Introduction
Prostate cancer (CaP) is the commonest cancer for Victorian men ( 27% of all cancers) and the third-ranking cause of cancer deaths ( 12%) in 2013. EBRT is a standard treatment option for CaP and can cause adverse effects on bowel, bladder and sexual function. We aimed to use CaP clinical registry data to evaluate variation in patient adverse effects after EBRT in Victoria.
Method
Study subjects were men diagnosed with primary prostate cancer between 2009 and 2014, treated with EBRT in metropolitan Melbourne, or one of three regional integrated cancer service (ICS) regions. Information on change in general and disease specific health outcome 12 and 24 months after the initial diagnosis were obtained using a modified EPIC-26 survey.
Results
The proportion of men who noted “big” (the most troublesome category) bother was compared between the ICS regions in Victoria (n=1031). There were no differences in the proportion of men reporting a big bother in urinary, bowel, and sexual function across the regions at 12 months, nor in urinary or sexual bother at 24 months. However, at 24 months following diagnosis, patients treated in one regional cancer service with EBRT had a higher proportions with “big bother” (12.28%) in bowel function compared to the rest of the Victoria (5.03%); (ᵡ2=5.51; p=0.01). Predictive factors for this was assessed using multivariable logistic analysis; the only significant factor was location of EBRT (OR=3.6; 95% CI 1.5-8.7; p=0.004). There was no association over time in that region with change in EBRT technique from 3D-CRT to IMRT (ᵡ2=1.055; p=0.590).
Conclusion
Cancer clinical registries have the capacity to identify hitherto unrecognised but clinically important variation in outcomes. The observational data strongly suggests men treated in one region have more bowel problems than experienced elsewhere, and this association was stable as EBRT techniques changed.