Population based time trends and socioeconomic variation in use of radiotherapy and radical surgery for prostate cancer in a UK region: continuous survey

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 ≥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 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.

Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population‐based study

“…In our study, men with high SES, and in particular men with high income, had significantly shorter waiting times, more frequently received treatment with curative intent, and had better short‐term surgical outcomes. Furthermore, men with high SES and intermediate and high‐risk Pca were more likely to receive curative treatment as recommended by prostate cancer guidelines6, 22, 23 in line with findings in previous studies, for example, men with high SES in the UK and the US were more likely to undergo surgery 24, 25. More men with high SES and very high‐risk Pca in our study received treatment with curative intent than men with low SES, despite the absence of guidelines recommending this treatment.…”

Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. A nationwide population-based study

“…Furthermore, men with high SES and intermediate and high-risk Pca were more likely to receive curative treatment as recommended by prostate cancer guidelines 6,22,23 in line with findings in previous studies, for example, men with high SES in the UK and the US were more likely to undergo surgery. 24,25 More men with high SES and very high-risk Pca in our study received treatment with curative intent than men with low SES, despite the absence of guidelines recommending this treatment.…”

Multilevel Analysis of Neighborhood Characteristics and Prostate Cancer

“…Neighborhood characteristics such as degree of deterioration, urbanization, poverty, educational attainment and percentage of low-income residents have been correlated with increasing disease rates and poorer health outcomes, including mortality (5, 9-12). To date, few studies have examined prostate cancer severity by neighborhood SES (13)(14)(15) or deprivation (16,17), and none have used a multi-level approach including other neighborhood factors plus patient-level behaviors, medical and family history, obesity and demographics.…”

“…Neighborhood characteristics such as degree of deterioration, urbanization, poverty, educational attainment and percentage of low-income residents have been correlated with increasing disease rates and poorer health outcomes, including mortality 11 (5, 9-12). To date, few studies have examined prostate cancer severity by neighborhood SES (13-15) or deprivation (16,17), and none have used a multi-level approach including other neighborhood factors plus patient-level behaviors, medical and family history, obesity and demographics.The results of this project to date demonstrate that there are significant associations of neighborhood SES on prostate cancer severity that are independent of patient age and race. Southeastern Pennsylvania patients residing in high income and highly educated neighborhoods were more likely to be diagnosed with prostate cancer at a younger age.…”