Work-up and treatment of prostate cancer before and after publication of the first national guidelines on prostate cancer care in Sweden

Abstract

Background and Objectives: In 2007, the Swedish National Board of Health and Welfare published the first Swedish guidelines on prostate cancer (PCa) to improve care and decrease geographical and social inequalities. The aim of this analysis was to assess how these guidelines affected PCa care.

Materials and Methods: Work-up and treatment for men diagnosed with PCa between 1998 and 2014 were assessed by use of data in the Prostate Cancer data Base Sweden (PCBaSe) with information from the National Prostate Cancer Register (NPCR) and other healthcare registries and demographic databases.

Results: Overall, there were modest improvements in the performance for 14 selected quality indicators, with some notable exceptions. There was a strong increase in the use of active surveillance for very low-risk PCa, up from 56% in 2009 to 92% in 2014, and use of bone imaging for high-risk PCa up from 50% in 2008 to 77% in 2014. There were large differences in work-up and treatment of PCa between healthcare providers with modest decreases over time. The differences between counties were larger than differences according to socioeconomic status with one exception: use of curative treatment for high-risk PCa was more common in men with high income, highest versus lowest tertile, OR 2.74 (95% CI, 1.85-4.06).

Conclusion: The modest improvements in PCa care after the publications of national guidelines indicate that if these are to make an impact on care, feedback to each point of care on their performance as well as local quality improvement programs implementing the guidelines are needed.

Keywords:

• Prostate cancer
• cancer guidelines
• quality indicators
• socio-economical differences
• cancer registries

Acknowledgments

This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden (NPCR) steering group: Pär Stattin (chairman), Anders Widmark, Camilla Thellenberg, Ove Andrén, Eva Johansson, Ann-Sofi Fransson, Magnus Törnblom, Stefan Carlsson, Marie Hjälm Eriksson, David Robinson, Mats Andén, Johan Stranne, Jonas Hugosson, Ingela Franck Lissbrant, Maria Nyberg, Göran Ahlgren, René Blom, Calle Walller, Per Fransson, Fredrik Sandin and Karin Hellström.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by The Swedish Research Council 2017-00847, The Swedish Cancer Society 16-0700, Uppsala County Council, Clinical Research Center of Dalarna. None of these funders had any part in the collection, management, analysis, interpretation of the data and not in preparation, review, or approval of the manuscript.