Using routinely collected data to stratify prostate cancer patients into phases of care in the United Kingdom: implications for resource allocation and the cancer survivorship programme

Abstract

Background: Prostate cancer is the most commonly diagnosed malignancy in British men. The increasing use of PSA screening test has resulted in many more patients being diagnosed with this condition. Advances in its treatment have improved the survival rate among these patients. By 2040, the prevalence of prostate cancer survivors is expected to reach 830 000. Many of them will require medical support for the management of their progressive disease or long-term toxicities from previous treatments. Successful implementation of the cancer survivorship programme among these patients depends on a good understanding of their demand on the health care system. The aim of this study is to segment the population of prostate cancer survivors into different needs groups and to quantify them with respect to their phase of care.

Methods: Incidence, survival, prevalence and mortality data collected and reported by cancer registries across the United Kingdom have been used for the current study to provide indicative estimates as to the number of prostate cancer patients in each phase of the care pathway in a year.

Results: The majority of prostate cancer patients are in the post-treatment monitoring phase. Around a fifth of the patients are either receiving treatment or in the recovery and readjustment phase having completed their treatment in the preceding year. Thirteen percent have not received any anticancer treatment, a further 12% (32 000) have developed metastatic disease and 4% are in the final stage of their lives.

Conclusion: On the basis of our estimates, patients undergoing post-treatment monitoring phase will constitute the biggest group among prostate cancer survivors. The pressure to provide adequate follow-up care to these patients will be a challenge. There is limited data available to definitively quantify the number of prostate cancer patients who follow different pathways of care, and we hope this study has highlighted the importance of collecting and reporting of such data to help future health care planning for these patients.

Figure 1

Assumptions and calculations used to estimate the prostate cancer care pathway.

Figure 2

People newly diagnosed, people living with prostate cancer by year since diagnosis and deaths for people with a prostate cancer diagnosis, UK, 2010. Data notes: prostate cancer (ICD-10 C61). Incidence is the number of newly diagnosed cases and is a count of tumours in 2010. Prevalence is a count of the number of people living with cancer at the end of 2010. Mortality is a count of deaths due to cancer only in 2010. In addition, a number of men living with prostate cancer will die from other causes. Sources: Office for National Statistics; Information Services Division (ISD) Scotland; Welsh Cancer Intelligence & Surveillance Unit; Northern Ireland Cancer Registry; Cancer Research UK Cancer mortality – UK statistics (Nov 2010); Maddams et al (2009).

Figure 3

Cancer care pathway – estimating the number of people in the United Kingdom, by cancer type, 2010. Data notes: for each cancer type, the size of the boxes reflects the approximate proportion of people in each phase. However, it should be noted that there is double counting for people who are diagnosed and die in the same year An approximation of this is presented in brackets within the end of life phase for each cancer, that is, for prostate cancer of the total of 11 000 men classified as end of life, around 2000 men die within the first year of diagnosis (2000, year 1). Percentages presented in the text exclude those who die in the first year, in the denominator. Female breast cancer (ICD-10 C50), prostate cancer (ICD-10 C61), colorectal cancer, which includes colon, rectum and anus (ICD-10 C18-C21), and lung cancer, which includes lung, bronchus and trachea (ICD-10 C33-C34). Sources: estimated based on Maddams et al (2009, 2012); Office for National Statistics and London School of Hygiene and Tropical Medicine, 2012. Cancer Survival Rates - Cancer Survival in England: Patients Diagnosed, 2006–2010 and Followed up to 2011; Cancer Research UK Cancer mortality – UK statistics (Nov 2010); Personal Communication for incidence trends from Office for National Statistics, Information Services Division (ISD) Scotland, Northern Ireland Cancer Registry, Welsh Cancer Intelligence and Surveillance Unit.