Braga (11. Braga SFM, Souza MC, Oliveira RR, Andrade EIG, Acurcio FA, Cherchiglia ML. Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System. Rev Saude Publica. 2017;51:46.) Retrospective cohort study Brazil study |
16280 prostate cancer patients (staged I-IV) treated in the Brazilian Unified Health system between 2000-2006 |
The mortality rate of prostate cancer patients |
Patient information from Base Onco was used to predict overall survival after 5 years through application of the Kaplan-Meier method. Prostate cancer specific survival was predicted by applying Fine and Gray's competitive risks model |
- Approximately 25%(n=3160) of patients died due to prostate cancer* -Probability of overall survival = 0.5* - Probability of specific survival = 0.7* *= (after a minimum of 5 years) - Increased mortality due to late diagnosis, poor cancer treatment and declining medical conditions |
Sasse et al. (1919. Sasse AD, Wiermann EG, Herchenhorn D, Bastos DA, Schutz FA, Maluf FC, et al. First Brazilian Consensus of Advanced Prostate Cancer: Recommendations for Clinical Practice. Int Braz J Urol. 2017;43:407-15.) Clinical consensus Brazil study |
18-man panel of professionals in the field of prostate cancer from Brazil. Made up of oncologists, urologists and radiooncologists |
Clinical effectiveness of treatment via the Brazilian prostate cancer guidelines |
An adapted model of the St. Gallen Advanced prostate cancer consensus conference was used to generate 40 questions on epidemiology, treatment of local prostate cancer and screening. The specialists had 2 months to analyse. Each question was based on current guidelines, needed 2/3 of the panel vote for consensus to potentially change |
- Consensus on keeping serum testosterone below 50 ng/dL for castration - Consensus 71%(n =13) agreed intermittent hormonal blockage is appropriated in specific patients - Consensus 100% (n=18) that rise in PSA whilst on androgenic suppression defines castration resistance - Many areas showed no clear consensus, indicates weak evidence available |
Nardi (2020. Nardi AC, Reis RB, Zequi Sde C, Nardozza A Jr. Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology. Int Braz J Urol. 2012;38:155-64.) Cross-sectional web based survey Brazil study |
1082 physicians from Brazilian Urology Society providing data on their prostate cancer patients |
Clinical effectiveness of different treatments, comparing public and private health care |
Questionnaire emailed to urologists regarding information on clinical, pathological features (Gleason score) of prostate cancer as well as socioeconomic factors. TNM staging was also measured. Clinical data was analysed descriptively whilst the chi-square test compared the amount of variation between groups |
- Median PSA value = 10 ng/mL - Most frequent Gleason score was 5-6 52% patients (n= 531) - In public system a prostatectomy was most common initial care 47% patients (n=485) - Higher median PSA in public system than private (10 vs 6.8 ng/mL; P<0.001) - More patients in private system with no health insurance had to move for treatment than when treated publically (73% n= 126 vs 69% n= 705; P<0.0001) |
Paterson (2121. Paterson C, Kata SG, Nandwani G, Das Chaudhury D, Nabi G. Unmet Supportive Care Needs of Men With Locally Advanced and Metastatic Prostate Cancer on Hormonal Treatment: A Mixed Methods Study. Cancer Nurs. 2017;40:497-507.) Mixed methods study Cross sectional studies Semi-structured interviews UK study |
31 men with ≥ T3 stage prostate cancer from the UK |
Quality of life measure through physical, emotional sexual well being |
The supportive care needs survey was completed by patients to measure physical living, health, physiological needs and patient care. The self-efficacy scale was completed to measure their self-management. The European organisation for research and treatment of cancer quality of life of prostate cancer was completed to assess quality of life. Questionnaires were analysed using SPSS. |
- Reduced level of selfefficacy was reported in comparison with literature - 42% (n=13) reported lack of supportive care and empathy in relation to information of cancer spread -33% (n=10) reported increased fatigue - 30% (n=9) reported felt results were out of their control -30% (n=9)felt they were not given adequate information - Men reported a lack of overall understanding of their treatment |
Paterson (2222. Paterson C, Alashkham A, Windsor P, Nabi, G: Management and treatment of men affected by metastatic prostate cancer: evidence-based recommendations for practice. Int J Urol Nurs 2015; 10;44-55.) Literature review UK study |
NICE guidelines on prostate cancer treatment |
Quality of life measure through ensuring guidance is clear on how prostate cancer is diagnosed, progresses, managed and provides information for patient education |
Literature review conducted across electronic databases, searching quantitative and qualitative studies. UK and European guidelines also reviewed. Guidelines and article information on diagnosis, management were narratively assessed |
- Multidisciplinary team important to provide consistent high quality treatment - The use of patient reported outcomes (PROMS) are essential to overcome unmet supportive care needs - A holistic needs assessment (HNA) helps tailor and improve care for individual |
Watts et al. (2323. Watts S, Leydon G, Eyles C, Moore CM, Richardson A, Birch B, et al. A quantitative analysis of the prevalence of clinical depression and anxiety in patients with prostate cancer undergoing active surveillance. BMJ Open. 2015;5:e006674.) Cross-sectional questionnaire survey UK study |
313 men diagnosed with prostate cancer who were managed by active surveillance across urology departments from the UK |
Quality of life measure, through prevalence of clinically meaningful anxiety/depression after prostate cancer diagnosis |
Selected patients completed a hospital anxiety and depression scale questionnaire (HADS). Patients with a score of 8 or more were considered to have depression/anxiety. Social and demographic information was also obtained via questionnaire, with only data with a P<0.05 considered significant |
- Depression scale showed 13% (n=39) of patients had a score of ≥8 = clinical depression - Anxiety scale showed 23% (n=73) had a score of ≥8 = clinical anxiety - Only one demographic, Southampton, showed statistically significant probability (P<0.0005) of increased depression in men |
Payne (2424. Payne H, Clarke N, Huddart R, Parker C, Troup J, Graham J. Nasty or Nice? Findings from a UK Survey to evaluate the impact of the National Institute for Health and Clinical Excellence (NICE) clinical guidelines on the management of prostate cancer. Clin Oncol (R Coll Radiol). 2013;25:178-89.) Semi-structured questionnaires UK study |
61 oncologists from the NHS |
Evaluating clinical effect of treatment via NICE guidance pre- 2014 |
72 question survey completed initially (2008). Followed by a 2nd focused questionnaire (2010) with 22 questions assessing adherence to clinical guidelines and whether practice had changed after 2 years |
- 60% of participants felt NICE guidance would improve prostate cancer care - 30% of participants felt NICE guidance would degrade treatment - 61% of participants felt NICE guidance required updating |