis have improved in the past two decades, survival analyses regarding the socioeconomic status (SES) suggest inequalities indicating worse prognosis for lower SES groups. An overview of the current literature is lacking and moreover, there is an ongoing discussion about the underlying causes but evidence is comparatively sparse. Several patient, disease and health care related factors are discussed to have an important impact on disparities in survival. Therefore, a systematic review was conducted to sum up the current evidence of survival inequalities and the contribution of different potential explanatory factors among prostate cancer patients. The PubMed database was screened for relevant articles published between January 2005 and September 2014 revealing 330 potentially eligible publications. After systematic review process, 46 papers met the inclusion criteria and were included in the review. About 75% of the studies indicate a significant association between low SES and worse survival among prostate cancer patients in the fully adjusted model. Overall, hazard ratios (low versus high SES) range from 1.02 to 3.57. A decrease of inequalities over the years was not identified. 8 studies examined the impact of explanatory factors on the association between SES and survival by progressive adjustment indicating mediating effects of comorbidity, stage at diagnosis and treatment modalities. Eventually, an apparent majority of the obtained studies indicates lower survival among patients with lower SES. The few studies that intend to explain inequalities found out instructive results regarding different contributing factors but evidence is still insufficient.
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12
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Baade PD, Yu XQ, Smith DP, Dunn J, Chambers SK. Geographic Disparities in Prostate Cancer Outcomes - Review of International Patterns. Asian Pac J Cancer Prev 2015; 16:1259-75. [DOI: 10.7314/apjcp.2015.16.3.1259] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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14
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Yu XQ, Luo Q, Smith DP, O'Connell DL, Baade PD. Geographic variation in prostate cancer survival in New South Wales. Med J Aust 2014; 200:586-90. [PMID: 24882490 DOI: 10.5694/mja13.11134] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine whether the previously reported urban-rural differential in prostate cancer survival remains after adjusting for demographic and clinical factors, and to investigate temporal trends in this differential. DESIGN, SETTING AND PARTICIPANTS Retrospective population-based survival analysis of 68 686 men diagnosed with prostate cancer from January 1982 to December 2007 in New South Wales. MAIN OUTCOME MEASURES Survival rate and relative excess risk (RER) of death over 10 years of follow-up in relation to geographic remoteness after adjusting for other prognostic factors. RESULTS Overall, 10-year survival increased during the study period, increasing from 57.5% in 1992-1996 and 75.7% in 1997-2001 to 83.7% in 2002-2007. The increasing trends were also observed across categories of geographic remoteness and socioeconomic status. Urban-rural differentials were significant (P < 0.001) after adjusting for five important prognostic factors, with men living outside major cities having higher risk of death from prostate cancer (RER, 1.18 and 1.32 for inner regional and rural areas, respectively). Socioeconomic status was also a significant factor (P < 0.001) for prostate cancer mortality, with the risk of dying being 34% to 40% higher for men living in socioeconomically disadvantaged areas than those living in least disadvantaged areas. There was no evidence that this inequality is reducing over time, particularly for men living in inner regional areas. CONCLUSIONS Despite the increasing awareness of urban-rural differentials in cancer outcomes, little progress has been made. Appropriately detailed data, including details of tumour characteristics, treatment and comorbid conditions, to help understand why these inequalities exist are required urgently so interventions and policy changes can be guided by appropriate evidence.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.
| | - Qingwei Luo
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - David P Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | | | - Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia
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15
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Papa N, Lawrentschuk N, Muller D, MacInnis R, Ta A, Severi G, Millar J, Syme R, Giles G, Bolton D. Rural residency and prostate cancer specific mortality: results from the Victorian Radical Prostatectomy Register. Aust N Z J Public Health 2014; 38:449-54. [DOI: 10.1111/1753-6405.12210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 10/01/2013] [Accepted: 01/01/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nathan Papa
- Austin Hospital, Victoria
- Cancer Epidemiology Centre, Cancer Council Victoria
| | | | - David Muller
- Cancer Epidemiology Centre, Cancer Council Victoria
| | | | | | | | | | | | - Graham Giles
- Cancer Epidemiology Centre, Cancer Council Victoria
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16
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Laing KA, Bramwell SP, McNeill A, Corr BD, Lam TBL. Prostate cancer in Scotland: does geography matter? An analysis of incidence, disease characteristics and survival between urban and rural areas. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813512303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to identify whether there is a difference in survival from prostate cancer in urban and rural areas of Scotland and to identify potential inequalities in incidence, disease characteristics and the treatment of prostate cancer between these areas. Subjects/patients and methods: A retrospective cohort study was undertaken. Retrospective analysis of data from Information Services Division and regional cancer databases from 2005 to 2010 was performed. A comparison of NHS Highland & Western Isles as the rural group with NHS Lothian as the urban group was made. Data were collected on patient and disease characteristics, first treatment and mortality. Non-parametric continuous data were analysed using the Mann-Whitney U test. Categorical data were assessed using a two-tailed Z test. The p value for statistical significance was set at < 0.05. Results: The incidence of prostate cancer was higher in rural areas. Rural patients were older at diagnosis ( p < 0.0001), presented with higher risk disease ( p < 0.0001) and underwent less curative treatment ( p < 0.0001). There was potentially poorer survival in rural areas. Conclusions: Men living in rural areas of Scotland present with more aggressive prostate cancer and may have poorer survival. This could be due to high levels of PSA testing in urban areas, therefore further studies are needed to identify patterns of PSA testing in Scotland. These inequalities will be highlighted to the Scottish Government to inform the ‘Detect Cancer Early’ campaign for its second phase in 2015.
