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Parry MG, Sujenthiran A, Nossiter J, Morris M, Berry B, Nathan A, Aggarwal A, Payne H, van der Meulen J, Clarke NW. Reply to: Letter to the editor regarding the article 'Prostate cancer outcomes following whole-gland and focal high-intensity focused ultrasound'. BJU Int 2024. [PMID: 38515403 DOI: 10.1111/bju.16348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- Flatiron, London, UK
| | - Julie Nossiter
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Brendan Berry
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arjun Nathan
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
- University College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
- Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
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Morris M, Cook A, Dodkins J, Price D, Waller S, Hassan S, Nathan A, Aggarwal A, Payne HA, Clarke N, van der Meulen J, Nossiter J. What can patient-reported experience measures tell us about the variation in patients' experience of prostate cancer care? A cross-sectional study using survey data from the National Prostate Cancer Audit in England. BMJ Open 2024; 14:e078284. [PMID: 38418235 PMCID: PMC10910410 DOI: 10.1136/bmjopen-2023-078284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/30/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES A national survey aimed to measure how men with prostate cancer perceived their involvement in and decisions around their care immediately after diagnosis. This study aimed to describe any differences found by socio-demographic groups. DESIGN Cross-sectional study of men who were diagnosed with and treated for prostate cancer. SETTING The National Prostate Cancer Audit patient-reported experience measures (PREMs) survey in England. PARTICIPANTS Men diagnosed in 2014-2016, with non-metastatic prostate cancer, were surveyed. Responses from 32 796 men were individually linked to records from a national clinical audit and to administrative hospital data. Age, ethnicity, deprivation and disease risk classification were used to explore variation in responses to selected questions. PRIMARY AND SECONDARY OUTCOME MEASURES Responses to five questions from the PREMs survey: the proportion responding to the highest positive category was compared across the socio-demographic characteristics above. RESULTS When adjusted for other factors, older men were less likely than men under the age of 60 to feel side effects had been explained in a way they could understand (men 80+: relative risk (RR)=0.92, 95% CI 0.84 to 1.00), that their views were considered (RR=0.79, 95% CI 0.73 to 0.87) or that they were involved in decisions (RR=0.92, 95% CI 0.85 to 1.00). The latter was also apparent for men who were not white (black men: RR=0.89, 95% CI 0.82 to 0.98; Asian men: RR=0.85, 95% CI 0.75 to 0.96) and, to a lesser extent, for more deprived men. CONCLUSIONS The observed discrepancies highlight the need for more focus on initiatives to improve the experience of ethnic minority patients and those older than 60 years. The findings also argue for further validation of discriminatory instruments to help cancer care providers fully understand the variation in the experience of their patients.
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Affiliation(s)
- Melanie Morris
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Adrian Cook
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Derek Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Steve Waller
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Syreen Hassan
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Arjun Nathan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Heather Ann Payne
- Consultant Clinical Oncologist, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Noel Clarke
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
- The Christie NHS Foundation Trust, Manchester, Manchester, UK
| | - Jan van der Meulen
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
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Dodkins J, Nossiter J, Cook A, Payne H, Clarke N, van der Meulen J, Aggarwal A. Does Research from Clinical Trials in Metastatic Hormone-sensitive Prostate Cancer Treatment Translate into Access to Treatments for Patients in the "Real World"? A Systematic Review. Eur Urol Oncol 2024; 7:14-24. [PMID: 37380578 DOI: 10.1016/j.euo.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/10/2023] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
CONTEXT Since 2015 there have been major advances in the management of primary metastatic hormone-sensitive prostate cancer (mHSPC) following the publication of key clinical trials that demonstrated significant clinical benefits with docetaxel chemotherapy or novel hormone therapy (NHT) in addition to androgen deprivation therapy (ADT). Despite these advances, there is evidence to show that these treatments are not being utilised for mHSPC in clinical practice. OBJECTIVE To determine the utilisation of docetaxel and NHT in mHSPC in routine practice and the determinants of variation in their use. EVIDENCE ACQUISITION MEDLINE and Embase were searched systematically for studies on utilisation of treatments for primary mHSPC that were based on regional or national data sets and published after January 2005. Study results were summarised using a narrative synthesis. EVIDENCE SYNTHESIS Thirteen papers were included in the analysis, six full-text articles and seven abstracts, on studies that included a total of 166 876 patients. The utilisation rate of treatment intensification with either docetaxel or NHT (enzalutamide, apalutamide, or abiraterone) in addition to ADT ranged from 9.3% to 38.1% across the studies. Younger, White patients with fewer comorbidities and living in more urban settings were more likely to be prescribed treatment intensification. Patients treated in private academic institutions by oncologists were more likely to receive docetaxel or NHT. Socioeconomic status did not impact receipt of systemic therapy. NHT utilisation rates appear to have increased over time. CONCLUSIONS These results highlight the need to change the approach to the treatment of primary mHSPC in the real world by harnessing the practice-changing results from recent trials in this setting to optimise upfront systemic therapy for this patient population. PATIENT SUMMARY We reviewed the use of treatments for primary metastatic hormone-sensitive prostate cancer that showed a benefit in key clinical trials. We found that these treatments are underused, particularly among certain patient groups.
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Affiliation(s)
- Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Cook
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Heather Payne
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Noel Clarke
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Ajay Aggarwal
- London School of Hygiene and Tropical Medicine, London, UK; Department of Oncology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Dodkins J, Cook A, Morris M, Nossiter J, Prust S, Waller S, van der Meulen J, Aggarwal A, Clarke N, Payne HA. Organisation and delivery of supportive services for patients with prostate cancer in the National Health Service in England and Wales: a national cross-sectional hospital survey and latent class analysis. BMJ Open 2023; 13:e071674. [PMID: 37989358 PMCID: PMC10668241 DOI: 10.1136/bmjopen-2023-071674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/29/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES We assessed how often National Health Service (NHS) hospitals reported that they had specific supportive services for patients with prostate cancer available onsite, including nursing support, sexual function and urinary continence services, psychological and genetic counselling, and oncogeriatric services. We identified groups of hospitals with similar patterns of supportive services. DESIGN/SETTING We conducted an organisational survey in 2021 of all NHS hospitals providing prostate cancer services in England and Wales. Latent class analysis grouped hospitals with similar patterns of supportive services. RESULTS In 138 hospitals, an advanced prostate cancer nurse was available in 125 hospitals (90.6%), 107 (77.5%) had a clinical nurse specialist (CNS) attending all clinics, 103 (75.7%) had sexual function services, 111 (81.6%) had continence services and 93 (69.4%) psychological counselling. The availability of genetic counselling (41 hospitals, 30.6%) and oncogeriatric services (15 hospitals, 11.0%) was lower. The hospitals could be divided into three groups. The first and largest group of 85 hospitals provided the most comprehensive supportive services onsite: all hospitals had a CNS attending all clinics, 84 (98.8%) sexual function services and 73 (85.9%) continence services. A key characteristic of the second group of 31 hospitals was that none had a CNS attending all clinics. A key characteristic of the third group of 22 hospitals was that none had sexual function services available. The hospitals in the largest group were more likely to run joint clinics (p<0.001) and host the regional specialist multidisciplinary team (p=0.002). CONCLUSIONS There is considerable variation in supportive services for prostate cancer available onsite in NHS hospitals in England and Wales. Availability of genetic counselling and oncogeriatric services is low. The different patterns of supportive services among hospitals demonstrate that initiatives to improve the availability of the entire range of supportive services to all patients should be carefully targeted.
