The trajectory of patients who die from metastatic prostate cancer: a population‐based study

Abstract

ObjectivesTo describe health service use, symptom and survival characteristics in metastatic prostate cancer (mPCa) in order to outline usual care practices and identify future opportunities to improve the quality of care in this patient group. Patients and MethodsThis population cohort study, conducted in Victoria, Australia, used 10 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) of linked hospital discharge, emergency visit, and death registration data, to track patients from their first inpatient admission with mPCa until death. Descriptive statistics on inpatient health service use, symptoms, procedures, survival, and place of death are presented. ResultsIn all, 4436 patients survived a median (interquartile range [IQR]) of 4 (1, 12) months from their first multiday admission with mPCa. They had a median (IQR) of 3 (1, 9) admissions, 1 (0, 2) emergency department presentation, and 35 (18, 63) days admitted to hospital. Lower urinary tract symptoms were common (50%), and 21% underwent lower urinary tract procedures, whilst 48% had blood product transfusions. In the last month of life, 3685 (83%) had at least one indicator of aggressive end-of-life care, including 48% with more than one acute hospital admission, and 55% staying ≥14 days. Hospital-based palliative care was accessed by 2657 (60%), occurring a median (IQR) of 30 (11, 74) days before death. In all, 23% died in the community, whilst 77% died in hospital, of whom 55% died in an acute hospital bed. ConclusionHalf of all decedents first admitted for a multiday stay with mPCa survived <4 months thereafter. They had a marked symptom burden, underwent multiple procedures and had multiple admissions. In all, 40% of patients did not receive any hospital-based palliative care. Several opportunities exist to improve the timely transition to palliative care services with mPCa. These data form a benchmark against which future improvements to palliative care integration may be measured.

TheraP: a randomized phase 2 trial of 177Lu‐PSMA‐617 theranostic treatment vs cabazitaxel in progressive metastatic castration‐resistant prostate cancer (Clinical Trial Protocol ANZUP 1603)

“…Secondary endpoints in this trial of PFS and OS are, however, of great interest. The trial will also obtain data on pain response, adverse events and health‐related quality of life which are important considerations in this patient cohort who are usually symptomatic from their disease or treatment‐related effects . Additionally, this study will provide outcome and treatment data on patients not eligible for the study on the basis of low PSMA avidity or discordant FDG disease at screening , compared to patients randomized to cabazitaxel or 177 Lu‐PSMA‐617.…”

Evaluating a web- and telephone-based personalised exercise intervention for individuals living with metastatic prostate cancer (ExerciseGuide): protocol for a pilot randomised controlled trial

“…Prostate cancer is one of the most common cancers diagnosed among men worldwide (1). Of those diagnosed, approximately 10-20% will present with metastatic disease at the time of diagnosis, and an additional one in ve will progress from localised to metastatic disease despite treatment (2,3). Once prostate cancer has metastasized, the ve year survival rate drops from 95% to 36% (4).…”

Evaluating a Web- and Telephone-based Personalised Exercise Intervention for Individuals Living With Metastatic Prostate Cancer (Exerciseguide): Protocol for a Pilot Randomised Controlled Trial

“…Prostate cancer is one of the most common cancers diagnosed among men worldwide (1). Of those diagnosed, approximately 10-20% will present with metastatic disease at the time of diagnosis, and an additional one in ve will progress from localised to metastatic disease despite treatment (2,3). Once prostate cancer has metastasized, the ve year survival rate drops from 95-36% (4).…”