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    Impact of centralisation of prostate cancer services on the choice of radical treatment

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    Authors
    Aggarwal, A.
    Han, L.
    Tree, A.
    Lewis, D.
    Roques, T.
    Sangar, Vijay K
    van der Meulen, J.
    Affiliation
    Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
    Issue Date
    2022
    
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    Abstract
    Objective: To assess the impact of centralisation of prostate cancer surgery and radiotherapy services on the choice of prostate cancer treatment. Patients and methods: This national population-based study used linked cancer registry data and administrative hospital-level data for all 16,621 men who were diagnosed between 1st Jan 2017 and 31st Dec 2018 with intermediate risk prostate cancer and underwent a radical prostatectomy (RP) or radical radiation therapy (RT) in the English National Health Service. Travel times by car to treating centres were estimated using a Geographic Information System. We used logistic regression to assess the impact of the relative proximity of alternative treatment options on the type of treatment received with adjustment for patient characteristics. Results: Of the 78 NHS hospitals that provide RT or RP for prostate cancer, 41% provide both, 36% provide RT and 23% provide RP. Compared to men who had both treatment options available at their nearest centre (57% received RT, 43% RP), men were less likely to receive RT if their nearest centre offered RP only and the extra travel time to a hospital providing RT was >15 minutes (RT 52%/RP 48%, OR 0.70 (0.58-0.85), p<0.001). Conversely, men were more likely to receive RT if their nearest centre offered RT and the extra travel time to a hospital providing RP was >15 minutes (RT 63%/RP 37%, OR 1.23 (1.08-1.40) p<0.001). There was a negligible impact on the type of treatment received if centres providing alternative treatment options were ≤15 minutes travel time from each other. Conclusion: The relative proximity of prostate cancer treatment options to a patient's residence is an independent predictor for the type of radical treatment received. Centralisation policies for prostate cancer should not focus on one treatment modality but consider all treatments to avoid a negative impact on treatment choice.
    Citation
    Aggarwal A, Han L, Tree A, Lewis D, Roques T, Sangar V, et al. Impact of centralization of prostate cancer services on the choice of radical treatment. BJU International. Wiley; 2022
    Journal
    BJU International
    URI
    http://hdl.handle.net/10541/625383
    DOI
    10.1111/bju.15830
    PubMed ID
    35726400
    Additional Links
    https://dx.doi.org/10.1111/bju.15830
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1111/bju.15830
    Scopus Count
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