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Affiliation(s)
- Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Adrian Cook
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Melanie Morris
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Steve Prust
- National Prostate Cancer Audit Patient and Public Involvement (PPI) Forum, Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Steve Waller
- National Prostate Cancer Audit Patient and Public Involvement (PPI) Forum, Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ajay Aggarwal
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Department of Oncology, Guy's & St Thomas' NHS Trust, London, UK
| | - Noel Clarke
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Department of Urology, The Christie and Salford Royal Hospitals, The Christie Hospital NHS Trust, Manchester, UK
| | - Heather Ann Payne
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Parry MG, Sujenthiran A, Nossiter J, Morris M, Berry B, Nathan A, Aggarwal A, Payne H, van der Meulen J, Clarke NW. Prostate cancer outcomes following whole-gland and focal high-intensity focused ultrasound. BJU Int 2023; 132:568-574. [PMID: 37422679 DOI: 10.1111/bju.16122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To report the 5-year failure-free survival (FFS) following high-intensity focused ultrasound (HIFU). PATIENTS AND METHODS This observational cohort study used linked National Cancer Registry data, radiotherapy data, administrative hospital data and mortality records of 1381 men treated with HIFU for clinically localised prostate cancer in England. The primary outcome, FFS, was defined as freedom from local salvage treatment and cancer-specific mortality. Secondary outcomes were freedom from repeat HIFU, prostate cancer-specific survival (CSS) and overall survival (OS). Cox regression was used to determine whether baseline characteristics, including age, treatment year, T stage and International Society of Urological Pathology (ISUP) Grade Group were associated with FFS. RESULTS The median (interquartile range [IQR]) follow-up was 37 (20-62) months. The median (IQR) age was 65 (59-70) years and 81% had an ISUP Grade Group of 1-2. The FFS was 96.5% (95% confidence interval [CI] 95.4%-97.4%) at 1 year, 86.0% (95% CI 83.7%-87.9%) at 3 years and 77.5% (95% CI 74.4%-80.3%) at 5 years. The 5-year FFS for ISUP Grade Groups 1-5 was 82.9%, 76.6%, 72.2%, 52.3% and 30.8%, respectively (P < 0.001). Freedom from repeat HIFU was 79.1% (95% CI 75.7%-82.1%), CSS was 98.8% (95% CI 97.7%-99.4%) and OS was 95.9% (95% CI 94.2%-97.1%) at 5 years. CONCLUSION Four in five men were free from local salvage treatment at 5 years but treatment failure varied significantly according to ISUP Grade Group. Patients should be appropriately informed with respect to salvage radical treatment following HIFU.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Arunan Sujenthiran
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
- Flatiron, London, UK
| | - Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
| | - Arjun Nathan
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of UK, London, UK
- University College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Noel W Clarke
- Departments of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
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Sujenthiran A, Parry MG, Dodkins J, Nossiter J, Morris M, Berry B, Nathan A, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Treatment-related toxicity using prostate bed versus prostate bed and pelvic lymph node radiation therapy following radical prostatectomy: A national population-based study. Clin Transl Radiat Oncol 2023; 40:100622. [PMID: 37152844 PMCID: PMC10159812 DOI: 10.1016/j.ctro.2023.100622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/08/2023] [Accepted: 03/25/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose There is debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation in addition to prostate bed radiotherapy when used to treat disease recurrence following radical prostatectomy. We compared toxicity from radiation therapy (RT) to the prostate bed and pelvic lymph nodes (PBPLN-RT) with prostatebed only radiation therapy (PBO-RT) following radical prostatectomy. Methods and Materials Patients with prostate cancer who underwent post-prostatectomy RT between 2010 and 2016 were identified by using the National Prostate Cancer Audit (NPCA) database. Follow-up data was available up to December 31, 2018. Validated outcome measures, based on a framework of procedural and diagnostic codes, were used to capture ≥Grade 2 gastrointestinal (GI) and genitourinary (GU) toxicity. An adjusted competing-risks regression analysis estimated subdistribution hazard ratios (sHR). A sHR > 1 indicated a higher incidence of toxicity with PBPLN-RT than with PBO-RT. Results 5-year cumulative incidences in the PBO-RT (n = 5,087) and PBPLNRT (n = 593) groups was 18.2% and 15.9% for GI toxicity, respectively. For GU toxicity it was 19.1% and 20.7%, respectively. There was no evidence of difference in GI or GU toxicity after adjustment between PBO-RT and PBPLN-RT (GI: adjusted sHR, 0.90, 95% CI, 0.67-1.19; P = 0.45); (GU: adjusted sHR, 1.19, 95% CI, 0.99-1.44; P = 0.09). Conclusions This national population-based study found that including PLNs in the radiation field following radical prostatectomy is not associated with a significant increase in rates of ≥Grade 2 GI or GU toxicity at 5 years.
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Affiliation(s)
- Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Flatiron Health, UK
| | - Matthew G. Parry
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
| | - Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
- Corresponding authors at: Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, England, UK.
| | - Julie Nossiter
- Department of Health Services Research & Policy, LHSTM, UK
| | - Melanie Morris
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
| | - Brendan Berry
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
- Department of Health Services Research & Policy, LHSTM, UK
| | - Arjun Nathan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, UK
| | - Paul Cathcart
- Department of Urology, Guy’s & St Thomas’ NHS Foundation Trust, UK
| | - Noel W. Clarke
- Department of Urology, The Christie & Salford Royal NHS Foundation Trusts, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | | | - Ajay Aggarwal
- Department of Health Services Research & Policy, LHSTM, UK
- Department of Radiotherapy, Guy’s & St Thomas’ NHS Foundation Trust, UK
- Department of Cancer Epidemiology, Population & Global Health, KCL, UK
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Fankhauser CD, Parry MG, Ali A, Cowling TE, Nossiter J, Sujenthiran A, Berry B, Morris M, Aggarwal A, Payne H, van der Meulen J, Clarke NW. A low prostate specific antigen predicts a worse outcome in high but not in low/intermediate-grade prostate cancer. Eur J Cancer 2023; 181:70-78. [PMID: 36641896 DOI: 10.1016/j.ejca.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The relationship between prostate-specific antigen (PSA) and prostate cancer (PCa) grade was traditionally thought to be linear but recent reports suggest this is not true in high-grade cancers. We aimed to compare the association between PSA and PCa-specific mortality (PCSM) in clinically localised low/intermediate and high-grade PCa. SUBJECTS/PATIENTS AND METHODS Retrospective cohort study using the National Prostate Cancer Audit database in England of men treated with external beam radiotherapy (EBRT), EBRT and brachytherapy boost (EBRT + BT), radical prostatectomy or no radical local treatment between 2014 and 2018. Multivariable competing-risk regression was used to examine the association between PSA, Gleason, and PCSM. Multivariable restricted cubic spline regression was used to explore the non-linear associations of PSA and PCSM. RESULTS 102,089 men were included, of whom 71,138 had low/intermediate-grade and 22,425 had high-grade PCa. In high-grade, 4-year PCSM was higher with PSA ≤5 than PSA 5.1-10 for men treated with EBRT (hazard ratio 1.96 (95% confidence interval 1.15-3.34) or no radical local treatment (hazard ratio 1.99 (95% confidence interval 1.33-2.98). Restricted cubic spline regression showed that PSA and PCSM have a non-linear association in high-grade but a linear association in low/intermediate-grade PCa. CONCLUSION The low-PSA/high-grade combination in M0 PCa treated with EBRT has a higher PCSM than those with high-grade and intermediate PSA levels. In high-grade disease, the PSA association was non-linear; by contrast, low/intermediate-grade had a linear relationship. This confirms a more aggressive biology in low PSA secreting high-grade PCa and a worse outcome following treatment.
