Socioeconomic differences in treatment, outcomes of treatment and survival in prostate cancer

Abstract

There is a lack of contemporary research that describes the relationship between SES, disease severity, primary treatment, and survival in Australian men with prostate cancer. The aim of this thesis was to more comprehensively characterise the relationships of SES with treatment, treatment outcomes and survival among men with prostate cancer in a contemporary context.

Prostate cancer treatment varies in adherence complexity, costs, and geographic accessibility. These distinctions may result in SES differences. Chapter 2 used systematic review and meta-analysis to quantify and describe SES variation in prostate cancer treatment in the literature.

Treatment in a higher volume hospital is associated with better outcomes. Previous research shows lower SES groups have poor access to these hospitals. Chapter 3 investigated SES differences in unplanned readmissions following radical prostatectomy, and whether differences depended on hospital volume.

Disease severity mediates the relationship between SES and prostate cancer survival. However, in Australia there is limited availability of disease severity variables. Chapter 4 demonstrated the feasibility of obtaining pathology data from cancer notifications held by a state-based registry. This data was used in chapter 5.

Studies of SES and survival among Australian prostate cancer cases do not include sufficient mediators. Consequently, inequalities are not explained. Chapter 5 investigated the relationship between SES and survival among men with incident prostate cancer from The 45 and up Study, whilst including novel mediators.

The 45 and Up Study likely suffers non-respondent bias. Chapter 6 investigated SES differences in survival after adjusting for confounders and mediators in a NSW population data set, during the period of 2004-2019.

The findings from this thesis may justify further research and development of public health initiatives that could more equitably improve the lives of men with prostate cancer.