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Affiliation(s)
| | | | - Alan McNeill
- Urology Department, Western General Hospital, UK
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17
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Evans SM, Millar JL, Davis ID, Murphy DG, Bolton DM, Giles GG, Frydenberg M, Andrianopoulos N, Wood JM, Frauman AG, Costello AJ, McNeil JJ. Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011. Med J Aust 2013; 198:540-5. [PMID: 23725268 DOI: 10.5694/mja12.11241] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe patterns of care for men diagnosed with prostate cancer in Victoria, Australia, between 2008 and 2011. DESIGN, SETTING AND PATIENTS Men who were diagnosed with prostate cancer at 11 public and six private hospitals in Victoria from August 2008 to February 2011, and for whom prostate cancer notifications were received by the Prostate Cancer Registry. MAIN OUTCOME MEASURES Characteristics of men diagnosed with prostate cancer; details of treatment provided within 12 months of diagnosis, according to National Comprehensive Cancer Network risk categories; and characteristics of men who did not receive active treatment within 12 months of diagnosis. RESULTS Treatment details were collected for 98.1% of men who were assessed as eligible to participate in the study (2724/2776) and were confirmed by telephone 12 months after diagnosis for 74.4% of them (2027/2724). Most patients (2531/2724 [92.9%]) were diagnosed with clinically localised disease, of whom 1201 (47.5%) were at intermediate risk of disease progression. Within 12 months of diagnosis, 299 of the 736 patients (40.6%) who had been diagnosed as having disease that was at low risk of progression had received no active treatment, and 72 of 594 patients (12.1%) who had been diagnosed as having disease that was at high risk of progression had received no active treatment. Of those diagnosed as having intermediate risk of disease progression, 54.5% (655/1201) had undergone radical prostatectomy. Those who received no active treatment were more likely than those who received active treatment to be older (odds ratio [95% CI], 2.96 [2.01-4.38], 10.94 [6.96-17.21] and 32.76 [15.84-67.89], respectively, for age 65-74 2013s, 75-84 2013s and ≥ 85 2013s, compared with < 55 2013s), to have less advanced disease (odds ratio [95% CI], 0.20 [0.16-0.26], 0.09 [0.06-0.12] and 0.05 [0.02-0.90], respectively, for intermediate, high and very high-risk [locally advanced] or metastatic disease, compared with low-risk disease) and to have had their prostate cancer notified by a private hospital (odds ratio [95% CI], 1.35 [1.10-1.66], compared with public hospital). CONCLUSION Our data reveal a considerable "stage migration" towards earlier diagnosis of prostate cancer in Victoria and a large increase in the use of radical prostatectomy among men with clinically localised disease.
