The authors declare that they have no competing interest.
Study concepts: XB. Study design: XB, MJM. Data acquisition: All authors. Quality control of data and algorithms: MJM, RV. Data analysis and interpretation: XB, MJM, RV. Statistical analysis: RV, VA. Manuscript preparation: XB MJM, RV. Manuscript editing: All authors. Manuscript review: All authors. All authors read and approved the final manuscript.
Little is known about the healthcare process for patients with prostate cancer, mainly because hospital-based data are not routinely published. The main objective of this study was to determine the clinical characteristics of prostate cancer patients, the, diagnostic process and the factors that might influence intervals from consultation to diagnosis and from diagnosis to treatment.
We conducted a multicentre, cohort study in seven hospitals in Spain. Patients’ characteristics and diagnostic and therapeutic variables were obtained from hospital records and patients’ structured interviews from October 2010 to September 2011. We used a multilevel logistic regression model to examine the association between patient care intervals and various variables influencing these intervals (age, BMI, educational level, ECOG, first specialist consultation, tumour stage, PSA, Gleason score, and presence of symptoms) and calculated the odds ratio (OR) and the interquartile range (IQR). To estimate the random inter-hospital variability, we used the median odds ratio (MOR).
470 patients with prostate cancer were included. Mean age was 67.8 (SD: 7.6) years and 75.4 % were physically active. Tumour size was classified as T1 in 41.0 % and as T2 in 40 % of patients, their median Gleason score was 6.0 (IQR:1.0), and 36.1 % had low risk cancer according to the D’Amico classification. The median interval between first consultation and diagnosis was 89 days (IQR:123.5) with no statistically significant variability between centres. Presence of symptoms was associated with a significantly longer interval between first consultation and diagnosis than no symptoms (OR:1.93, 95%CI 1.29–2.89). The median time between diagnosis and first treatment (therapeutic interval) was 75.0 days (IQR:78.0) and significant variability between centres was found (MOR:2.16, 95%CI 1.45–4.87). This interval was shorter in patients with a high PSA value (p = 0.012) and a high Gleason score (p = 0.026).
Most incident prostate cancer patients in Spain are diagnosed at an early stage of an adenocarcinoma. The period to complete the diagnostic process is approximately three months whereas the therapeutic intervals vary among centres and are shorter for patients with a worse prognosis. The presence of prostatic symptoms, PSA level, and Gleason score influence all the clinical intervals differently.
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- Clinical intervals and diagnostic characteristics in a cohort of prostate cancer patients in Spain: a multicentre observational study
María José Martinez-Zapata
Robin WM Vernooij
María José Sánchez
María Morales Suárez-Varela
Javier de la Cruz
José Ignacio Emparanza
José Ignacio Pijoán
Juan M. Ramos-Goñi
on behalf of the EMPARO-CU study group
- BioMed Central
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