Prostate cancer patients get worse care than other cancer patientsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7534.139-c (Published 19 January 2006) Cite this as: BMJ 2006;332:139
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The fact that Prostate Cancer sufferers are receiving a higher
standard of care is not in the least bit surprising, when you consider the
public profile of the condition.
Prostate Cancer is now the most commonly diagnosed cancer in men in
the U.K. In addition, it is the second leading cause of death from cancer
in males. Yet, despite the fact that incidence rates have tripled over the
past thirty years, Prostate Cancer has kept a relatively low profile in
the public eye. Breast Cancer, in contrast, is an extremely highly-
publicised condition, with a high number of charities dedicated to raising
money and awareness of it. In addition, a multitude of nationwide
fundraising events for breast cancer take place annualy, as well as the
Breast Cancer Awareness month in October of each year.
Breast Cancer is not undeserving of all the publicity and public
support it receives. After all, it is the most common cancer in women in
the U.K, and as with prostate cancer, is the 2nd leading cause of death
from cancer in women in the U.K, after lung cancer.
However, surely it is time that the balance was re-addressed? Whilst
approximately 12,000 women in the U.K die from breast cancer annually,
prostate cancer isn't far behind, killing around 10,000 men in the U.K
each year. Considering this, it appears that Prostate Cancer does not
receive the focus and financial support it deserves, which surely
ultimately reflects on the care that we are able to offer as a health
Competing interests: No competing interests
It is not surprising that the report discussed by Susan Mayor shows
that patients with prostate cancer get worse care than other cancer
patients. Until quite recently the same was true of patients with chronic
lymphocytic leukaemia (CLL). In the case of CLL, the lengthy survival of
some patients and the indolent course of the disease were overemphasised,
the value of active treatment was queried, and frequently a policy of
masterly inactivity was advocated. The greatly overrated maxim of "first
let us do no harm" was too widely quoted. When it was demonstrated that in
many cases CLL was not an indolent disease, and that the majority of
patients with CLL, with the exception of the oldest old, die of their
disease, more active approaches were tried, and major advances in
treatment were made. Not only was the quality of life improved, but
current indications are that the duration of survival is enhanced, because
a majority of patients with CLL can achieve a remission of their disease
when the primary treatment is with fludarabine and rituximab.
Unfortunately, prostate cancer remains a relatively neglected
disease. Some (but not all) studies suggest that treatment of early
prostate cancer has no effect on survival compared with that of untreated
patients. The fact that some elderly men die with prostate cancer but not
because of it is overemphasised. The occurrence of lengthy remissions of
metastatic disease with hormonal manipulations is overstressed. Meanwhile
the life expectancy of elderly men without prostate cancer continues to
increase. As a result, a cancer of the prostate diagnosed at age 70
becomes ever more likely to be the cause of the patient's death.
It seems probable that ageism is playing a part. Patients with cancer
of the breast, lung, or bowel are on average younger than those with CLL
or prostate cancer, their cancers are seen as a more urgent matter, and
their referral receives a higher priority. It needs to be recognised that
for an otherwise healthy elderly man, a diagnosis of cancer of the
prostate is a dire, life-threatening event that merits prompt attention.
Competing interests: No competing interests
There are ongoing problems meeting the targets for waiting times for patients with suspected cancer1. Reliable measurement is essential for improvement in healthcare, otherwise it is impossible to know whether changes are making things better or worse2. We undertook a validation process of the data collected on the cancer waiting times database on waiting times for women referred to our cancer centre with suspected gynaecological cancer. Data was extracted from the case sheets and compared with data on the database. 114 case sheets were reviewed. 13 cases (11%) had been incorrectly entered on the database as receiving primary treatment for a gynaecological cancer. Date of General Practitioner (GP) referral was not documented in the cancer centre notes for any tertiary referrals (n=94). In 74/94 (79%) cases the date entered on the database as the date of GP referral was, in fact, the date of tertiary referral. The remaining information extracted was then compared, case for case, with the data entered on the network database (table). 6 cases were not suitable for analysis.
The accuracy of the database was poor. Investigation of the process of data collection has identified several systematic problems, and possible solutions. Common data entry mistakes have been identified and non-clinical staff are being educated in these areas. Time for clinical staff to be involved in the data collection exercise is being identified. Simple internal validation of the database may further reduce errors. Changes in documentation will require information on the GP referral and date of diagnosis (where relevant). A prospective audit will be undertaken to assess the impact of these changes.
Achieving the maximum waiting times for patients with suspected cancer is a major goal for the NHS3. Data improvement is necessary now to ensure that the Service can measure its success in meeting these targets.
1. Mayor S. Prostate cancer patients get worse care than other cancer patients. BMJ 2006;332:139
2. Smith R. Is the NHS getting better or worse? BMJ 2003;327:1239-1241
3. The NHS Cancer Plan: a plan for investment, a plan for reform. Department of Health. 2000. London
Data Correct Incorrect Missing* Date of referral 76 11 9 Date referral received 91 3 2 Referring hospital 93 3 0 Date first seen 49 13 34 Decision to treat 62 34 0 MDT discussion 90 1 5 Treatment modality 79 17 0 Date of first treatment 66 27 3 Diagnosis 91 4 1 Overall 25(27%) 55(58%) 14(15%) *data point empty on database
Competing interests: Data Correct Incorrect Missing*Date of referral 76 11 9Date referral received 91 3 2Referring hospital 93 3 0Date first seen 49 13 34Decision to treat 62 34 0MDT discussion 90 1 5Treatment modality 79 17 0Date of first treatment 66 27 3Diagnosis 91 4 1Overall 25(27%) 55(58%) 14(15%)*data point empty on database