Project summary

Background

Prostate cancer is the most commonly diagnosed male cancer and the third most common cause of male cancer death in Aotearoa/New Zealand. About 600 New Zealand men die from prostate cancer every year (NZ Cancer Statistics). For Maori men, prostate cancer ranks as the 2nd most common cause of cancer death after lung cancer (Robson 2010). For Māori, the age adjusted incidence in 2005 was 74.9 per 100,000 compared to 95 per 100,000 for the total population. Mortality due to prostate cancer was 32.9 per 100,000 for Maori compared to 19.9 per 100,000 for the total population (Ministry of Health 2009). Maori men are thus 20% less likely to be diagnosed with - but 65% more likely to die from prostate cancer than non-Maori men. However, once inequity in stage of diagnosis is accounted for, Maori men are 76% more likely to die of their prostate cancer than non-Maori men. This large inequity from diagnosis to death occurs along the treatment pathway and is suggestive of differences in access to and quality of care. Prostate cancer has the second largest inequity in cancer survival between Maori and non-Maori after uterine cancer. (Robson 2010). Prostate cancer has been ranked as the 3rd highest priority cancer to focus on for Maori cancer control (Scott 2011).

The study

Our proposal considers the pathways of care following a diagnosis of metastatic prostate cancer. We will incorporate three separate studies to provide a broad national perspective as well as an in-depth overview of the disease.

Study 1: National view of metastatic prostate cancer 2006-2010


We will examine the New Zealand Cancer Registry (NZCR) to identify all men with a diagnosis of metastatic prostate cancer from 1st Jan 2006 until 31st Dec 2010. We will carry out two principal studies using the routinely available cancer data. Firstly we will carry out a comparison of the use of pharmaceutical treatments in men with prostate cancer comparing usage in Maori and Pacific with non-Maori, non-Pacific. We will link the cancer registry data, the hospital admission data and the pharmaceutical prescribing data and estimate the use of key anti-androgen treatments by age, stage, primary treatment and ethnicity.  We will also identify second line therapies usually used in castrate resistant prostate cancer and compare their usage by ethnicity. The key outcome will thus be the proportion of Maori men treated 1) with anti-androgen therapy compared with Pacific men and non-Maori, non-Pacific. 2) the proportion of Maori men treated with pharmaceutical medications usually used in castrate resistant prostate cancer compared with Pacific and non-Maori, non-Pacific.

We will also carry out a survival analysis for all men with a diagnosis of metastatic prostate cancer comparing outcomes for Maori and Pacific men and non-Maori/non-Pacific for age, year of diagnosis and use of medications.

Study 2: Pathways and costs of metastatic prostate cancer 2009-2011


This study would be an in-depth examination of the characteristics of and treatment for men with metastatic prostate cancer within the Midland Cancer Network region; including Waikato, Lakes and Bay of Plenty District Health Boards. We would identify all new cases of metastatic prostate cancer in the region diagnosed during 2009-2012. Following on from Study 1 we would look at the proportion of Maori men with metastatic prostate cancer being offered various treatments including orchidectomy, palliative radiotherapy and anti-androgen therapy. Although the numbers are much smaller than the national data set the completeness of the data particularly around initial staging will allow a more robust estimate of the differences in treatment pathways for Maori and Pacific men as compared with non-Maori, non-Pacific. We would carry out a detailed cost analysis by estimating the patient costs in the first twelve months after diagnosis of metastatic disease or their costs from diagnosis to death if the period was less than 12 months. Key components will include hospital visits, admission costs, costs of surgery, radiotherapy and therapeutics.

Study 3: Understanding experiences of men diagnosed with metastatic cancer


This study will explore in-depth experiences of Maori and Pacific men living with a diagnosis of metastatic prostate cancer. This qualitative study would involve interviews with 10-15 Maori and Pacific men and/or their whanau looking at barriers and enablers of access to and quality of treatment for men with metastatic disease. We would ascertain their views on service acceptability, treatment and the acceptability of anti-androgen drug treatments. We would also consider patient and family experiences along their pathway and management of their care.

Research Impact  

The main outcomes of the study will be:

  1. A national overview of the epidemiology and pharmaceutical treatment of metastatic prostate cancer, including differences in pharmaceutical treatments by ethnicity;
  2. A detailed understanding of pathways to diagnosis and of access to and through treatment, and quality of treatment for Maori, Pacific and Other New Zealand men with metastatic prostate cancer.
  3. An in-depth understanding of the experiences of Maori and Pacific men living with metastatic prostate cancer.

An assessment of the health and economic costs of treatment for metastatic prostate cancer following diagnosis for Maori, Pacific and Other New Zealand men.