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Regional Variations in Quality of Survival Among Men with Prostate Cancer Across the United Kingdom

Lookup NU author(s): Professor Linda Sharp



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2019 The Author(s) Background: Prostate cancer incidence, treatment, and survival rates vary throughout the UK, but little is known about regional differences in quality of survival. Objective: To investigate variations in patient-reported outcomes between UK countries and English Cancer Alliances. Design, setting, and participants: A cross-sectional postal survey of prostate cancer survivors diagnosed 18–42 mo previously. Outcome measurements and statistical analysis: Urinary, bowel, and sexual problems and vitality were patient reported using the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. General health was also self-assessed. Regional variations were identified using multivariable log-linear regression. Results and limitations: A total of 35 823 men responded, 60.8% of those invited. Self-assessed health was significantly lower than the UK average in Wales and Scotland. Respondents reported more urinary incontinence in Scotland, more urinary irritation/obstruction in Scotland and Northern Ireland (NI), poorer bowel function in Scotland and NI, worse sexual function in Scotland, and reduced vitality/hormonal function in Scotland, Wales, and NI. Self-assessed health was poorer than the English average in South Yorkshire and North-East and Cumbria, with more urinary incontinence in North-East and Cumbria and Peninsula, greater sexual problems in West Midlands, and poorer vitality in North-East and Cumbria and West Midlands. Limitations include difficulty identifying clinically significant differences and limited information on pretreatment conditions. Conclusions: Despite adjustment for treatment, and clinical and sociodemographic factors, quality of survival among prostate cancer survivors varied by area of residence. Adoption of best practice from areas performing well could support enhanced survival quality in poorer performing areas, particularly with regard to bowel problems and vitality, where clinically relevant differences were reported. Patient summary: We conducted a UK-wide survey of patient's quality of life after treatment for prostate cancer. Outcomes were found to vary depending upon where patients live. Different service providers need to ensure that all prostate cancer patients receive the same follow-up care. Prostate cancer survivors from England report better quality of survival than those from Scotland, Wales, and Northern Ireland, with differences unrelated to treatment type, and patient and disease characteristics. Within England, regional variations in general health and functional outcome also exist.

Publication metadata

Author(s): Donnelly DW, Gavin A, Downing A, Hounsome L, Kearney T, McNair E, Allan D, Huws DW, Wright P, Selby PJ, Kind P, Watson E, Wagland R, Wilding S, Butcher H, Mottram R, Allen M, McSorley O, Sharp L, Mason MD, Cross WR, Catto JWF, Glaser AW

Publication type: Article

Publication status: Published

Journal: European Urology

Year: 2019

Volume: 76

Issue: 2

Pages: 228-237

Print publication date: 01/08/2019

Online publication date: 04/05/2019

Acceptance date: 12/04/2019

Date deposited: 13/05/2019

ISSN (print): 0302-2838

ISSN (electronic): 1873-7560

Publisher: Elsevier B.V.


DOI: 10.1016/j.eururo.2019.04.018


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