When it comes to prostate cancer diagnosis and treatment, Maori men emerge worse in most or all statistics and there is significant variation in screening between GP practices, with Maori and rural men less likely to be screened.
These are the key findings to emerge from a three-year study exploring the pathways of care associated with prostate cancer which was conducted by the Midland Cancer Network in conjunction with researchers from the University of Auckland.
The study was launched today at Waikato Hospital’s Bryant Education Centre, where Health Minister Tony Ryall featured as keynote speaker ().
Funded by the Health Research Council and Ministry of Health, the Midland Prostate Cancer Project researched access to quality of care, with a particular focus on urban vs. rural men and Māori vs. non-Māori men.
“We wanted to understand more about the care pathway for men following an abnormal prostate-specific antigen (PSA) test, and to demonstrate the equity issues, costs and complications arising from diagnosis,” says Professor Ross Lawrenson who led the study.
“Among our findings, we have found significant variation in screening between GP practices, with Māori and rural men less likely to be screened.
“There is also considerable unnecessary screening of men aged 70 years and over, even in men over 70 years who were asymptomatic with a history of negative PSA results. Very few of these men went further along the pathway to the referral and biopsy stage.”
Speaking at the launch today, Mr Ryall said, “the study showed good results for men with prostate cancer. There is a high survival rate – with a majority of men surviving over ten years.
“It has also identified areas where we can make future improvements to the work already being done to improve patient care.
“The report made 18 recommendations which support the work already underway by the Ministry of Health to improve health outcomes for men with prostate cancer.”
The study found that most PSA testing is conducted for screening purposes, most commonly when the individual is being examined for another reason.
It also found that Māori men are significantly less likely to be screened and tested than non-Māori; that Māori men have an overall lower rate of prostate cancer than non-Māori men, but their mortality is much higher with Māori men being more likely to die with and of prostate cancer compared to non-Māori men.
The researchers believe the disparity in survival rates is also a factor of location and socio-economic situations.
The study population was 37,529 New Zealand men who had been diagnosed with prostate cancer in the period 1 January 1996 – 31 December 2010, with 5748 (or 15 per cent) residing in the Midland Cancer Network region at the time of diagnosis.
More than 30 GP practices in the region were involved with the study and helped researchers to identify the pathways for patients following diagnosis.
Professor Lawrenson said the study also looked at the costs associated with prostate cancer which extend beyond the health professional to social, economic, psychological and physical effects, affecting both the man and his family.
This is particularly notable with Māori men.
“We interviewed more than 100 men who had been diagnosed with prostate cancer and found that many men and their families want more information at the primary health care level, and that Māori men and their families need long-term post-treatment support ranging from counselling to navigating the healthcare system,” he said.
“Our goal was to understand the prostate cancer pathway, across New Zealand and in the Midland Region in particular.
“We believe our research shows that clear recommendations for GPs regarding PSA testing, referrals to specialists, monitoring after an abnormal PSA test, the recording of data, and post-treatment care and support will improve that pathway.”
Professor Lawrenson and his team have developed recommendations, including:
- Regional cancer networks to record basic information on all men newly diagnosed with prostate cancer.
- Primary healthcare professionals need to give patients more information and information that is culturally appropriate.
- Men newly diagnosed should have a digital rectal examination (DRE) as part of their initial assessment.
- Men over 70 who have had a previously negative PSA test should not be screened again.
- Standardisation in recording biopsies and histology.
- Clear guidelines for managing men with localised prostate cancer.
- Further research to identify the reasons for higher mortality for Māori men
- More support for Māori men and their partners who identified a higher long-term need for assistance with the healthcare system and further information
- Post-treatment counselling to manage social, economic, psychological and physics outcomes, particularly for Māori men and their partners
- Funding for dedicated sexual function support as part of post-treatment rehabilitation.
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