Past and current physical and psychological side-effects following prostate cancer treatments – an All-Ireland population-based study

Heather Kinnear, Frances Drummond, Linda Sharp, David Donnelly, Eamonn O’Leary, Anna Gavin

Investigation differences There has been a vast increase in the number of

PSA tests performed over last 10 yearsTreatment differences RoI patients receive more radiotherapy and

surgery and less hormone treatment than NI patients

More younger men in RoI are diagnosed with prostate cancer than in NI

Rates of diagnosis have been higher in RoI from 1996 onwards

Differences between NI and RoI

Why this research in Ireland?

• Incidence of prostate cancer is 34% higher

in RoI than in NI

Postal Questionnaire to men, any age, identified by Cancer registries, vetted for exclusions (end of life care, not aware of own diagnosis, cognitive/physical impairments) by Research Nurses/Clinicians/GP’s◦ 2 reminders◦ Standardised instruments used (EORTC QLQ C30,

EORTC PR25, DASS, Decision regret scale, EQ5D-5L)◦ Freephone facility set up – high volume of calls (13%

in both RoI (n=632/4,838) and NI (274/2,106)) ◦ Ethics and research governance etc

Methods

From Cance

r Registries

• Men diagnosed in NI and RoI with prostate cancer up to 17 years ago• N=12,900 (Stratified by time since diagnosis – 1-2.9, 3-4.9, 5-9.9, 10+ years)

Eligible

cases

• Research nurses checked patient eligibility according to inclusion/exclusion criteria

• N=4,838 (RoI) and n=2,106 (NI)

Questionnai

res return

ed

• N=2,494 (RoI) RR 54%• N=1,010 (NI) RR 48%• Overall n=3,504 RR 50%

Cohort

NI RoI

Same as expected

27% 26%

Worse than expected

19% 20%

No side effects experienced

13% 18%

Q. Overall were your side effects …?

Pro

state

ctom

y

Horm

one T

hera

py

Radio

thera

py

Monit

ori

ng

Pro

state

ctom

y

Horm

one T

hera

py

Radio

thera

py

Monit

ori

ng

Pro

state

ctom

y

Horm

one T

hera

py

Radio

thera

py

Monit

ori

ng

Urinary Symptoms Impotence Loss of interest in sex

0

10

20

30

40

50

60

70

80

90

100

PreviousOngoing

Symptom/Side effect

Perc

enta

ge o

f P

ati

ents

Urinary symtoms, impotence and loss of interest in sex

Urinar

y in

cont

inen

ce

Loss

inte

rest

sex

Impo

tenc

e

Bowel

Pro

bs

Breas

t Cha

nges

Hot Fl

ushe

s

Depre

ssio

n0

10

20

30

40

50

60

70

80

90

100

ProstatectomyRadiotherapyHormone TherapyMonitoring

Ongoing side effects

Perc

enta

ge o

f P

ati

ents

Ongoing side effects

Preliminary analysis Biases relating to responders (prostate

cancer survivors) and first survey responders

Not yet standardised for age, stage and treatment received

Multiple treatment groups need to be identified

Limitations

Large cohort of prostate cancer survivors It compares 2 healthcare systems with

different levels of uncovered disease and treatment

It contributes to the debate of whether increased investigation and treatment, in the era of increased PSA testing leads to better health

It is population-based Validated treatment data It used standardised instruments

Strengths of study

h.kinnear@qub.ac.ukTel: 028 9063 2618