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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 doi: https://doi.org/10.1136/bmj.c1928 (Published 22 April 2010) Cite this as: BMJ 2010;340:c1928
  1. Georgios Lyratzopoulos, senior clinical research associate 1,
  2. Josephine M Barbiere, research associate1,
  3. David C Greenberg, senior analyst2,
  4. Karen A Wright, quality assurance/analyst2,
  5. David E Neal, professor of surgical oncology and honorary consultant urological surgeon3
  1. 1Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Institute of Public Health, Cambridge CB2 0SR
  2. 2Eastern Cancer Registration and Information Centre, Cambridge CB22 3AD
  3. 3University Department of Oncology, Addenbrooke’s Hospital, Cambridge CB2 OQQ
  1. Correspondence to: G Lyratzopoulos gl290{at}medschl.cam.ac.uk
  • Accepted 25 February 2010

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 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.

Footnotes

  • We thank Clement Brown, medical director, Eastern Cancer Registration and Information Centre (ECRIC), for his work relating to staging of cases, and all ECRIC staff; Chris Palmer, Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, for commenting and advising on aspects of the statistical analysis; and the four peer reviewers for their constructive comments.

  • Contributors: GL conceived the study hypothesis and its design, with contributions from all other authors. DCG and KAW provided and quality assured data. JMB collected data. JMB and GL analysed data, with commentary and interpretation support from DEN, DCG, and KAW. Information about staging directly relates to the work of Clement Brown, medical director, Eastern Cancer Registration and Information Centre (ECRIC). All authors contributed and commented on the manuscript. GL is guarantor.

  • Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) (URL) and declare that all authors had: (1) No financial support for the submitted work from anyone other than their  employer; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No Non-financial interests that may be relevant to the submitted work.

  • Ethics approval: Not required.

  • Data sharing: For data sharing requests please contact the corresponding author at gl290@medschl.cam.ac.uk. As was the case in this study, cancer registries in the UK have policies that permit the release of anonymised (non-identifiable and non-disclosive) data to researchers, with the aim of generating evidence that can be of use to improving patient care. More information about the regulatory environment underpinning the function of UK Cancer Registries can be found at the UK Association of Cancer Registries website http://82.110.76.19/ .

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