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Affiliation(s)
- Christian D Fankhauser
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; University of Zurich, Zurich, Switzerland; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
| | - Matthew G Parry
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Adnan Ali
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Thomas E Cowling
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Julie Nossiter
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Arun Sujenthiran
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
| | - Brendan Berry
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Melanie Morris
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Ajay Aggarwal
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust
| | - Heather Payne
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Department of Clinical Oncology University College London Hospital NHS Trust, London, United Kingdom
| | - Jan van der Meulen
- National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, GU Cancer/FASTMAN Research Group, Manchester University, Manchester, United Kingdom
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK; National Prostate Cancer Audit, Royal College of Surgeons of England, London, UK; Department of Urology, Salford Royal NHS Foundation Trust, Manchester, UK
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Nathan A, Morris M, Parry MG, Berry B, Sujenthiran A, Nossiter J, Payne H, Van Der Meulen J, Clarke NW, Green JSA. Interventions for obstructive uropathy in advanced prostate cancer: a population-based study. BJU Int 2022; 130:688-695. [PMID: 35485254 DOI: 10.1111/bju.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To develop and validate a coding framework to identify interventions for upper tract obstructive uropathy (UTOU) in men with locally advanced and metastatic prostate cancer (PCa) using administrative hospital data to assess clinical outcomes. There are no population-based studies on the incidence, treatment, and outcomes of this complication. PATIENTS AND METHODS Patients newly diagnosed with PCa between April 2014 and March 2019 were identified in the English cancer registry. A coding framework based on procedure (Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures fourth edition) and diagnostic (International Classification of Diseases, 10th edition) codes was developed and validated. Subsequent clinical outcomes were determined using Hospital Episodes Statistics to determine the utility of the intervention. RESULTS A total of 77 010 patients newly diagnosed with locally advanced, and 30 083 patients with metastatic PCa were identified. Of these, 1951 (1.8%) patients underwent an intervention for UTOU according to our coding framework: 830 (42.5%) had locally advanced disease and 1121 (57.5%) had metastatic disease. In all, 844 (43.3%) had a percutaneous nephrostomy (PCN), 473 (24.2%) had a PCN with antegrade stent, and 634 (32.5%) had a retrograde stent. The mean follow-up was 43.2 months. The cumulative incidence of the use of these interventions at 1, 3, and 5 years was 2.5%, 3.6% and 4.2% in men with metastases compared to 0.5%, 0.9% and 1.4% in men with locally advanced disease. CONCLUSION A new coding framework, developed to identify procedures for UTOU was applied in the largest study to date of UTOU in men with primary locally advanced and metastatic PCa. Results demonstrated that 2% of men with locally advanced PCa and 4% of men with metastatic PCa require an intervention to resolve UTOU within 5 years of their PCa diagnosis.
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Affiliation(s)
- Arjun Nathan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Melanie Morris
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew G Parry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brendan Berry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Flatiron Health, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jan Van Der Meulen
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts Manchester, UK
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9
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Conibear J, Nossiter J, Foster C, West D, Cromwell D, Navani N. The National Lung Cancer Audit: The Impact of COVID-19. Clin Oncol (R Coll Radiol) 2022; 34:701-707. [PMID: 36180356 PMCID: PMC9474418 DOI: 10.1016/j.clon.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
Since 2014, the National Lung Cancer Audit (NLCA) has been evaluating the performance of the UK NHS lung cancer services against established standards of care. Prior to the onset of the COVID-19 pandemic, the NLCA's annual reports revealed a steady stream of improvements in early diagnosis, access to surgery, treatment with anti-cancer therapies, input from specialist nursing and survival for patients with lung cancer in the NHS. In January 2022, the NLCA reported on the negative impact COVID-19 has had on all aspects of the lung cancer diagnosis and treatment pathway within the NHS. This article details the fundamental changes made to the NLCA data collection and analysis process during the COVID-19 pandemic and details the negative impact COVID-19 had on NHS lung cancer patient outcomes during 2020.
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Affiliation(s)
- J Conibear
- Barts Cancer Centre, St. Bartholomew's Hospital, London, UK.
| | - J Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - C Foster
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - D West
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - D Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - N Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Department of Thoracic Medicine, University College London Hospital, London, UK
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10
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Dodkins J, Morris M, Nossiter J, van der Meulen J, Payne H, Clarke N, Aggarwal A. Practicalities, challenges and solutions to delivering a national organisational survey of cancer service and processes: Lessons from the National Prostate Cancer Audit. J Cancer Policy 2022; 33:100344. [PMID: 35724956 DOI: 10.1016/j.jcpo.2022.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/27/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
Organisational surveys are a critical process to assess the configuration and availability of services within health care systems. Cancer service organizational surveys enable understanding of variation in structure, processes and outcomes of cancer care according to the availability of facilities and their geographical organisation. This is critical for evaluating the delivery of cancer care services across a specified region. Furthermore, the organisational survey provides essential information about patient support services which can be used to inform patients where particular allied health services are available. The National Prostate Cancer Audit (NPCA) is an audit of all prostate cancer services in England and Wales. The NPCA encompasses all prostate cancer diagnostics, treatments (including surgery, radiotherapy and systemic therapy) and allied services. The NPCA conducted an organisational survey in 2021 via an online questionnaire sent to the prostate cancer clinical leads within each of the 138 NHS providers and we had a response rate of 93 %. There are many challenges to conducting an organisational survey and gaining a high completion rate is still difficult. The challenges that the NPCA faced included accuracy, completion, duplicates and discrepancies in responses. From this experience, we have developed some suggestions for the practical delivery and development of future organisational surveys. It was thanks to the use of many of these strategies, and the engagement of clinicians with the NPCA, that we were able to achieve such a high response rate. Despite these challenges, the importance of organisational surveys of cancer services is demonstrated by the better understanding of structure, processes and outcomes of cancer care according to the accessibility of facilities and their geographical organisation. This is essential for evaluating and improving the delivery of cancer care services across a region.
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Affiliation(s)
- Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom; London School of Hygiene and Tropical Medicine, United Kingdom.
| | - Melanie Morris
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom; London School of Hygiene and Tropical Medicine, United Kingdom
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom; London School of Hygiene and Tropical Medicine, United Kingdom
| | - Jan van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom; London School of Hygiene and Tropical Medicine, United Kingdom
| | - Heather Payne
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom; University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Noel Clarke
- Clinical Effectiveness Unit, Royal College of Surgeons, London, United Kingdom; The Christie NHS Foundation Trust, United Kingdom
| | - Ajay Aggarwal
- London School of Hygiene and Tropical Medicine, United Kingdom; King's College London, United Kingdom
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11
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Nossiter J, Morris M, Parry MG, Sujenthiran A, Cathcart P, van der Meulen J, Aggarwal A, Payne H, Clarke NW. Impact of the Covid-19 pandemic on the diagnosis and treatment of men with prostate cancer. BJU Int 2022; 130:262-270. [PMID: 35080142 DOI: 10.1111/bju.15699] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the impact of the Covid-19 pandemic on diagnostic and treatment activity in 2020 across hospital providers of prostate cancer (PCa) care in the English National Health Service. METHODS Diagnostic and treatment activity between March 23rd (start of first national lockdown in England) and December 31st 2020 was compared with same calendar period in 2019. Patients newly diagnosed with PCa were identified in national rapid cancer registration data linked to other electronic healthcare datasets. RESULTS There was a 30.8% reduction (22,419 versus 32,409) in the number of men with newly diagnosed PCa in 2020 after the start of the first lockdown, compared with the corresponding period in 2019. Men diagnosed in 2020 were typically at more advanced stage (21.2% versus 17.4%, stage IV) and slightly older (57.9% versus 55.9% ≥ 70 years, p<0.001). Prostate biopsies in 2020 were more often performed through using transperineal routes (64.0% versus 38.2%). The number of radical prostatectomies in 2020 was reduced by 26.9% (3,896 versus 5,331) and the number treated by external beam radiotherapy (EBRT) by 14.1% (9,719 versus 11,309). Other changes included an increased use of EBRT with hypofractionation and reduced use of docetaxel chemotherapy in men with hormone-sensitive metastatic PCa (413 versus 1,519) with related increase in the use of enzalutamide. CONCLUSION We found substantial deficits in the number of diagnostic and treatment procedures for men with newly diagnosed PCa after the start of the first lockdown in 2020. The number of men diagnosed with PCa decreased by about one third and those diagnosed had more advanced disease. Treatment patterns shifted towards those that limit the risk of Covid-19 exposure including increased use of transperineal biopsy, hypofractionated radiation, and enzalutamide. Urgent concerted action is required to address the Covid-19-related deficits in PCa services to mitigate their impact on long-term outcomes.
