Lesley Smith1, Amy Downing2, Paul Norman3, Penny Wright4, Luke Hounsome5, Eila Watson6, Richard Wagland7, Peter Selby8, Paul Kind9, David W Donnelly10, Hugh Butcher4, Dyfed Huws11, Emma McNair12, Anna Gavin10, Adam W Glaser13. 1. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, Leeds, UK. Electronic address: L.F.Smith@leeds.ac.uk. 2. Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK. 3. School of Geography, University of Leeds, Leeds, UK. 4. Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK. 5. National Cancer Registration and Analysis Service, Public Health England, Bristol, UK. 6. Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK. 7. Faculty of Health Sciences, University of Southampton, Southampton, UK. 8. Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK. 9. Academic Unit of Health Economics, University of Leeds, Leeds, UK. 10. Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK. 11. Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK. 12. Information Services Division, NHS National Services Scotland, Edinburgh, UK. 13. Leeds Institute of Data Analytics, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Abstract
BACKGROUND: In the UK, inequalities exist in prostate cancer incidence, survival and treatment by area deprivation and rurality. This work aimed to identify variation in patient-reported outcomes of men with prostate cancer by area type. METHODS: A population-based survey of men 18-42 months after prostate cancer diagnosis (N = 35608) measured self-assessed health (SAH) using the EQ-5D and five functional domains using the Expanded Prostate Cancer Index Composite (EPIC-26). RESULTS: Mean SAH was higher for men in least deprived areas compared to most deprived (difference 6.3 (95 %CI 5.6-7.2)). SAH scores were lower for men in most urban areas compared to most rural (difference 2.4 (95 %CI 1.8-3.0)). Equivalent estimates in the general population reported a 13 point difference by deprivation and a 4 point difference by rurality. For each EPIC-26 domain, functional outcomes were better for men in the least deprived areas, with clinically meaningful differences observed for urinary incontinence and hormonal function. There were no clinically meaningful differences in EPIC-26 outcomes by rurality with less than a three point difference in scores for each domain between urban and rural areas. CONCLUSION: In men 18-42 months post diagnosis of prostate cancer in the UK, impacts of area deprivation and rurality on self-assessed health related quality of life were not greater than would be expected in the general population. However, clinically meaningful differences were identified for some prostate functional outcomes (urinary and hormonal function) by deprivation. No impact by rurality of residence was identified.
BACKGROUND: In the UK, inequalities exist in prostate cancer incidence, survival and treatment by area deprivation and rurality. This work aimed to identify variation in patient-reported outcomes of men with prostate cancer by area type. METHODS: A population-based survey of men 18-42 months after prostate cancer diagnosis (N = 35608) measured self-assessed health (SAH) using the EQ-5D and five functional domains using the Expanded Prostate Cancer Index Composite (EPIC-26). RESULTS: Mean SAH was higher for men in least deprived areas compared to most deprived (difference 6.3 (95 %CI 5.6-7.2)). SAH scores were lower for men in most urban areas compared to most rural (difference 2.4 (95 %CI 1.8-3.0)). Equivalent estimates in the general population reported a 13 point difference by deprivation and a 4 point difference by rurality. For each EPIC-26 domain, functional outcomes were better for men in the least deprived areas, with clinically meaningful differences observed for urinary incontinence and hormonal function. There were no clinically meaningful differences in EPIC-26 outcomes by rurality with less than a three point difference in scores for each domain between urban and rural areas. CONCLUSION: In men 18-42 months post diagnosis of prostate cancer in the UK, impacts of area deprivation and rurality on self-assessed health related quality of life were not greater than would be expected in the general population. However, clinically meaningful differences were identified for some prostate functional outcomes (urinary and hormonal function) by deprivation. No impact by rurality of residence was identified.
Authors: Preveina Mahadevan; Mia Harley; Stuart Fordyce; Susan Hodgson; Rebecca Ghosh; Puja Myles; Helen Booth; Eleanor Axson Journal: J Epidemiol Community Health Date: 2022-07-28 Impact factor: 6.286