Research Article: Phase of care prevalence for prostate cancer in New South Wales, Australia: A population-based modelling study

Date Published: February 8, 2017

Publisher: Public Library of Science

Author(s): Xue Qin Yu, Qingwei Luo, David P. Smith, Mark S. Clements, Manish I. Patel, Dianne L. O’Connell, Stephanie Filleur.

http://doi.org/10.1371/journal.pone.0171013

Abstract

To develop a method for estimating the future numbers of prostate cancer survivors requiring different levels of care.

Analysis of population-based cancer registry data for prostate cancer cases (aged 18–84 years) diagnosed in 1996–2007, and a linked dataset with hospital admission data for men with prostate cancer diagnosed during 2005–2007 in New South Wales (NSW), Australia.

Cancer registry data (1996–2007) were used to project complete prostate cancer prevalence in NSW, Australia for 2008–2017, and treatment information from hospital records (2005–2007) was used to estimate the inpatient care needs during the first year after diagnosis. The projected complete prevalence was divided into care needs-based groups. We first divided the cohort into two groups based on patient’s age (<75 and 75–84 years). The younger cohort was further divided into initial care and monitoring phases. Cause of death data were used as a proxy for patients requiring last year of life prostate cancer care. Finally, episode data were used to estimate the future number of cases with metastatic progression. Of the estimated total of 60,910 men with a previous diagnosis of prostate cancer in 2017, the largest groups will be older patients (52.0%) and younger men who require monitoring (42.5%). If current treatment patterns continue, in the first year post-diagnosis 41% (1380) of patients (<75 years) will have a radical prostatectomy, and 52.6% (1752) will be likely to have either active surveillance, external beam radiotherapy or androgen deprivation therapy. About 3% will require care for subsequent metastases, and 1288 men with prostate cancer are likely to die from the disease in 2017. This method extends the application of routinely collected population-based data, and can contribute much to the knowledge of the number of men with prostate cancer and their health care requirements. This could be of significant use in planning future cancer care services and facilities in Australia.

Partial Text

Prostate cancer is the most common non-skin cancer among Australian men, with 21,800 new diagnoses in 2009 [1], and as the population grows and ages it is expected that prostate cancer incidence will continue to increase [2]. Fortunately, earlier detection as a result of widespread prostate-specific antigen (PSA) testing and improved treatments mean that the majority of newly diagnosed prostate cancer patients will live for many years after their diagnosis [3], but with an expected increase in both incidence and years of life after diagnosis, the prevalence of prostate cancer will increase significantly in the future.

The number of NSW resident men aged less than 85 years with a previous diagnosis of prostate cancer is projected to rise by about 60% in 10 years, from 38,322 in 2007 to 60,910 in 2017 [4]. The magnitude of this increase varies across age groups however, with a steeper increase among men aged 75–84 years, and a more moderate rise for those aged <75 years (Fig 2). As reported in the previous publication [4], the increased incidence rates should be the major contributors to this increase in prevalence along with population growth and ageing. Historical data indicated that the age-standardised incidence rates increased from 113.8 per 100,000 in 1996 to 157.6 per 100,000 in 2007, and our age-period-cohort model suggested that the increasing trend would peak at 181.8 per 100,000 in 2015, then start to drop slightly in 2016 (181.6 per 100,000) to 2017 (180.8 per 100,000). In contrast, observed mortality data showed that the annual number of deaths from prostate cancer decreased slightly over time, from 673 in 1996 to 622 in 2007 among men aged less than 85 years because of population growth and ageing. In this study we identified stratified pathways of care for men living with prostate cancer using data from a well-established, long-standing Australian population-based cancer registry, and estimated the likely magnitude of groups of survivors who may require prostate cancer services and care in the future. Such evidence-based information is essential for better understanding the number of men with prostate cancer and their likely demands on the health care system. This is a step forward in the use of routinely collected population-based data to provide policy and clinically relevant information about the future health service needs for patients at different stages of their cancer journey [5,17,18,19]. It is therefore a useful tool for planning future cancer care services and facilities, with the goal of improving the cancer experience for survivors, their caregivers and their families.   Source: http://doi.org/10.1371/journal.pone.0171013