Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence
Open Access
- 8 April 2019
- journal article
- review article
- Published by Frontiers Media SA in Frontiers in Oncology
- Vol. 9, 238
- https://doi.org/10.3389/fonc.2019.00238
Abstract
Background: Previous reviews of geographical disparities in the prostate cancer continuum from diagnosis to mortality have identified a consistent pattern of poorer outcomes with increasing residential disadvantage and for rural residents. However, there are no contemporary, systematic reviews summarizing the latest available evidence. Our objective was to systematically review the published international evidence for geographical variations in prostate cancer indicators by residential rurality and disadvantage. Methods: Systematic searches of peer-reviewed articles in English published from 1/1/1998 to 30/06/2018 using PubMed, EMBASE, CINAHL, and Informit databases. Inclusion criteria were: population was adult prostate cancer patients; outcome measure was PSA testing, prostate cancer incidence, stage at diagnosis, access to and use of services, survival, and prostate cancer mortality with quantitative results by residential rurality and/or disadvantage. Studies were critically appraised using a modified Newcastle-Ottawa Scale. Results: Overall 169 studies met the inclusion criteria. Around 50% were assessed as high quality and 50% moderate. Men from disadvantaged areas had consistently lower prostate-specific antigen (PSA) testing and prostate cancer incidence, poorer survival, more advanced disease and a trend toward higher mortality. Although less consistent, predominant patterns by rurality were lower PSA testing, prostate cancer incidence and survival, but higher stage disease and mortality among rural men. Both geographical measures were associated with variations in access and use of prostate cancer-related services for low to high risk disease. Conclusions: This review found substantial evidence that prostate cancer indicators varied by residential location across diverse populations and geographies. While wide variations in study design limited comparisons across studies, our review indicated that internationally, men living in disadvantaged areas, and to a lesser extent more rural areas, face a greater prostate cancer burden. This review highlights the need for a better understanding of the complex social, environmental, and behavioral reasons for these variations, recognizing that, while important, geographical access is not the only issue. Implementing research strategies to help identify these processes and to better understand the central role of disadvantage to variations in health outcome are crucial to inform the development of evidence-based targeted interventions.Keywords
Funding Information
- National Health and Medical Research Council
- Prostate Cancer Foundation of Australia
- University of Southern Queensland
This publication has 187 references indexed in Scilit:
- Racial/ethnic disparities in survival among men diagnosed with prostate cancer in TexasCancer, 2010
- Socioeconomic inequalities in cancer survival in England after the NHS cancer planBritish Journal of Cancer, 2010
- Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups?Cancer Causes & Control, 2010
- Interplay of Race, Socioeconomic Status, and Treatment on Survival of Patients With Prostate CancerUrology, 2009
- Prevalent and incident use of androgen deprivation therapy among men with prostate cancer in the United StatesUrologic Oncology: Seminars and Original Investigations, 2009
- Trends in non-metastatic prostate cancer management in the Northern and Yorkshire region of England, 2000–2006British Journal of Cancer, 2009
- Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of CaliforniaCancer Causes & Control, 2009
- Rural reversal?Cancer, 2009
- Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality StudyCancer Causes & Control, 2008
- Survival from prostate cancer in England and Wales up to 2001British Journal of Cancer, 2008