Oral Presentation COSA-IPOS Joint Scientific Meeting 2012

A method to project prevalence by phase of care for prostate cancer (#162)

Xue Qin Yu 1 2 , Qingwei Luo 1 3 , David P Smith 1 , Mark S Clements 4 , Dianne L O’Connell 1 2 5 6
  1. Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
  2. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
  3. PhD candidate, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  5. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  6. School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia

Aims
With a growing number of men living with prostate cancer in Australia, methods to assess the health demands of this group are of increasing importance. We described previously a statistical method to project prevalence for prostate cancer (Yu et al. 2011 Asia-Pac J Clin Oncol). We developed a method to estimate the future health demands of this group of men and provide more meaningful data for healthcare planning purposes.

Methods
The prevalence of prostate cancer was projected forward (2008-2017) by modeling incidence and survival using data from the NSW Central Cancer Registry (1990-2007). We then decomposed the projected prevalence into four phases of care: initial care (up to 12 months after diagnosis), long-term survivors (those with no excess mortality risk), continued monitoring (those between initial care and long-term survivors), and those in the last year of life. Finally, the NSW Admitted Patient Data Collection (2001-2007) was used to estimate the need for radical prostatectomy (RP) by prostate cancer patients in initial care.

Results
There were 38,711 men living with prostate cancer in NSW in 2007. This number is expected to increase to 84,690 by 2017 based on our modeling. The majority will require continued monitoring (39.9%) or will be long-term survivors (43.4%). 14.5% (12,254) will need initial care and 2.2% will need end of life care. If current treatment patterns continue, of those under initial care, 31% (3,800) will have a RP; the others will be treated by radiotherapy, active surveillance or androgen deprivation therapy. And if we extrapolate the estimated prevalence to the Australian population, a total of 267,250 men will be living with prostate cancer in 2017.

Conclusions
Our method apportions cancer prevalence into homogeneous groups according to expected healthcare needs. As the healthcare needs for prostate cancer are expected to increase by about 2.2 fold by 2017, designing a health system that can respond to and resource this increasing service demand is an extremely important issue.