Estimating the impact of randomised control trial results on clinical practice: results from a survey and modelling study of androgen deprivation therapy plus radiotherapy for locally advanced prostate cancer

Background Recent trials have shown that the addition of external beam radiotherapy (EBRT) to androgen deprivation therapy (ADT) improves survival among men with locally advanced prostate cancer. Objective To examine the potential impact of these trials on changes in clinical practice and life-years saved. Design, setting, and participants A model was developed to examine the impact of changes in clinical practice in the UK. A survey of clinicians who treat men with prostate cancer in the UK and Canada was performed. Measurements Outcomes of interest were the proportion of patients treated with different approaches and the predicted number of life-years saved due to changes in clinical practice. Survey data were cross-tabulated and Pearson's χ2 tests were applied. Results and limitations The survey was completed by 193 clinicians (105 from the UK, 80 from Canada), of whom 70% were clinical/radiation oncologists, 8% were medical oncologists, and 15% were urologists. UK respondents were more likely to report a change in practice in response to the results (44% UK vs 21% Canada). Canadians were more likely to have already been using ADT plus radiotherapy (77% Canada vs 56% UK). The increase in the proportion of patients in the UK treated with ADT + EBRT could result in around 3730–5177 extra life-years at 15 yr from a cohort of 7930 men diagnosed in a single calendar year, compared to if all had been treated with ADT alone. Conclusions Trial findings have changed clinical practice, meaning that men with locally advanced prostate cancer are likely to survive longer. Patient summary Doctors in the UK have changed practice in response to evidence on the superiority of hormone therapy plus radiotherapy to hormone therapy alone. These changes will improve the survival of men with locally advanced prostate cancer. Further reductions in the use of hormone therapy alone could further improve survival

A Canadian approach to the regionalization of testis cancer: A review

At the Canadian Testis Cancer Workshop, the rationale and feasibility of regionalization of testis cancer care were discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, and nurses, as well as patients and patient advocacy groups. This review summarizes the discussion and recommendations of one of the central topics of the workshop — the centralization of testis cancer in Canada. It was acknowledged that non-guideline-concordant care in testis cancer occurs frequently, in the range of 18–30%. The National Health Service in the U.K. stipulates various testis cancer care modalities be delivered through supra-regional network. All cases are reviewed at a multidisciplinary team meeting and aspects of care can be delivered locally through the network. In Germany, no such network exists, but an insurance-supported online second opinion network was developed that currently achieves expert case review in over 30% of cases. There are clear benefits to regionalization in terms of survival, treatment morbidity, and cost. There was agreement at the workshop that a structured pathway for diagnosis and treatment of testis cancer patients is required. Regionalization may be challenging in Canada because of geography; independent administration of healthcare by each province; physicians fearing loss of autonomy and revenue; patient unwillingness to travel long distances from home; and the inability of the larger centers to handle the ensuing increase in volume. We feel the first step is to identify the key performance indicators and quality metrics to track the quality of care received. After identifying these metrics, implementation of a “networks of excellence” model, similar to that seen in sarcoma care in Ontario, could be effective, coupled with increased use of health technology, such as virtual clinics and telemedicine

National cancer strategy 2006: a strategy for cancer control in Ireland: evaluation panel report.

The evaluation panel was very impressed with the excellent progress in the cancer control system in Ireland since the publication of “A Strategy for Cancer Control in Ireland” in 2006. P. 22-23 - In particular the National Cancer Strategy 2006 (rec. 3-5) made 3 specific recommendations aimed at reducing smoking prevalence in Ireland including - Compliance with all provisions of the Public Health (Tobacco) acts, 2002 and 2004 should be monitored. - Excise Duty on cigarettes should be substantially increased each year above the rate of inflation. - Nicotine replacement therapy should be made available free of charge to all medical card holders. These recommendations have largely been implemented and have been remarkably successful in reducing smoking prevalence. In 2007 approximately 29% of the population smoked and this has dropped to 24% in 2010 and 22% in 2012, which is in accordance with international standards. As regards alcohol misuse the National Substance Misuse Strategy of 2012 identified a number of concrete measures that have been incorporated into the proposed Public Health (Alcohol) Bill. These include: • Minimum unit pricing for alcohol products • The regulation of advertising and marketing of alcohol • Structural separation of alcohol from other products in mixed trading outlets • Health labelling of alcohol products • Regulation of sports sponsorship. If these alcohol misuse measures are introduced in Ireland, it will become an international leader in the field. P.48 3. Percentage of the population who consume more than the recommended alcohol weekly limits by age, sex and social class. “Alcohol consumption in Ireland 2013” published by the Health Research Board indicates from survey results that more than 150,000 people are dependent drinkers, more than a 1.35 million are harmful drinkers according to WHO standards. Thirty per cent of people interviewed say that they experienced some form of harm as a result of their own drinking. The report also reveals that the respondents underestimate what they drink by about 60%. Furthermore, the rate of abstinence, defined as consuming no alcohol in the previous 12 months, was 20.6%. Almost two-thirds (63.9%) of males and half (51.4%) of females started drinking alcohol before the age of 18 years. 67 % of drinkers and 80% of male drinkers consumed six or more standard drinks on the occasion that they consumed the highest number of standard drinks in the last year