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Affiliation(s)
- Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Clinical Effectiveness Unit, Royal College of Surgeons of England
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Clinical Effectiveness Unit, Royal College of Surgeons of England
| | - Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Clinical Effectiveness Unit, Royal College of Surgeons of England
| | | | - Paul Cathcart
- Department of Urology, NHS Foundation Trust, Guy's and St Thomas
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine.,Department of Radiotherapy, NHS Foundation Trust, Guy's and St Thomas.,Department of Cancer Epidemiology, Population, and Global Health, King's College London
| | - Heather Payne
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts
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12
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Parry MG, Nossiter J, Morris M, Sujenthiran A, Skolarus TA, Berry B, Nathan A, Cathcart P, Aggarwal A, van der Meulen J, Trinh QD, Payne H, Clarke NW. Comparison of the treatment of men with prostate cancer between the US and England: an international population-based study. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-021-00482-6. [PMID: 35001083 DOI: 10.1038/s41391-021-00482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The treatment of prostate cancer varies between the United States (US) and England, however this has not been well characterised using recent data. We therefore investigated the extent of the differences between US and English patients with respect to initial treatment. METHODS We used the Surveillance, Epidemiology, and End Results (SEER) database to identify men diagnosed with prostate cancer in the US and the treatments they received. We also used the National Prostate Cancer Audit (NPCA) database for the same purposes among men diagnosed with prostate cancer in England. Next, we used multivariable regression to estimate the adjusted risk ratio (aRR) of receiving radical local treatment for men with non-metastatic prostate cancer according to the country of diagnosis (US vs. England). The five-tiered Cambridge Prognostic Group (CPG) classification was included as an interaction term. RESULTS We identified 109,697 patients from the SEER database, and 74,393 patients from the NPCA database, who were newly diagnosed with non-metastatic prostate cancer between April 1st 2014 and December 31st 2016 with sufficient information for risk stratification according to the CPG classification. Men in the US were more likely to receive radical local treatment across all prognostic groups compared to men in England (% radical treatment US vs. England, CPG1: 38.1% vs. 14.3% - aRR 2.57, 95% CI 2.47-2.68; CPG2: 68.6% vs. 52.6% - aRR 1.27, 95% CI 1.25-1.29; CPG3: 76.7% vs. 67.1% - aRR 1.12, 95% CI 1.10-1.13; CPG4: 82.6% vs. 72.4% - aRR 1.09, 95% CI 1.08-1.10; CPG5: 78.2% vs. 71.7% - aRR 1.06, 95% CI 1.04-1.07) CONCLUSIONS: Treatment rates were higher in the US compared to England raising potential over-treatment concerns for low-risk disease (CPG1) in the US and under-treatment of clinically significant disease (CPG3-5) in England.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Flatiron, London, UK
| | - Ted A Skolarus
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Arjun Nathan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,University College London, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Quoc-Dien Trinh
- Harvard Medical School, Boston, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
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13
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Parry MG, Skolarus TA, Nossiter J, Sujenthiran A, Morris M, Cowling TE, Berry B, Aggarwal A, Payne H, Cathcart P, Clarke NW, van der Meulen J. Urinary incontinence and use of incontinence surgery after radical prostatectomy: a national study using patient-reported outcomes. BJU Int 2021; 130:84-91. [PMID: 34846770 DOI: 10.1111/bju.15663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether patient-reported urinary incontinence and bother scores after radical prostatectomy result in subsequent intervention with incontinence surgery. METHODS Men diagnosed with prostate cancer in the English National Health Service between April 2014 and January 2016 were identified. Administrative data were used to identify men who had undergone a radical prostatectomy and those who subsequently underwent a urinary incontinence procedure. The National Prostate Cancer Audit database was used to identify men who had also completed a post-treatment survey. These surveys included the Expanded Prostate Cancer Composite Index (EPIC-26). The frequency of subsequent incontinence procedures, within 6 months of the survey, was explored according to EPIC-26 urinary incontinence scores. The relationship between "good" (≥75) or "bad" (≤25) EPIC-26 urinary incontinence scores and perceptions of urinary bother was also explored (responses ranging from 'no problem' to 'big problem' with respect to their urinary function). RESULTS We identified 11,290 men who had undergone a radical prostatectomy. The 3-year cumulative incidence of incontinence surgery was 2.5%. After exclusions, we identified 5,165 men who had also completed a post-treatment survey after a median time of 19 months (response rate 74%). 481 men (9.3%) reported a "bad" urinary incontinence score and 207 men (4.0%) also reported that they had a big problem with their urinary function. 47 men went on to have incontinence surgery within 6 months of survey completion (0.9%), of whom 93.6% had a "bad" urinary incontinence score. Of the 71 men with the worst urinary incontinence score (zero), only 11 men (15.5%) subsequently had incontinence surgery. CONCLUSION In England, there is a significant number of men living with severe, bothersome urinary incontinence following radical prostatectomy, and an unmet clinical need for incontinence surgery. The systematic collection of patient-reported outcomes could be used to identify men who may benefit from incontinence surgery.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research & Policy, LHSTM, USA.,Clinical Effectiveness Unit, Royal College of Surgeons of England, USA
| | - Ted A Skolarus
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, USA
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, USA.,Flatiron, UK
| | - Melanie Morris
- Department of Health Services Research & Policy, LHSTM, USA.,Clinical Effectiveness Unit, Royal College of Surgeons of England, USA
| | | | - Brendan Berry
- Department of Health Services Research & Policy, LHSTM, USA.,Clinical Effectiveness Unit, Royal College of Surgeons of England, USA
| | - Ajay Aggarwal
- Department of Radiotherapy, NHS Foundation Trust, Guy's & St Thomas, UK.,Department of Cancer Epidemiology, KCL, Population & Global Health, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Paul Cathcart
- Department of Urology, NHS Foundation Trust, Guy's & St Thomas, UK
| | - Noel W Clarke
- Department of Urology, Salford Royal NHS Foundation Trusts, The Christie &, UK
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14
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Parry MG, Boyle JM, Nossiter J, Morris M, Sujenthiran A, Berry B, Cathcart P, Aggarwal A, van der Meulen J, Payne H, Clarke NW. Determinants of variation in radical local treatment for men with high-risk localised or locally advanced prostate cancer in England. Prostate Cancer Prostatic Dis 2021:10.1038/s41391-021-00439-9. [PMID: 34493837 DOI: 10.1038/s41391-021-00439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many factors are implicated in the potential 'under-treatment' of prostate cancer but little is known about the between-hospital variation. METHODS The National Prostate Cancer Audit (NPCA) database was used to identify high-risk localised or locally advanced prostate cancer patients in England, between January 2014 and December 2017, and the treatments received. Hospital-level variation in radical local treatment was explored visually using funnel plots. The intra-class correlation coefficient (ICC) quantified the between-hospital variation in a random-intercept multivariable logistic regression model. RESULTS 53,888 men, from 128 hospitals, were included and 35,034 (65.0%) received radical local treatment. The likelihood of receiving radical local treatment was increased in men who were younger (the strongest predictor), more affluent, those with fewer comorbidities, and in those with a non-Black ethnic background. There was more between-hospital variation (P < 0.001) for patients aged ≥80 years (ICC: 0.235) compared to patients aged 75-79 years (ICC: 0.070), 70-74 years (ICC: 0.041), and <70 years (ICC: 0.048). Comorbidity and socioeconomic deprivation did not influence the between-hospital variation. CONCLUSIONS Radical local treatment of high-risk localised or locally advanced prostate cancer depended strongly on age and comorbidity, but also on socioeconomic deprivation and ethnicity, with the between-hospital variation being highest in older patients.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - Jemma M Boyle
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ajay Aggarwal
- Department of Cancer Epidemiology, Population, and Global Health, King's College London, London, UK.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
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15
