The impact of a universal, streamlined diagnostic pathway on socioeconomic health inequality in prostate cancer.
BAUS ePoster online library. Bass E. 06/22/21; 319022; p11-4
Disclosure(s): HUA's research is supported by core funding from the United Kingdom’s National Institute of Health Research (NIHR) Imperial Biomedical Research Centre. HUA currently receives funding from the Wellcome Trust, Medical Research Council (UK), Cancer Research UK, Prostate Cancer UK, The Urology Foundation, BMA Foundation, Imperial Health Charity, NIHR Imperial BRC, Sonacare Inc., Trod Medical and Sophiris Biocorp for trials in prostate cancer. HUA was a paid medical consultant for Sophiris Biocorp in the previous 3 years.
Mr. Edward Bass
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Abstract
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Introduction: Health outcome disparities in prostate cancer can be attributed in particular to ethnicity and socioeconomic status. We assess the impact of a standardised regional diagnostic pathway on cancer diagnostic outcome equality.
Methods: 1439 consecutive men were referred for investigation of possible prostate cancer (04/2017-07/2020), with men undergoing multiparametric MRI and, if required, transperineal targeted and systematic biopsy. Age, presenting PSA and Gleason grade group (GG) at biopsy was recorded. Men were sorted by the index of multiple deprivation rank (IMD) of their lower layer super output area, (specific geographical location in which they live) and the percent white population in their political constituency. Equality of disease burden, defined by diagnosis with high-risk disease (PSA >/=20 and Gleason GG >/=4+3) by ethnicity and deprivation was assessed by the Gini coefficient (Perfect equality=0.00; complete inequality=1.00)).
Results: Median age was 69 [IQR 62-74] years and median PSA 7.0 [IQR 5.1-10.3] ng/ml. 74 had a PSA >/= 20ng/dL and 142 diagnosed with Gleason GG >/=4+3. Gini coefficient for IMD correlation with PSA was 0.03; it was 0.08 for IMD and Gleason GG >/=4+3. Gini coefficient for percent white population correlation with PSA was 0.01 and 0.05 for GG >/=4+3.
Conclusions: The establishment of a standardised regional diagnostic pathway within a universal healthcare system such as the NHS contributes to a high degree of health equality.
Methods: 1439 consecutive men were referred for investigation of possible prostate cancer (04/2017-07/2020), with men undergoing multiparametric MRI and, if required, transperineal targeted and systematic biopsy. Age, presenting PSA and Gleason grade group (GG) at biopsy was recorded. Men were sorted by the index of multiple deprivation rank (IMD) of their lower layer super output area, (specific geographical location in which they live) and the percent white population in their political constituency. Equality of disease burden, defined by diagnosis with high-risk disease (PSA >/=20 and Gleason GG >/=4+3) by ethnicity and deprivation was assessed by the Gini coefficient (Perfect equality=0.00; complete inequality=1.00)).
Results: Median age was 69 [IQR 62-74] years and median PSA 7.0 [IQR 5.1-10.3] ng/ml. 74 had a PSA >/= 20ng/dL and 142 diagnosed with Gleason GG >/=4+3. Gini coefficient for IMD correlation with PSA was 0.03; it was 0.08 for IMD and Gleason GG >/=4+3. Gini coefficient for percent white population correlation with PSA was 0.01 and 0.05 for GG >/=4+3.
Conclusions: The establishment of a standardised regional diagnostic pathway within a universal healthcare system such as the NHS contributes to a high degree of health equality.
Introduction: Health outcome disparities in prostate cancer can be attributed in particular to ethnicity and socioeconomic status. We assess the impact of a standardised regional diagnostic pathway on cancer diagnostic outcome equality.
Methods: 1439 consecutive men were referred for investigation of possible prostate cancer (04/2017-07/2020), with men undergoing multiparametric MRI and, if required, transperineal targeted and systematic biopsy. Age, presenting PSA and Gleason grade group (GG) at biopsy was recorded. Men were sorted by the index of multiple deprivation rank (IMD) of their lower layer super output area, (specific geographical location in which they live) and the percent white population in their political constituency. Equality of disease burden, defined by diagnosis with high-risk disease (PSA >/=20 and Gleason GG >/=4+3) by ethnicity and deprivation was assessed by the Gini coefficient (Perfect equality=0.00; complete inequality=1.00)).
Results: Median age was 69 [IQR 62-74] years and median PSA 7.0 [IQR 5.1-10.3] ng/ml. 74 had a PSA >/= 20ng/dL and 142 diagnosed with Gleason GG >/=4+3. Gini coefficient for IMD correlation with PSA was 0.03; it was 0.08 for IMD and Gleason GG >/=4+3. Gini coefficient for percent white population correlation with PSA was 0.01 and 0.05 for GG >/=4+3.
Conclusions: The establishment of a standardised regional diagnostic pathway within a universal healthcare system such as the NHS contributes to a high degree of health equality.
Methods: 1439 consecutive men were referred for investigation of possible prostate cancer (04/2017-07/2020), with men undergoing multiparametric MRI and, if required, transperineal targeted and systematic biopsy. Age, presenting PSA and Gleason grade group (GG) at biopsy was recorded. Men were sorted by the index of multiple deprivation rank (IMD) of their lower layer super output area, (specific geographical location in which they live) and the percent white population in their political constituency. Equality of disease burden, defined by diagnosis with high-risk disease (PSA >/=20 and Gleason GG >/=4+3) by ethnicity and deprivation was assessed by the Gini coefficient (Perfect equality=0.00; complete inequality=1.00)).
Results: Median age was 69 [IQR 62-74] years and median PSA 7.0 [IQR 5.1-10.3] ng/ml. 74 had a PSA >/= 20ng/dL and 142 diagnosed with Gleason GG >/=4+3. Gini coefficient for IMD correlation with PSA was 0.03; it was 0.08 for IMD and Gleason GG >/=4+3. Gini coefficient for percent white population correlation with PSA was 0.01 and 0.05 for GG >/=4+3.
Conclusions: The establishment of a standardised regional diagnostic pathway within a universal healthcare system such as the NHS contributes to a high degree of health equality.
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