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Affiliation(s)
- Sue M Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Goldsbury DE, Armstrong K, Simonella L, Armstrong BK, O'Connell DL. Using administrative health data to describe colorectal and lung cancer care in New South Wales, Australia: a validation study. BMC Health Serv Res 2012; 12:387. [PMID: 23140341 PMCID: PMC3512511 DOI: 10.1186/1472-6963-12-387] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/03/2012] [Indexed: 11/10/2022] Open
Abstract
Background Monitoring treatment patterns is crucial to improving cancer patient care. Our aim was to determine the accuracy of linked routinely collected administrative health data for monitoring colorectal and lung cancer care in New South Wales (NSW), Australia. Methods Colorectal and lung cancer cases diagnosed in NSW between 2000 and 2002 were identified from the NSW Central Cancer Registry (CCR) and linked to their hospital discharge records in the NSW Admitted Patient Data Collection (APDC). These records were then linked to data from two relevant population-based patterns of care surveys. The main outcome measures were the sensitivity and specificity of data from the CCR and APDC for disease staging, investigative procedures, curative surgery, chemotherapy, radiotherapy, and selected comorbidities. Results Data for 2917 colorectal and 1580 lung cancer cases were analysed. Unknown disease stage was more common for lung cancer in the administrative data (18%) than in the survey (2%). Colonoscopies were captured reasonably accurately in the administrative data compared with the surveys (82% and 79% respectively; 91% sensitivity, 53% specificity) but all other colorectal or lung cancer diagnostic procedures were under-enumerated. Ninety-one percent of colorectal cancer cases had potentially curative surgery recorded in the administrative data compared to 95% in the survey (96% sensitivity, 92% specificity), with similar accuracy for lung cancer (16% and 17%; 92% sensitivity, 99% specificity). Chemotherapy (~40% sensitivity) and radiotherapy (sensitivity≤30%) were vastly under-enumerated in the administrative data. The only comorbidity that was recorded reasonably accurately in the administrative data was diabetes. Conclusions Linked routinely collected administrative health data provided reasonably accurate information on potentially curative surgical treatment, colonoscopies and comorbidities such as diabetes. Other diagnostic procedures, comorbidities, chemotherapy and radiotherapy were not well enumerated in the administrative data. Other sources of data will be required to comprehensively monitor the primary management of cancer patients.
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Affiliation(s)
- David E Goldsbury
- Cancer Research Division, Cancer Council NSW, PO Box 572, Kings Cross, NSW 1340, Australia.
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Evans SM, Millar JL, Wood JM, Davis ID, Bolton D, Giles GG, Frydenberg M, Frauman A, Costello A, McNeil JJ. The Prostate Cancer Registry: monitoring patterns and quality of care for men diagnosed with prostate cancer. BJU Int 2012; 111:E158-66. [PMID: 23116361 DOI: 10.1111/j.1464-410x.2012.11530.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish a pilot population-based clinical registry with the aim of monitoring the quality of care provided to men diagnosed with prostate cancer. PATIENTS AND METHODS All men aged >18 years from the contributing hospitals in Victoria, Australia, who have a diagnosis of prostate cancer confirmed by histopathology report notified to the Victorian Cancer Registry are eligible for inclusion in the Prostate Cancer Registry (PCR). A literature review was undertaken aiming to identify existing quality indicators and source evidence-based guidelines from both Australia and internationally. RESULTS A Steering Committee was established to determine the minimum dataset, select quality indicators to be reported back to clinicians, identify the most effective recruitment strategy, and provide a governance structure for data requests; collection, analysis and reporting of data; and managing outliers. A minimum dataset comprising 72 data items is collected by the PCR, enabling ten quality indicators to be collected and reported. Outcome measures are risk adjusted according to the established National Comprehensive Cancer Network and Cancer of the Prostate Risk Assessment Score (surgery only) risk stratification model. Recruitment to the PCR occurs concurrently with mandatory notification to the state-based Cancer Registry. The PCR adopts an opt-out consent process to maximize recruitment. The data collection approach is standardized, using a hybrid of data linkage and manual collection, and data collection forms are electronically scanned into the PCR. A data access policy and escalation policy for mortality outliers has been developed. CONCLUSIONS The PCR provides potential for high-quality population-based data to be collected and managed within a clinician-led governance framework. This approach satisfies the requirement for health services to establish quality assessment, at the same time as providing clinically credible data to clinicians to drive practice improvement.
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Affiliation(s)
- Sue M Evans
- Centre of Research Excellence in Patient Safety, Monash University, Melbourne, Australia.
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Baade PD, Youlden DR, Coory MD, Gardiner RA, Chambers SK. Urban-rural differences in prostate cancer outcomes in Australia: what has changed? Med J Aust 2011; 194:293-6. [PMID: 21426283 DOI: 10.5694/j.1326-5377.2011.tb02977.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update our previous analysis of trends for prostate-specific antigen (PSA) testing, prostate cancer incidence, radical prostatectomy and prostate cancer mortality to assess whether men in rural and regional areas of Australia now have more equitable access to prostate cancer services, and improved outcomes. DESIGN, SETTING AND PARTICIPANTS Descriptive study using population-based data for Australian men aged 50-79 years from 1982 to the 2008-09 financial year (depending on data availability for each outcome measure). MAIN OUTCOME MEASURES Age-standardised rates per 100,000 men and 5-year survival rates. RESULTS Overall, rates of PSA screening and radical prostatectomy increased, accompanied by reductions in mortality and improvements in survival throughout Australia. Incidence rates were similar for men in urban and rural areas. However, in the last year of data collection, for men in rural areas compared with urban areas, rates of PSA screening (21,267/100,000 v 24,606/100,000; P < 0.01) and radical prostatectomy (182.2/100,000 v 239.2/100,000; P < 0.01) remained lower, mortality remained higher (56.9/100,000 v 45.8/100,000; P < 0.01), and survival outcomes continued to be poorer (5-year relative survival, 87.7% v 91.4%; P < 0.01). CONCLUSIONS With some limitations, these ecological data demonstrate that the use of diagnostic and treatment services among men living in rural areas of Australia remains lower than among their urban counterparts, their survival and mortality outcomes are poorer, and these differentials are continuing. There is an urgent need to explore further the reasons for these differences and to implement changes so these inequalities can be reduced.
