Differences in Prostate Cancer Investigation and Treatment in RoI and NI
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A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013. Physical and psychological side-effects following prostate cancer treatments - Heather Kinnear
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Differences in Prostate Cancer Investigation and Treatment in RoI and NI
- 1. Heather Kinnear, Frances Drummond, Linda Sharp, David Donnelly, Eamonn O’Leary, Anna Gavin
- 2. Investigation differences There has been a vast increase in the number of PSA tests performed over last 10 years Treatment differences RoI patients receive more radiotherapy and surgery and less hormone treatment than NI patients More younger men in RoI are diagnosed with prostate cancer than in NI Rates of diagnosis have been higher in RoI from 1996 onwards 2
- 3. •Incidence of prostate cancer is 34% higher in RoI than in NI
- 4. Postal Questionnaire to men, any age, identified by Cancer registries, vetted for exclusions (end of life care, not aware of own diagnosis, cognitive/physical impairments) by Research Nurses/Clinicians/GP’s ◦ 2 reminders ◦ Standardised instruments used (EORTC QLQ C30, EORTC PR25, DASS, Decision regret scale, EQ5D-5L) ◦ Freephone facility set up – high volume of calls (13% in both RoI (n=632/4,838) and NI (274/2,106)) ◦ Ethics and research governance etc
- 5. From Cancer Registries •Men diagnosed in NI and RoI with prostate cancer up to 17 years ago •N=12,900 (Stratified by time since diagnosis – 1-2.9, 3-4.9, 5-9.9, 10+ years) Eligible cases •Research nurses checked patient eligibility according to inclusion/exclusion criteria •N=4,838 (RoI) and n=2,106 (NI) Questionnaires returned •N=2,494 (RoI) RR 54% •N=1,010 (NI) RR 48% •Overall n=3,504 RR 50% 5
- 6. NI RoI Same as expected 27% 26% Worse than expected 19% 20% No side effects experienced 13% 18%
- 7. 0 10 20 30 40 50 60 70 80 90 100 Prostatectomy HormoneTherapy Radiotherapy Monitoring Prostatectomy HormoneTherapy Radiotherapy Monitoring Prostatectomy HormoneTherapy Radiotherapy Monitoring Urinary Symptoms Impotence Loss of interest in sex PercentageofPatients Symptom/Side effect Previous Ongoing
- 8. 0 10 20 30 40 50 60 70 80 90 100 Urinary incontinence Loss interest sex Impotence Bowel Probs Breast Changes Hot Flushes Depression PercentageofPatients Ongoing side effects Prostatectomy Radiotherapy Hormone Therapy Monitoring
- 9. Preliminary analysis Biases relating to responders (prostate cancer survivors) and first survey responders Not yet standardised for age, stage and treatment received Multiple treatment groups need to be identified
- 10. Large cohort of prostate cancer survivors It compares 2 healthcare systems with different levels of uncovered disease and treatment It contributes to the debate of whether increased investigation and treatment, in the era of increased PSA testing leads to better health It is population-based Validated treatment data It used standardised instruments 10
Notes de l'éditeur
- Today I’m going to present preliminary results from an all-ireland population-based study on side effects, past and current, physical and psychological for men who have been diagnosed and treated for prostate cancer in Ireland over the past 17 years. I would like to thank my collaborators who worked with me on the study and am presenting to you today on their behalf.
- All Ireland Study – investigating side effects, regret and quality of life post prostate cancer investigation/treatment in the last 17 years All Ireland – similar men, 2 different healthcare systems, incidence, investigation and treatment differences
- This map shows the increased incidence inRoI compared to NI. Point out line that represents the border between the north and south.The average age at diagnosis in NI is ........... And is ..............for RoI.
- There were 3 phases of eligibility checks carried out by the research nurses – COIS and medical note review and the final eligibility was conducted with the patient’s GP – those who hadn’t been seen at the hospital in the past 18 months. 2 reminders were issued at 10 day intervals and a replacement questionnaire was also sent with the second reminderThe questionnaire was piloted with groups of men who attended a prostate cancer support group. Clinicians views were also incorporated in the final version of the questionnaire
- Less than one fifth reported not to have any side effects. We need to check if men who indicated that they did not have any side effects did not continue to tell us about their side effects. Need to include some more adjustments in these analysis.Also interesting to note similarities between 2 jurisdictions for all above.
- While treatment has beneficial effects for reducing pre treatment levels of incontinence it appears to do the opposite for impotence and loss of interest in sex.
- Urinary incontinence after treatment was common with one quarter of prostatectomy patients and 13% of radio and hormone therapy patients reporting ongoing symptoms. Approximately half of all men reported ongoing impotence following treatment. A loss of interest in sex was ongoing for 40% of men after any treatment and was highest for men who had prostatectomy. Bowel problems were ongoing for approximately one fifth of all men and was highest for men who had radio. Approximately 10% of men reported depression after treatment, an increase from 1 in 20 men before treatment with highest levels for men who had hormone therapy. Sweats/hot flushes and changes in breast tissue were more common with hormone therapy. The levels of depression were quite low following treatment but were higher for men who had hormone therapy compared to other treatments. This reflects what’s observed in clinical practice eg men who have hormone therapy have hot flushes etc.