Regional Variations in Quality of Survival Among Men with Prostate Cancer Across the United Kingdom

David W Donnelly; Anna Gavin; Amy Downing; Luke Hounsome; Therese Kearney; Emma McNair; Dawn Allan; Dyfed W Huws; Penny Wright; Peter J Selby; Paul Kind; Eila Watson; Richard Wagland; Sarah Wilding; Hugh Butcher; Rebecca Mottram; Majorie Allen; Oonagh McSorley; Linda Sharp; Malcolm D Mason; William R Cross; James W F Catto; Adam W Glaser

doi:10.1016/j.eururo.2019.04.018

Regional Variations in Quality of Survival Among Men with Prostate Cancer Across the United Kingdom

Eur Urol. 2019 Aug;76(2):228-237. doi: 10.1016/j.eururo.2019.04.018. Epub 2019 May 4.

Authors

David W Donnelly¹, Anna Gavin², Amy Downing³, Luke Hounsome⁴, Therese Kearney², Emma McNair⁵, Dawn Allan⁶, Dyfed W Huws⁶, Penny Wright⁷, Peter J Selby⁸, Paul Kind⁹, Eila Watson¹⁰, Richard Wagland¹¹, Sarah Wilding³, Hugh Butcher⁷, Rebecca Mottram³, Majorie Allen³, Oonagh McSorley¹², Linda Sharp¹³, Malcolm D Mason¹⁴, William R Cross¹⁵, James W F Catto¹⁶, Adam W Glaser¹⁷

Affiliations

¹ Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK. Electronic address: david.donnelly@qub.ac.uk.
² Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK.
³ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK.
⁴ National Cancer Registration and Analysis Service, Public Health England, Bristol, UK.
⁵ Information Services Division, NHS National Services Scotland, Edinburgh, UK.
⁶ Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK.
⁷ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
⁸ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
⁹ Academic Unit of Health Economics, University of Leeds, Leeds, UK.
¹⁰ Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK.
¹¹ Faculty of Health Sciences, University of Southampton, Southampton, UK.
¹² School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
¹³ Institute for Health & Society, Newcastle University, Newcastle upon Tyne, UK.
¹⁴ Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK.
¹⁵ Department of Urology, St James's University Hospital, Leeds, UK.
¹⁶ Academic Urology Unit, University of Sheffield, Sheffield, UK.
¹⁷ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK.

PMID: 31060822
DOI: 10.1016/j.eururo.2019.04.018

Abstract

Background: Prostate cancer incidence, treatment, and survival rates vary throughout the UK, but little is known about regional differences in quality of survival.

Objective: To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances.

Design, setting, and participants: A cross-sectional postal survey of prostate cancer survivors diagnosed 18-42mo previously.

Outcome measurements and statistical analysis: Urinary, bowel, and sexual problems and vitality were patient reported using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression.

Results and limitations: A total of 35823 men responded, 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales, and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East and Cumbria, with more urinary incontinence in North-East and Cumbria and Peninsula, greater sexual problems in West Midlands, and poorer vitality in North-East and Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pretreatment conditions.

Conclusions: Despite adjustment for treatment, and clinical and sociodemographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regard to bowel problems and vitality, where clinically relevant differences were reported.

Patient summary: We conducted a UK-wide survey of patient's quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow-up care.

Keywords: Cancer Alliances; Patient-reported outcomes; Prostate cancer; Quality of survival; Regional variation; Treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Cancer Survivors*
Cross-Sectional Studies
England / epidemiology
Erectile Dysfunction / epidemiology*
Health Status
Humans
Male
Middle Aged
Northern Ireland / epidemiology
Patient Reported Outcome Measures
Prevalence
Prostatic Neoplasms / therapy*
Quality of Life*
Scotland / epidemiology
Urinary Incontinence / epidemiology*
Wales / epidemiology