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Parry M, Sujenthiran A, Nossiter J, Morris M, Berry B, Cathcart P, Clarke N, Payne H, van der Meulen J, Aggarwal A. PD-0768 Treatment-related toxicity of prostate bed versus whole pelvis post-prostatectomy radiation therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Parry MG, Nossiter J, Sujenthiran A, Cowling TE, Patel RN, Morris M, Berry B, Cathcart P, Clarke NW, van der Meulen J, Aggarwal A. In Reply to Langley et al. Int J Radiat Oncol Biol Phys 2021; 110:913-914. [PMID: 34089685 DOI: 10.1016/j.ijrobp.2021.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, LSHTM, London, England; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England
| | - Julie Nossiter
- Department of Health Services Research and Policy, LSHTM, London, England; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England
| | - Arunan Sujenthiran
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England
| | - Thomas E Cowling
- Department of Health Services Research and Policy, LSHTM, London, England
| | - Rajan N Patel
- Department of Gastroenterology, The Whittington Hospital NHS Trust, London, England
| | - Melanie Morris
- Department of Health Services Research and Policy, LSHTM, London, England; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England
| | - Brendan Berry
- Department of Health Services Research and Policy, LSHTM, London, England; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, England; Heather Payne, FRCP FRCR, Department of Oncology, University College London Hospitals, London, England
| | - Jan van der Meulen
- Department of Health Services Research and Policy, LSHTM, London, England
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, LSHTM, London, England; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, England
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17
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Parry M, Boyle J, Nossiter J, Morris M, Sujenthiran A, Berry B, Cathcart P, Aggawal A, Van Der Meulen J, Payne H, Clarke N. Determinants of variation in radical local treatment for men with high-risk localised or locally advanced prostate cancer in England. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Parry M, Sujenthiran A, Nossiter J, Morris M, Berry B, Cathcart P, Clarke N, Payne H, Van Der Meulen J, Aggawal A. Treatment-related toxicity using prostate bed versus prostate bed and pelvic lymph node radiation therapy following radical prostatectomy: A national population-based study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aggarwal A, Nossiter J, Parry M, Sujenthiran A, Zietman A, Clarke N, Payne H, van der Meulen J. Public reporting of outcomes in radiation oncology: the National Prostate Cancer Audit. Lancet Oncol 2021; 22:e207-e215. [DOI: 10.1016/s1470-2045(20)30558-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/18/2022]
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Parry MG, Nossiter J, Sujenthiran A, Cowling TE, Patel RN, Morris M, Berry B, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Impact of High-Dose-Rate and Low-Dose-Rate Brachytherapy Boost on Toxicity, Functional and Cancer Outcomes in Patients Receiving External Beam Radiation Therapy for Prostate Cancer: A National Population-Based Study. Int J Radiat Oncol Biol Phys 2020; 109:1219-1229. [PMID: 33279595 DOI: 10.1016/j.ijrobp.2020.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/16/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE External beam radiation therapy (EBRT) with brachytherapy boost reduces cancer recurrence in patients with prostate cancer compared with EBRT monotherapy. However, randomized controlled trials or large-scale observational studies have not compared brachytherapy boost types directly. METHODS AND MATERIALS This observational cohort study used linked national cancer registry data, radiation therapy data, administrative hospital data, and mortality records of 54,642 patients with intermediate-risk, high-risk, and locally advanced prostate cancer in England. The records of 11,676 patients were also linked to results from a national patient survey collected at least 18 months after diagnosis. Competing risk regression analyses were used to compare gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, skeletal-related events (SRE), and prostate cancer-specific mortality (PCSM) at 5 years with adjustment for patient and tumor characteristics. Linear regression was used to compare Expanded Prostate Cancer Index Composite 26-item version domain scores (scale, 0-100, with higher scores indicating better function). RESULTS Five-year GI toxicity was significantly increased after low-dose-rate brachytherapy boost (LDR-BB) (32.3%) compared with high-dose-rate brachytherapy boost (HDR-BB) (16.7%) or EBRT monotherapy (18.7%). Five-year GU toxicity was significantly increased after both LDR-BB (15.8%) and HDR-BB (16.6%), compared with EBRT monotherapy (10.4%). These toxicity patterns were matched by the mean patient-reported bowel function scores (LDR-BB, 77.3; HDR-BB, 85.8; EBRT monotherapy, 84.4) and the mean patient-reported urinary obstruction/irritation function scores (LDR-BB, 72.2; HDR-BB, 78.9; EBRT monotherapy, 83.8). Five-year incidences of SREs and PCSM were significantly lower after HDR-BB (2.4% and 2.7%, respectively) compared with EBRT monotherapy (2.8% and 3.5%, respectively). CONCLUSIONS Compared with EBRT monotherapy, LDR-BB has worse GI and GU toxicity and HDR-BB has worse GU toxicity. HDR-BB has a lower incidence of SREs and PCSM than EBRT monotherapy.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, LSHTM, London, UK; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - Julie Nossiter
- Department of Health Services Research and Policy, LSHTM, London, UK; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Thomas E Cowling
- Department of Health Services Research and Policy, LSHTM, London, UK
| | - Rajan N Patel
- Department of Gastroenterology, The Whittington Hospital NHS Trust, London, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, LSHTM, London, UK; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Brendan Berry
- Department of Health Services Research and Policy, LSHTM, London, UK; The National Prostate Cancer Audit, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | | | - Ajay Aggarwal
- Department of Health Services Research and Policy, LSHTM, London, UK; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Parry M, Cowling T, Sujenthiran A, Nossiter J, Berry B, Cathcart P, Clarke N, Payne H, Aggarwal A, Van der Meulen J. PO-1178: Identifying skeletal-related events for prostate cancer in routinely collected hospital data. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Parry M, Sujenthiran A, Nossiter J, Cathcart P, Clarke N, Payne H, Aggarwal A. PD-0060: Treatment-related toxicity of hypofractionated radiation therapy for prostate cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Parry M, Sujenthiran A, Cowling T, Nossiter J, Cathcart P, Clarke N, Payne H, Van der Meulen J, Aggarwal A. PO-1177: Treatment-related toxicity using prostate only vs prostate and pelvic lymph node radiation therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Parry MG, Nossiter J, Cowling TE, Sujenthiran A, Berry B, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Toxicity of Pelvic Lymph Node Irradiation With Intensity Modulated Radiation Therapy for High-Risk and Locally Advanced Prostate Cancer: A National Population-Based Study Using Patient-Reported Outcomes. Int J Radiat Oncol Biol Phys 2020; 108:1196-1203. [PMID: 32717261 DOI: 10.1016/j.ijrobp.2020.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Little is known about the toxicity of additional pelvic lymph node irradiation in men receiving intensity modulated radiation therapy (IMRT) for prostate cancer. The aim of this study was to compare patient-reported outcomes after IMRT to the prostate only (PO-IMRT) versus the prostate and pelvic lymph nodes (PPLN-IMRT). METHODS AND MATERIALS Patients who received a diagnosis of high-risk or locally advanced prostate cancer in the English National Health Service between April 2014 and September 2016 who were treated with IMRT were mailed a questionnaire at least 18 months after diagnosis. Patient-reported urinary, sexual, bowel, and hormonal functional domains on a scale from 0 to 100, with higher scores indicating better outcomes, and generic health-related quality of life were collected using the Expanded Prostate Cancer Index Composite 26-item version and EQ-5D-5L. We used linear regression to compare PPLN-IMRT versus PO-IMRT with adjustment for patient, tumor, and treatment characteristics. RESULTS Of the 7017 men who received a questionnaire, 5468 (77.9%) responded; 4196 (76.7%) had received PO-IMRT and 1272 (23.3%) PPLN-IMRT. Adjusted differences in the Expanded Prostate Cancer Index Composite 26-item version domain scores were smaller than 1 (P always >.2), except for sexual function, with men who had PPNL-IMRT reporting a lower mean score (adjusted difference, 2.3; 95% confidence interval, 0.9-3.7; P = .002). This did not represent a clinically relevant difference. There was no significant difference in health-related quality of life (P = .5). CONCLUSIONS Additional pelvic lymph node irradiation does not lead to clinically meaningful increases in the toxicity of IMRT for prostate cancer according to patient-reported functional outcomes and health-related quality of life.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom.