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Affiliation(s)
- Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD, Australia.
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Yu XQ, Smith DP, Clements MS, Patel MI, McHugh B, O'Connell DL. Projecting prevalence by stage of care for prostate cancer and estimating future health service needs: protocol for a modelling study. BMJ Open 2011; 1:e000104. [PMID: 22021763 PMCID: PMC3191396 DOI: 10.1136/bmjopen-2011-000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Current strategies for the management of prostate cancer are inadequate in Australia. We will, in this study, estimate current service needs and project the future needs for prostate cancer patients in Australia. Methods and analysis First, we will project the future prevalence of prostate cancer for 2010-2018 using data for 1972-2008 from the New South Wales (NSW) Central Cancer Registry. These projections, based on modelled incidence and survival estimates, will be estimated using PIAMOD (Prevalence, Incidence, Analysis MODel) software. Then the total prevalence will be decomposed into five stages of care: initial care, continued monitoring, recurrence, last year of life and long-term survivor. Finally, data from the NSW Prostate Cancer Care and Outcomes Study, including data on patterns of treatment and associated quality of life, will be used to estimate the type and amount of services that will be needed by prostate cancer patients in each stage of care. In addition, Central Cancer Registry episode data will be used to estimate transition rates from localised or locally advanced prostate cancer to metastatic disease. Medicare and Pharmaceutical Benefits data, linked with Prostate Cancer Care and Outcomes Study data, will be used to complement the Cancer Registry episode data. The methods developed will be applied Australia-wide to obtain national estimates of the future prevalence of prostate cancer for different stages of clinical care. Ethics and dissemination This study was approved by the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated widely to different interest groups and organisations through a report, conference presentations and peer-reviewed articles.
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Affiliation(s)
- Xue Q Yu
- Cancer Epidemiology Research Unit, Cancer Council New South Wales, Sydney, Australia
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22
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The Effect of Race and Rural Residence on Prostate Cancer Treatment Choice Among Men in Georgia. Urology 2011; 77:581-7. [DOI: 10.1016/j.urology.2010.10.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/27/2010] [Accepted: 10/14/2010] [Indexed: 11/23/2022]
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Baade PD, Aitken JF, Ferguson M, Gardiner RA, Chambers SK. Diagnostic and treatment pathways for men with prostate cancer in Queensland: investigating spatial and demographic inequalities. BMC Cancer 2010; 10:452. [PMID: 20731875 PMCID: PMC2936907 DOI: 10.1186/1471-2407-10-452] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/23/2010] [Indexed: 12/01/2022] Open
Abstract
Background Patterns of diagnosis and management for men diagnosed with prostate cancer in Queensland, Australia, have not yet been systematically documented and so assumptions of equity are untested. This longitudinal study investigates the association between prostate cancer diagnostic and treatment outcomes and key area-level characteristics and individual-level demographic, clinical and psychosocial factors. Methods/Design A total of 1064 men diagnosed with prostate cancer between February 2005 and July 2007 were recruited through hospital-based urology outpatient clinics and private practices in the centres of Brisbane, Townsville and Mackay (82% of those referred). Additional clinical and diagnostic information for all 6609 men diagnosed with prostate cancer in Queensland during the study period was obtained via the population-based Queensland Cancer Registry. Respondent data are collected using telephone and self-administered questionnaires at pre-treatment and at 2 months, 6 months, 12 months, 24 months, 36 months, 48 months and 60 months post-treatment. Assessments include demographics, medical history, patterns of care, disease and treatment characteristics together with outcomes associated with prostate cancer, as well as information about quality of life and psychological adjustment. Complementary detailed treatment information is abstracted from participants' medical records held in hospitals and private treatment facilities and collated with health service utilisation data obtained from Medicare Australia. Information about the characteristics of geographical areas is being obtained from data custodians such as the Australian Bureau of Statistics. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residences to treatment centres. Analyses will be conducted using standard statistical methods along with multilevel regression models including individual and area-level components. Conclusions Information about the diagnostic and treatment patterns of men diagnosed with prostate cancer is crucial for rational planning and development of health delivery and supportive care services to ensure equitable access to health services, regardless of geographical location and individual characteristics. This study is a secondary outcome of the randomised controlled trial registered with the Australian New Zealand Clinical Trials Registry (ACTRN12607000233426)
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Affiliation(s)
- Peter D Baade
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill QLD 4004, Australia.
