Factors associated with diagnostic and treatment intervals and the treatment received by prostate cancer patients in Queensland (#799)
Aim: To determine the demographic, clinical and quality of life factors that influence the time to diagnosis and treatment for men with prostate cancer and the type of treatment that they receive. Methods: Data were obtained by telephone interviews and self-administered questionnaires from a prospective sample of 1,064 men (response rate = 82%) who were diagnosed with prostate cancer in Queensland between 2005 and 2007. Stepwise processes were used to build multivariate models and results were presented in terms of either odds ratios (logistic regression) or adjusted predicted probabilities (multinomial regression). Results: Men were more likely to wait longer for a definitive diagnosis when they initially presented with symptoms or if they did not have private health insurance. The time between diagnosis and treatment was greater for those without private health insurance, who had less advanced cancer at diagnosis, or who were treated with radiotherapy alone. Patients who had a radical prostatectomy were younger, lived closer to tertiary treatment centres, had lower grade cancers and assessed their physical health as being above average, while androgen deprivation therapy was administered for more advanced disease. Watchful waiting was more common among those who were older, were symptomatic at presentation and who had a Gleason score of 6 or less. Two-thirds of the study cohort made their own decision regarding treatment. Conclusions: Our results demonstrate that some of the disparity in the timeliness of a definitive diagnosis and the commencement of treatment for prostate cancer patients is related to clinical factors and access to private health care. Furthermore, health status, proximity to services and tumour characteristics are among the factors that influence treatment choices. The findings also highlight the importance of making information regarding the benefits and risks of treatment options readily available to guide the decision-making process.