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay Aggarwal
- Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Cancer Epidemiology, Population, and Global Health, King's College London, London, United Kingdom
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Berry B, Parry M, Sujenthiran A, Nossiter J, Cowling T, Aggarwal A, Cathcart P, Payne H, Clarke N, Van Der Meulen J. Comparison of complications after transrectal and transperineal prostate biopsy: A national population-based study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Parry M, Nossiter J, Cowling T, Sujenthiran A, Berry B, Cathcart P, Clarke N, Payne H, Van Der Meulen J, Aggarwal A. Patient-reported outcomes after prostate only vs. prostate and pelvic lymph node radiation therapy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34043-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Parry M, Nossiter J, Cowling T, Sujenthiran A, Berry B, Aggarwal A, Cathcart P, Payne H, Clarke N, Skolarus T, Van Der Meulen J. Patient-reported urinary incontinence following radical prostatectomy for prostate cancer and its association with undergoing incontinence surgery: A national population-based study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Parry MG, Cowling TE, Sujenthiran A, Nossiter J, Berry B, Cathcart P, Aggarwal A, Payne H, van der Meulen J, Clarke NW, Gnanapragasam VJ. Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation. BMC Med 2020; 18:114. [PMID: 32460859 PMCID: PMC7254634 DOI: 10.1186/s12916-020-01588-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The five-tiered Cambridge Prognostic Group (CPG) classification is a better predictor of prostate cancer-specific mortality than the traditional three-tiered classification (low, intermediate, and high risk). We investigated radical treatment rates according to CPG in men diagnosed with non-metastatic prostate cancer in England between 2014 and 2017. METHODS Patients diagnosed with non-metastatic prostate cancer were identified from the National Prostate Cancer Audit database. Men were risk stratified according to the CPG classification. Risk ratios (RR) were estimated for undergoing radical treatment according to CPG and for receiving radiotherapy for those treated radically. Funnel plots were used to display variation in radical treatment rates across hospitals. RESULTS A total of 61,999 men were included with 10,963 (17.7%) in CPG1 (lowest risk group), 13,588 (21.9%) in CPG2, 9452 (15.2%) in CPG3, 12,831 (20.7%) in CPG4, and 15,165 (24.5%) in CPG5 (highest risk group). The proportion of men receiving radical treatment increased from 11.3% in CPG1 to 78.8% in CGP4, and 73.3% in CPG5. Men in CPG3 were more likely to receive radical treatment than men in CPG2 (66.3% versus 48.4%; adjusted RR 1.44; 95% CI 1.36-1.53; P < 0.001). Radically treated men in CPG3 were also more likely to receive radiotherapy than men in CPG2 (59.2% versus 43.9%; adjusted RR, 1.18; 95% CI 1.10-1.26). Although radical treatment rates were similar in CPG4 and CPG5 (78.8% versus 73.3%; adjusted RR 1.01; 95% CI 0.98-1.04), more men in CPG5 had radiotherapy than men in CPG4 (79.9% versus 59.1%, adjusted RR 1.26; 95% CI 1.12-1.40). CONCLUSIONS The CPG classification distributes men in five risk groups that are about equal in size. It reveals differences in treatment practices in men with intermediate-risk disease (CPG2 and CPG3) and in men with high-risk disease (CPG4 and CPGP5) that are not visible when using the traditional three-tiered risk classification.
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Affiliation(s)
- M G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England.
| | - T E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - J Nossiter
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - B Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - P Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Aggarwal
- Department of Cancer Epidemiology, Population, and Global Health, King's College London, London, UK.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - J van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
| | - V J Gnanapragasam
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
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Berry B, Parry MG, Sujenthiran A, Nossiter J, Cowling TE, Aggarwal A, Cathcart P, Payne H, van der Meulen J, Clarke N. Comparison of complications after transrectal and transperineal prostate biopsy: a national population-based study. BJU Int 2020; 126:97-103. [PMID: 32124525 DOI: 10.1111/bju.15039] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess the complications of transrectal (TR) compared to transperineal prostate (TP) biopsies. PATIENTS AND METHODS Men diagnosed with prostate cancer between 1 April 2014 and 31 March 2017 in England were identified in the National Prostate Cancer Audit. Administrative hospital data were then used to categorize the type of prostate biopsy and subsequent complications requiring hospital admission. Administrative hospital data were used to identify patients staying overnight immediately after biopsy and those readmitted separately for hospital admissions because of sepsis, urinary retention or haematuria. Procedure-related mortality and total length of hospital stay within 30 days were also recorded. Generalized linear models were used to calculate adjusted risk differences (aRDs). RESULTS A total of 73 630 patients undergoing prostate biopsy were identified. Those undergoing TP biopsy (n = 13 723) were more likely to have an overnight hospital stay (12.3% vs 2.4%; aRD 9.7%, 95% confidence interval [CI] 7.1-12.3), were less likely to be readmitted because of sepsis (1.0% vs 1.4%; aRD -0.4%, CI -0.6 to -0.2), and were more likely to be readmitted with urinary retention (1.9% vs 1.0%; aRD 1.1%, CI 0.7-1.4) than those undergoing a TR biopsy (n = 59 907). There were no significant differences in the risk of haematuria or mortality. CONCLUSIONS Our results showed that TP biopsy had a lower risk of readmission for sepsis but a higher risk of readmission for urinary retention than TR biopsy. Use of the TP route would prevent one readmission for sepsis in 278 patients at the cost of three additional patients readmitted for urinary retention.
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Affiliation(s)
- Brendan Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Ajay Aggarwal
- Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Cancer Epidemiology, Population, and Global Health, King's College London, London, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Noel Clarke
- Department of Urology, Christie and Salford Royal Hospitals Manchester NHS Foundation Trust, Manchester, UK
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Nossiter J, Sujenthiran A, Cowling TE, Parry MG, Charman SC, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Patient-Reported Functional Outcomes After Hypofractionated or Conventionally Fractionated Radiation for Prostate Cancer: A National Cohort Study in England. J Clin Oncol 2020; 38:744-752. [PMID: 31895608 DOI: 10.1200/jco.19.01538] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of the current study was to determine patient-reported functional outcomes in men with prostate cancer (PCa) undergoing moderately hypofractionated (H-RT) or conventionally fractionated radiation therapy (C-RT) in a national cohort study. PATIENDS AND METHODS All men diagnosed with PCa between April 2014 and September 2016 in the English National Health Service undergoing C-RT or H-RT were identified in the National Prostate Cancer Audit and mailed a questionnaire at least 18 months after diagnosis. We estimated differences in patient-reported urinary, bowel, sexual, and hormonal function-Expanded Prostate Cancer Index Composite short-form 26 domain scores on a 0 to 100 scale-and health-related quality of life-EQ-5D-5L on a 0 to 1 scale-using linear regression with adjustment for patient, tumor, and treatment-related factors in addition to GI and genitourinary baseline function, with higher scores representing better outcomes. RESULTS Of the 17,058 men in the cohort, 77% responded: 8,432 men received C-RT (64.2%) and 4,699 H-RT (35.8%). Men in the H-RT group were older (age ≥ 70 years: 67.5% v 60.9%), fewer men had locally advanced disease (56.5% v 71.3%), were less likely to receive androgen-deprivation therapy (79.5% v 87.8%), and slightly more men had pretreatment genitourinary procedures (24.2% v 21.2%). H-RT was associated with small increases in adjusted mean Expanded Prostate Cancer Index Composite short-form 26 sexual (3.3 points; 95% CI, 2.1 to 4.5; P < .001) and hormonal function scores (3.2 points; 95% CI, 1.8 to 4.6; P < .001). These differences failed to meet established thresholds for a clinically meaningful change. There were no statistically significant differences in urinary or bowel function and quality of life. CONCLUSION This is the first national cohort study comparing functional outcomes after H-RT and C-RT reported by patients. These real-world results further support the use of H-RT as the standard for radiation therapy in men with nonmetastatic PCa.