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Lyratzopoulos G, Barbiere JM, Greenberg DC, Wright KA, Neal DE. Population based time trends and socioeconomic variation in use of radiotherapy and radical surgery for prostate cancer in a UK region: continuous survey. BMJ 2010; 340:c1928. [PMID: 20413566 PMCID: PMC2858795 DOI: 10.1136/bmj.c1928] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine variation in the management of prostate cancer in patients with different socioeconomic status. DESIGN Survey using UK regional cancer registry data. SETTING Regional population based cancer registry. PARTICIPANTS 35 171 patients aged >or=51 with a diagnosis of prostate cancer, 1995-2006. MAIN OUTCOME MEASURES Use of radiotherapy and radical surgery. Socioeconomic status according to fifths of small area deprivation index. RESULTS Over the nine years of the study, information on stage at diagnosis was available for 15 916 of 27 970 patients (57%). During the study period, the proportion of patients treated with radiotherapy remained at about 25%, while use of radical surgery increased significantly (from 2.9% (212/7201) during 1995-7 to 8.4% (854/10 211) during 2004-6, P<0.001). Both treatments were more commonly used in least deprived compared with most deprived patients (28.5% v 21.0% for radiotherapy and 8.4% v 4.0% for surgery). In multivariable analysis, increasing deprivation remained strongly associated with lower odds of radiotherapy or surgery (odds ratio 0.92 (95% confidence interval 0.90 to 0.94), P<0.001, and 0.91 (0.87 to 0.94), P<0.001, respectively, per incremental deprivation group). There were consistently concordant findings with multilevel models for clustering of observations by hospital of diagnosis, with restriction of the analysis to patients with information on stage, and with sequential restriction of the analysis to different age, stage, diagnosis period, and morphology groups. CONCLUSIONS After a diagnosis of prostate cancer, men from lower socioeconomic groups were substantially less likely to be treated with radical surgery or radiotherapy. The causes and impact on survival of such differences remain uncertain.
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Affiliation(s)
- Georgios Lyratzopoulos
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Institute of Public Health, Cambridge CB2 0SR.
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Bolton D, Severi G, Millar JL, Kelsall H, Davidson AJ, Smith C, Bagnato M, Pedersen J, Giles G, Syme R. A whole of population-based series of radical prostatectomy in Victoria, 1995 to 2000. Aust N Z J Public Health 2010; 33:527-33. [PMID: 20078569 DOI: 10.1111/j.1753-6405.2009.00448.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Radical prostatectomy (RP) as a first line treatment of prostate cancer was rare prior to the advent of prostate specific antigen (PSA) testing, yet little is known of its use and outcomes in a population setting. We described baseline characteristics of cases in the Victorian Radical Prostatectomy Register (VRPR), investigated possible associations between demographic characteristics and characteristics at diagnosis and at surgery and trends over time. METHODS The VRPR is a population-based series of all RPs performed in Victoria from July 1995 to December 2000 (n=2,154). RESULTS On average, socio-economic status for cases was higher than for the general Victorian population (34% vs 20% in the highest quintile respectively, p<0.0001). The proportion of PSA-detected cases increased from 53% in 1995 to 79% in 2000 (p for linear trend=0.0004). Age at surgery and PSA levels at diagnosis decreased over time (p=0.006 and p=0.04 respectively). The proportion of cases with Gleason score < or =5 from RP decreased from 35% in 1995 to 14% in 2000, while cases with Gleason score 6-7 increased from 60% to 79%. Similar trends were observed for Gleason score from biopsy. We found little evidence of significant trends over time in other pathological characteristics relevant to prognosis. CONCLUSION AND IMPLICATIONS The VRPR provides a unique whole of population based description of radical prostatectomy in Victoria, confirms findings previously reported in single institution clinical series overseas such as migration to younger age at surgery and to Gleason scores 6 to 7, and provides a resource for evaluating RP outcomes in the future.
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