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Epidemiology
Research
Cancer-related hospitalisations and ‘unknown’ stage prostate cancer: a population-based record linkage study
  1. Qingwei Luo1,2,
  2. Xue Qin Yu1,2,
  3. David Paul Smith1,2,3,
  4. David Eamon Goldsbury1,
  5. Claire Cooke-Yarborough4,
  6. Manish Indravadan Patel5,6,
  7. Dianne Lesley O'Connell1,2,7
  1. 1Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
  2. 2Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
  4. 4New South Wales Cancer Registry, Cancer Institute NSW, Sydney, New South Wales, Australia
  5. 5Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
  6. 6Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
  7. 7School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  1. Correspondence to Qingwei Luo; qingweil{at}nswcc.org.au

Abstract

Objectives To identify reasons for prostate cancer stage being recorded as ‘unknown’ in Australia's largest population-based cancer registry.

Design Prospective population-based cohort.

Setting New South Wales (NSW) is the most populous state in Australia, with almost one third of the total national population.

Participants NSW Cancer Registry (NSWCR) records for prostate cancer cases diagnosed in 2001–2009 were linked to the NSW Admitted Patient Data Collection (APDC) for 2000–2010. All patients in this study had a minimum of 12 months follow-up in the hospital episode records after their date of diagnosis as recorded by the NSWCR.

Main outcome measures Incidence of ‘unknown’ stage prostate cancer and cancer-specific survival.

Results Of 50 597 prostate cancer cases, 39.9% were recorded as having ‘unknown’ stage. Up to 4 months after diagnosis, 77.2% of cases without a hospital-reported cancer diagnosis were recorded as having ‘unknown’ stage. Among those patients with a hospital-reported cancer diagnosis, stage was ‘unknown’ for 7.6% of cases who received a radical prostatectomy (RP) and for 34.0% of cases who had procedures other than RP. In the latter group, the factors that were related to having ‘unknown’ stage were living in disadvantaged areas (adjusted OR (aOR) range: 1.13 to 1.20), attending a private hospital (aOR range: 1.25 to 2.13), having day-only admission for care (aOR=1.23, 95% CI 1.11 to 1.36), or having procedures other than multiple procedures with imaging (eg, biopsy only, aOR range: 1.11 to 1.45).

Conclusions Over half of ‘unknown’ stage prostate cancer cases did not have a hospital-reported prostate cancer diagnosis within the 4 months after initial diagnosis. We identified differences in the likelihood of cases being recorded as ‘unknown’ stage based on socioeconomic status and facility type, which suggests that further investigation of reporting practices in relation to diagnostic and treatment pathways is required.

  • prostate cancer
  • unknown stage at diagnosis
  • population-based cancer registry
  • socio-economic status
  • data linkage
  • health service

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi-org.ezproxy.u-pec.fr/10.1136/bmjopen-2016-014259

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    Footnotes

    • Twitter Follow Qingwei Luo @qingweil

    • Contributors QL designed the study with input from XQY and DLO. QL performed the literature review, statistical analysis and interpretation of the results and drafted the manuscript. DLO and XQY guided the analysis and revised the manuscript. DPS contributed to the interpretation of the results. DEG provided advice on the data analysis. CC-Y provided technical input regarding cancer registry procedures. MP provided advice on clinical practice. DPS, DEG, CC-Y and MIP reviewed the manuscript. All authors read and approved the final manuscript.

    • Funding This study was funded by the Prostate Cancer Foundation of Australia (YI-0410). DPS was supported by an Australian National Health and Medical Research Council Training Fellowship (App1016598).

    • Competing interests None declared.

    • Ethics approval This study was approved by the NSW Population and Health Services Research Ethics Committee (Reference: 2010/04/223). The study uses existing, routinely collected and de-identified health records and does not involve any direct contact with participants. The Ethics Committee waived the need for individual consent from participants.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.