Wait Times for Prostate Cancer Treatment and Patient Perceptions of Care in Canada: A Mixed-Methods Report

Tran, Kim; Sandoval, Carolyn L.; Rahal, Rami; Porter, Geoff; Siemens, Robert; Hernández, José Ángel; Fung, Sharon; Louzado, C.; Liu, J; Bryant, Heather

doi:10.3747/co.22.2795

Cited by 13 publications

(13 citation statements)

References 9 publications

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“…Despite these aspects, the very long waiting times for men with prostate cancer in Sweden as well as the differences between counties are unacceptable and need to be addressed. It is not known whether these long waiting times have a negative impact on outcome, but it has been shown in previous studies that a prolonged wait causes psychological distress to these patients [14,15].…”

Section: Discussionmentioning

confidence: 99%

Waiting times for cancer patients in Sweden: A nationwide population-based study

Robertson

Adolfsson

Stattin

et al. 2017

Scand J Public Health

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Section: Discussionmentioning

confidence: 99%

Waiting times for cancer patients in Sweden: A nationwide population-based study

Robertson

Adolfsson

Stattin

et al. 2017

Scand J Public Health

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“…One-fifth to half of cancer patients identify cancer diagnosis as a major source of distress and suspected cancer patients may be more negatively affected by anxiety compared to cancer patients with confirmed diagnoses. 5 Men with prostate cancer in Canada have longer wait times for diagnosis and treatment than other cancers 2,6 and prolonged wait times for cancer diagnosis and treatment have been associated with increased anxiety, distress, and a feeling of powerlessness. 6 There is evidence that it is the uncertainty about their prostate cancer that causes men the most distress 11,12 and the faster they can move on to diagnosis and treatment, the better they are able to cope with their illness.…”

Section: Discussionmentioning

confidence: 99%

“…5 Men with prostate cancer in Canada have longer wait times for diagnosis and treatment than other cancers 2,6 and prolonged wait times for cancer diagnosis and treatment have been associated with increased anxiety, distress, and a feeling of powerlessness. 6 There is evidence that it is the uncertainty about their prostate cancer that causes men the most distress 11,12 and the faster they can move on to diagnosis and treatment, the better they are able to cope with their illness. 13 Biopsy results, even when they are not the preferred outcome, have been shown to have a general anxiety relief value for men with elevated PSA.…”

Section: Discussionmentioning

confidence: 99%

“…2 Although the evidence on the impact of wait times on prostate cancer mortality is inconclusive, diagnosis and treatment delays have been shown to impact patient and family psychosocial distress. [3][4][5][6] The Saskatoon Prostate Assessment Pathway (SPAP) was established with several goals in mind, one of which was to reduce the time from physician referral to biopsy, thus shortening the diagnostic wait time. This study does not assess the appropriateness of using PSA as a screening tool or whether prostate cancer screening should be performed.…”

Section: Introductionmentioning

confidence: 99%

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Can a supervised algorithmic assessment of men for prostate cancer improve the quality of care? A retrospective evaluation of a prostate assessment pathway in Saskatchewan

Liu

Jana

Groot

2017

CUAJ

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Introduction: The Saskatoon Prostate Assessment Pathway (SPAP) was developed in 2013 in part to decrease the wait times between physician referral and biopsy for patients with suspected prostate cancer. Using an algorithm carefully designed to optimize appropriate prostate biopsy rates, physicians can directly refer patients for biopsy through the SPAP without seeing a urologist. All other patients are referred to the Saskatoon Urology Associates (SUA). The present study evaluates the performance of the algorithm. Methods: 971 patients seen at the SUA and 302 patients seen through the SPAP were identified. Information on age, biopsy status and outcome, risk stratification, and time between referral and biopsy was collected. Biopsy wait time data was analyzed using gamma distribution. Association between referral method and biopsy rate, and between referral method and risk stratification, was analyzed using Z-test. Results: The expected wait time from referral to biopsy for patients seen through SUA was 2.63 times longer than those seen through SPAP (34 vs. 91 days). The biopsy rate of patients seen in the SPAP was significantly higher than those by SUA (88% vs. 69%, 95% confidence interval [CI] 0.14-0.26; p<0.00001). There was no significant difference in positive biopsy rates for patients seen through the SPAP vs. SUA (81% vs. 74%, 95% CI -0.011,0.14; p=0.095), for detection of low-risk cancer, (12% vs. 10%, 95% CI -0.034,0.080; p=0.44), or for clinically relevant cancer, i.e., for SPAP vs. SUA (56.54% vs. 56.68%,0.089; p=0.49). Conclusions:The algorithm used in the SPAP is effective in decreasing wait time to prostate biopsy and has the same cancer/pre-cancer detection rate, but at the cost of a higher biopsy rate. Both referral mechanisms result in few low-risk cancer detection biopsies, finding primarily cases of high-or intermediate-risk cancer.

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“…The global population is also aging, with the number of those aged 60 years and over expected to rise from 1 in 10 currently to 1 in 6 in the next 10 years; the United Nations estimates that by 2050, this number will grow to be 1 in 3 [ 3 ]. Given the increased risk with age for this increasingly high-mortality cancer, an unprecedented population of prostate cancer survivors will require specialized support and services from a potentially underprepared health care system [ 4 , 5 ]. To mitigate these impending challenges, durable support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care.…”

Section: Introductionmentioning

confidence: 99%

Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App

2017

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BackgroundBy 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have been lauded as a promising complement to current outpatient treatment and monitoring strategies, but have not yet been widely used to support prostate cancer survivorship needs. A realist evaluation is needed to examine the impact of such apps on the prostate cancer survivorship experience.ObjectiveWe seek to gain an understanding of how an mHealth app for prostate cancer survivorship care called Ned (No Evident Disease) is adopted and accepted by patients, caregivers, and clinicians. We also aim to determine the effect of Ned on health-related quality of life, satisfaction with cancer care, unmet needs, self-efficacy, and prostate cancer-related levels of anxiety.MethodsThe Ned case study is a 12-month mixed-methods embedded single-case study with a nested within-group pre-post comparison of health outcomes. We will give 400 patients, 200 caregivers, and 10 clinicians access to Ned. Participants will be asked to complete study assessments at baseline, 2 months, 6 months, and 12 months. We will conduct 30 semistructured qualitative interviews with patients (n=20) and their caregivers (n=10) poststudy to gain insight into their experience with the app.ResultsWe recruited our first survivor in October 2017 and anticipate completing this study by May 2019.ConclusionsThis will, to our knowledge, be the first realist case study to evaluate an app for prostate cancer survivorship care. Prostate cancer survivors are set to increase in number and longevity, heightening the need for integrated survivorship solutions to provide them with optimal and durable outcomes. The knowledge gained from this study will comprehensively inform how and why Ned works, for whom, and in what circumstances. Understanding the impact of digital health interventions such as Ned on how survivors care for themselves is critical to realizing patient-centered care.

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Wait Times for Prostate Cancer Treatment and Patient Perceptions of Care in Canada: A Mixed-Methods Report

Abstract: Background Access to cancer care is a significant concern for Canadians. Prolonged delays between cancer diagnosis

Cited by 13 publications

References 9 publications

Waiting times for cancer patients in Sweden: A nationwide population-based study

Waiting times for cancer patients in Sweden: A nationwide population-based study

Can a supervised algorithmic assessment of men for prostate cancer improve the quality of care? A retrospective evaluation of a prostate assessment pathway in Saskatchewan

Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App

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