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Affiliation(s)
- Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew G Parry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom
| | - Susan C Charman
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay Aggarwal
- Department of Cancer Epidemiology, Population, and Global Health, King's College London, London, United Kingdom.,Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Parry MG, Cowling TE, Sujenthiran A, Nossiter J, Berry B, Cathcart P, Clarke NW, Payne H, Aggarwal A, van der Meulen J. Identifying skeletal-related events for prostate cancer patients in routinely collected hospital data. Cancer Epidemiol 2019; 63:101628. [DOI: 10.1016/j.canep.2019.101628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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Parry MG, Sujenthiran A, Cowling TE, Nossiter J, Cathcart P, Clarke NW, Payne H, van der Meulen J, Aggarwal A. Treatment-Related Toxicity Using Prostate-Only Versus Prostate and Pelvic Lymph Node Intensity-Modulated Radiation Therapy: A National Population-Based Study. J Clin Oncol 2019; 37:1828-1835. [PMID: 31163009 DOI: 10.1200/jco.18.02237] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE There is a debate about the effectiveness and toxicity of pelvic lymph node (PLN) irradiation for the treatment of men with high-risk prostate cancer. This study compared the toxicity of intensity-modulated radiation therapy (IMRT) to the prostate and the pelvic lymph nodes (PPLN-IMRT) with prostate-only IMRT (PO-IMRT). MATERIALS AND METHODS Patients with high-risk localized or locally advanced prostate cancer treated with IMRT in the English National Health Service between 2010 and 2013 were identified by using data from the Cancer Registry, the National Radiotherapy Dataset, and Hospital Episode Statistics, an administrative database of all hospital admissions. Follow-up was available up to December 31, 2015. Validated indicators were used to identify patients with severe toxicity according to the presence of both a procedure code and diagnostic code in patient Hospital Episode Statistics records. A competing risks regression analysis, with adjustment for patient and tumor characteristics, estimated subdistribution hazard ratios (sHRs) by comparing GI and genitourinary (GU) complications for PPLN-IMRT versus PO-IMRT. RESULTS Three-year cumulative incidence in the PPLN-IMRT (n = 780) and PO-IMRT (n = 3,065) groups was 14% for both groups for GI toxicity, and 9% and 8% for GU toxicity, respectively. Patients receiving PPLN-IMRT and PO-IMRT had similar levels of severe GI (adjusted sHR, 1.00; 95% CI, 0.80 to 1.24; P = .97) and GU (adjusted sHR, 1.10; 95% CI, 0.83 to 1.46; P = .50) toxicity rates. CONCLUSION Including PLNs in radiation fields for high-risk or locally advanced prostate cancer is not associated with increased GI or GU toxicity at 3 years. Additional follow-up is required to answer questions about its impact on late GU toxicity. Results from ongoing trials will provide insight into the anticancer effectiveness of PLN irradiation.
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Affiliation(s)
- Matthew G Parry
- 1 London School of Hygiene and Tropical Medicine, London, United Kingdom.,2 Royal College of Surgeons of England, London, United Kingdom
| | | | - Thomas E Cowling
- 1 London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julie Nossiter
- 2 Royal College of Surgeons of England, London, United Kingdom
| | - Paul Cathcart
- 3 Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Noel W Clarke
- 4 The Christie and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Heather Payne
- 5 University College London Hospitals, London, United Kingdom
| | - Jan van der Meulen
- 1 London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay Aggarwal
- 3 Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.,6 King's College London, London, United Kingdom
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Parry MG, Sujenthiran A, Cowling TE, Nossiter J, Cathcart P, Clarke NW, Payne H, Aggarwal A, van der Meulen J. Impact of cancer service centralisation on the radical treatment of men with high-risk and locally advanced prostate cancer: A national cross-sectional analysis in England. Int J Cancer 2019; 145:40-48. [PMID: 30549266 PMCID: PMC6590431 DOI: 10.1002/ijc.32068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/30/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
In many countries, specialist cancer services are centralised to improve outcomes. We explored how centralisation affects the radical treatment of high‐risk and locally advanced prostate cancer in the English NHS. 79,085 patients diagnosed with high‐risk and locally advanced prostate cancer in England (April 2014 to March 2016) were identified in the National Prostate Cancer Audit database. Poisson models were used to estimate risk ratios (RR) for undergoing radical treatment by whether men were diagnosed at a regional co‐ordinating centre (‘hub’), for having surgery by the presence of surgical services on‐site, and for receiving high dose‐rate brachytherapy (HDR‐BT) in addition to external beam radiotherapy by its regional availability. Men were equally likely to receive radical treatment, irrespective of whether they were diagnosed in a hub (RR 0.99, 95% CI 0.91–1.08). Men were more likely to have surgery if they were diagnosed at a hospital with surgical services on site (RR 1.24, 1.10–1.40), and more likely to receive additional HDR‐BT if they were diagnosed at a hospital with direct regional access to this service (RR 6.16, 2.94–12.92). Centralisation of specialist cancer services does not affect whether men receive radical treatment, but it does affect treatment modality. Centralisation may have a negative impact on access to specific treatment modalities. What's new? More than one‐quarter of men with high‐risk or locally advanced prostate cancer in England do not receive radical treatment with radiotherapy or surgery, potentially owing to differences in treatment access. Here, prostate cancer service centralisation in England was investigated for potential impacts on treatment access. Among English patients in the National Prostate Cancer Audit database, centralisation had no impact on decisions to use radical treatment. It did, however, affect treatment option availability, with potential consequences for patient outcome. Patients were more likely to undergo surgery or high dose‐rate brachytherapy when diagnosed at hospitals with direct links to these services.
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Affiliation(s)
- Matthew G Parry
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
| | - Julie Nossiter
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, England.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, England
| | - Heather Payne
- Department of Oncology, University College London Hospitals, Department of Cancer, London, England
| | - Ajay Aggarwal
- Epidemiology, Population, and Global Health, King's College London, London, England.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, England
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, England
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Parry MG, Sujenthiran A, Cowling TE, Charman S, Nossiter J, Aggarwal A, Clarke NW, Payne H, van der Meulen J. Imputation of missing prostate cancer stage in English cancer registry data based on clinical assumptions. Cancer Epidemiol 2018; 58:44-51. [PMID: 30463041 DOI: 10.1016/j.canep.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cancer stage can be missing in national cancer registry records. We explored whether missing prostate cancer stage can be imputed using specific clinical assumptions. METHODS Prostate cancer patients diagnosed between 2010 and 2013 were identified in English cancer registry data and linked to administrative hospital and mortality data (n = 139,807). Missing staging items were imputed based on specific assumptions: men with recorded N-stage but missing M-stage have no distant metastases (M0); low/intermediate-risk men with missing N- and/or M-stage have no nodal disease (N0) or metastases; and high-risk men with missing M-stage have no metastases. We tested these clinical assumptions by comparing 4-year survival in men with the same recorded and imputed cancer stage. Multi-variable Cox regression was used to test the validity of the clinical assumptions and multiple imputation. RESULTS Survival was similar for men with recorded N-stage but missing M-stage and corresponding men with M0 (89.5% vs 89.6%); for low/intermediate-risk men with missing M-stage and corresponding men with M0 (92.0% vs 93.1%); and for low/intermediate-risk men with missing N-stage and corresponding men with N0 (90.9% vs 93.7%). However, survival was different for high-risk men with missing M-stage and corresponding men with M0. Imputation based on clinical imputation performs as well as statistical multiple imputation. CONCLUSION Specific clinical assumptions can be used to impute missing information on nodal involvement and distant metastases in some patients with prostate cancer.
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Affiliation(s)
- Matthew G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom.
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom.
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom.
| | - Susan Charman
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom.
| | - Julie Nossiter
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom.
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, England, United Kingdom; Department of Cancer Epidemiology, Population, and Global Health, King's College London, Strand, London, WC2R 2LS, England, United Kingdom.
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, England, United Kingdom; Department of Urology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, England, United Kingdom.
| | - Heather Payne
- Department of Oncology, University College London Hospitals, 235 Euston Road, London, NW1 2BU, England, United Kingdom.
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, United Kingdom; Clinical Effectiveness Unit, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, England, United Kingdom.
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Sujenthiran A, Nossiter J, Parry M, Charman SC, Cathcart PJ, van der Meulen J, Clarke NW, Payne H, Aggarwal A. Treatment-related toxicity in men who received Intensity-modulated versus 3D-conformal radiotherapy after radical prostatectomy: A national population-based study. Radiother Oncol 2018; 128:357-363. [PMID: 29773442 DOI: 10.1016/j.radonc.2018.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE In the post-prostatectomy setting the value of Intensity-modulated (IMRT) relative to 3D-conformal radiotherapy (3D-CRT) in reducing toxicity remains unclear. We compared genitourinary (GU) and gastrointestinal (GI) toxicity after post-prostatectomy IMRT or 3D-CRT. MATERIALS AND METHODS A population-based study of all patients treated with post-prostatectomy 3D-CRT (n = 2422) and IMRT (n = 603) was conducted between January 1 2010 and December 31 2013 in the English National Health Service. We identified severe GI and GU toxicity using a validated coding-framework and compared IMRT and 3D-CRT using a competing-risks proportional hazards regression analysis. RESULTS There was no difference in GI toxicity between patients who received IMRT and 3D-CRT (3D-CRT: 5.8 events/100 person-years; IMRT: 5.5 events/100 person-years; adjusted HR: 0.85, 95%CI: 0.63-1.13; p = 0.26). The GU toxicity rate was lower with IMRT but this effect was not statistically significant (3D-CRT: 5.4 events/100 person-years; IMRT: 3.8 events/100 person-years; adjusted HR: 0.76, 95%CI: 0.55-1.03; p = 0.08). CONCLUSIONS The use of post-prostatectomy IMRT compared to 3D-CRT is not associated with a statistically significant reduction in rates of severe GU and GI toxicity, although there is some evidence that GU toxicity is lower with IMRT. We would caution against rapid transition to post-prostatectomy IMRT until further evidence is available supporting its superiority.
