Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.
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We conducted a multicentre, cohort study in seven hospitals in Spain. Patients' characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients' structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).
470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4% were physically active. Tumour size was classified as T1 in 41.0% and as T2 in 40% of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1% had low risk cancer according to the D'Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29-2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45-4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).
Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.
BMC urology 2015 Jul 02*** epublish ***
Xavier Bonfill, María José Martinez-Zapata, Robin W M Vernooij, María José Sánchez, María Morales Suárez-Varela, Javier de la Cruz, José Ignacio Emparanza, Montserrat Ferrer, José Ignacio Pijoán, Juan M Ramos-Goñi, Joan Palou, Stefanie Schmidt, Víctor Abraira, Javier Zamora, EMPARO-CU study group
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Xbonfill@santpau cat , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain mmartinezz@santpau cat , Institute of Biomedical Research (IIB Sant Pau), Iberoamerican Cochrane Centre, Barcelona, Spain rwmvernooij@cochrane es , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain mariajose sanchez easp@juntadeandalucia es , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Maria M Morales@uv es , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain jdlcruz@h12o es , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain JOSEIGNACIO EMPARANZA@osakidetza net , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain mferrer@imim es , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain joseignacio pijoanzubizarreta@osakidetza net , Health Services Research on Chronic Patients Network (REDISSEC), HTA Unit of the Canary Islands Health Service (SESCS), S/C de Tenerife, La Laguna, Spain juanmanuel ramosgoni@gmail com , Universitat Autònoma de Barcelona, Barcelona, Spain jpalou@fundacio-puigvert es , Department of Experimental and Health Sciences, Universidad Pompeu Fabra (UPF), Barcelona, Spain sschmidt@imim es , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain victor abraira@gmail com , CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain javier zamora@hrc es