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Affiliation(s)
- Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom.
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom
| | - Matthew Parry
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Susan C Charman
- Clinical Effectiveness Unit, Royal College of Surgeon of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul J Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, United Kingdom
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, United Kingdom
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Sujenthiran A, Nossiter J, Parry M, Charman SC, Aggarwal A, Payne H, Dasgupta P, Clarke NW, van der Meulen J, Cathcart P. National cohort study comparing severe medium-term urinary complications after robot-assisted vs laparoscopic vs retropubic open radical prostatectomy. BJU Int 2018; 121:445-452. [PMID: 29032582 PMCID: PMC5873443 DOI: 10.1111/bju.14054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the occurrence of severe urinary complications within 2 years of surgery in men undergoing either robot-assisted radical prostatectomy (RARP), laparoscopic radical prostatectomy (LRP) or retropubic open radical prostatectomy (ORP). PATIENTS AND METHODS We conducted a population-based cohort study in men who underwent RARP (n = 4 947), LRP (n = 5 479) or ORP (n = 6 873) between 2008 and 2012 in the English National Health Service (NHS) using national cancer registry records linked to Hospital Episodes Statistics, an administrative database of admissions to NHS hospitals. We identified the occurrence of any severe urinary or severe stricture-related complication within 2 years of surgery using a validated tool. Multi-level regression modelling was used to determine the association between the type of surgery and occurrence of complications, with adjustment for patient and surgical factors. RESULTS Men undergoing RARP were least likely to experience any urinary complication (10.5%) or a stricture-related complication (3.3%) compared with those who had LRP (15.8% any or 5.7% stricture-related) or ORP (19.1% any or 6.9% stricture-related). The impact of the type of surgery on the occurrence of any urinary or stricture-related complications remained statistically significant after adjustment for patient and surgical factors (P < 0.01). CONCLUSION Men who underwent RARP had the lowest risk of developing severe urinary complications within 2 years of surgery.
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Affiliation(s)
| | - Julie Nossiter
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
| | - Matthew Parry
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Susan C. Charman
- Clinical Effectiveness UnitRoyal College of Surgeons of EnglandLondonUK
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Ajay Aggarwal
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Heather Payne
- Department of OncologyUniversity College London HospitalsLondonUK
| | | | - Noel W. Clarke
- Department of UrologyChristie and Salford Royal NHS Foundation TrustsManchesterUK
| | - Jan van der Meulen
- Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Paul Cathcart
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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Nossiter J, Sujenthiran A, Charman SC, Cathcart PJ, Aggarwal A, Payne H, Clarke NW, van der Meulen J. Robot-assisted radical prostatectomy vs laparoscopic and open retropubic radical prostatectomy: functional outcomes 18 months after diagnosis from a national cohort study in England. Br J Cancer 2018; 118:489-494. [PMID: 29348490 PMCID: PMC5830598 DOI: 10.1038/bjc.2017.454] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) has been rapidly adopted without robust evidence comparing its functional outcomes against laparoscopic radical prostatectomy (LRP) or open retropubic radical prostatectomy (ORP) approaches. This study compared patient-reported functional outcomes following RARP, LRP or ORP. METHODS All men diagnosed with prostate cancer in England during April - October 2014 who underwent radical prostatectomy were identified from the National Prostate Cancer Audit and mailed a questionnaire 18 months after diagnosis. Group differences in patient-reported sexual, urinary, bowel and hormonal function (EPIC-26 domain scores) and generic health-related quality of life (HRQoL; EQ-5D-5L scores), with adjustment for patient and tumour characteristics, were estimated using linear regression. RESULTS In all, 2219 men (77.0%) responded; 1310 (59.0%) had RARP, 487 (21.9%) LRP and 422 (19.0%) ORP. RARP was associated with slightly higher adjusted mean EPIC-26 sexual function scores compared with LRP (3·5 point difference; 95% CI: 1.1-5.9, P=0.004) or ORP (4.0 point difference; 95% CI: 1.5-6.5, P=0.002), which did not meet the threshold for a minimal clinically important difference (10-12 points). There were no significant differences in other EPIC-26 domain scores or HRQoL. CONCLUSIONS It is unlikely that the rapid adoption of RARP in the English NHS has produced substantial improvements in functional outcomes for patients.
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Affiliation(s)
- Julie Nossiter
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - Susan C Charman
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - Paul J Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Noel W Clarke
- Department of Urology, The Christie, Manchester M20 4BX, UK
- Department of Urology, Salford Royal NHS Foundation Trusts, Manchester M6 8HD, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London WC2A 3PE, UK
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Sujenthiran A, Charman SC, Parry M, Nossiter J, Aggarwal A, Dasgupta P, Payne H, Clarke NW, Cathcart P, van der Meulen J. Quantifying severe urinary complications after radical prostatectomy: the development and validation of a surgical performance indicator using hospital administrative data. BJU Int 2017; 120:219-225. [PMID: 28075516 DOI: 10.1111/bju.13770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To develop and validate a surgical performance indicator based on severe urinary complications that require an intervention within 2 years of radical prostatectomy (RP), identified in hospital administrative data. PATIENTS AND METHODS Men who underwent RP between 2008 and 2012 in England were identified using hospital administrative data. A transparent coding framework based on procedure codes was developed to identify severe urinary complications which were grouped into 'stricture', 'incontinence' and 'other'. Their validity as a performance indicator was assessed by evaluating the consistency with diagnosis codes and association with patient and surgical characteristics. Kaplan-Meier methods were used to assess time to first occurrence and multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for patient and surgical characteristics. RESULTS A total of 17 299 men were included, of whom 2695 (15.6%) experienced at least one severe urinary complication within 2 years. High proportions of men with a complication had relevant diagnosis codes: 86% for strictures and 93% for incontinence. Urinary complications were more common in men from poorer socio-economic backgrounds (OR comparing lowest with highest quintile: 1.45; 95% confidence interval [CI] 1.26-1.67) and in those with prolonged length of hospital stay (OR 1.54, 95% CI 1.40-1.69), and were less common in men who underwent robot-assisted surgery (OR 0.65, 95% CI 0.58-0.74). CONCLUSION These results show that severe urinary complications identified in administrative data provide a medium-term performance indicator after RP. They can be used for research assessing outcomes of treatment methods and for service evaluation comparing performance of prostate cancer surgery providers.
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Affiliation(s)
- Arunan Sujenthiran
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Susan C Charman
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Parry
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Ajay Aggarwal
- London School of Hygiene and Tropical Medicine, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Noel W Clarke
- Department of Urology, Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Paul Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Aggarwal A, Nossiter J, Cathcart P, van der Meulen J, Rashbass J, Clarke N, Payne H. Organisation of Prostate Cancer Services in the English National Health Service. Clin Oncol (R Coll Radiol) 2016; 28:482-489. [DOI: 10.1016/j.clon.2016.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 11/28/2022]
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Aggarwal A, Cathcart P, Payne H, Neal D, Rashbass J, Nossiter J, van der Meulen J. The National Prostate Cancer Audit — Introducing a New Generation of Cancer Audit. Clin Oncol (R Coll Radiol) 2014; 26:90-3. [DOI: 10.1016/j.clon.2013.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/09/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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Cathcart P, Nossiter J, Aggarwal A, Rashbass J, Lyratzopoulos Y, Payne H, Neal DE, van der Meulen J. The first national clinical audit of prostate cancer care. BJU Int 2013; 112:883-4. [PMID: 24053511 DOI: 10.1111/bju.12365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Cathcart
- Department of Urology, University College Hospital London & St. Bartholomew's Hospital London & Centre for Experimental cancer Medicine, Bart's Cancer Institute, London, UK
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Affiliation(s)
- Nick Black
- London School of Hygiene and Tropical Medicine
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