The changing age distribution of prostate cancer in Canada.

BACKGROUND: Prostate cancer incidence rates are still increasing steadily; mortality rates are levelling, possibly decreasing; and hospitalization rates for many diagnoses are decreasing. Our objective is to examine changes in age distributions of prostate cancer during these times of change. METHODS: Prostate cancer cases were derived from the Canadian Cancer Registry, prostate cancer deaths from Vital Statistics, hospitalizations from the Hospital Morbidity File. Age-standardized rates were calculated based on the 1991 Canadian population. A prevalence correction for incidence rates was calculated. RESULTS: Age-specific incidence rates increased until 1995 for all ages, but a superimposed peak (1991-94) was greatest between ages 60-79. After 1995, increases in incidence continued for the under-70 age groups. Prevalence correction indicated the greatest underestimation of incidence rates for the oldest ages, but was less in Canada than in the United States. Mortality rates increased until 1994, then levelled and slowly decreased; age-specific mortality rates showed the greatest increase for the oldest ages but the earliest downturn for younger age groups. While hospitalizations dropped drastically after 1991, this drop was confined to elderly men (70+). CONCLUSIONS: Dramatic changes in age distributions of prostate cancer incidence, mortality and hospitalizations altered age profiles of men with prostate cancer. This illustrated the changing nature of prostate cancer as a public health issue and has important implications for health care provision, e.g., the increased numbers of younger new patients have different needs from the increasing numbers of elderly long-term patients who now spend less time in hospital.

Trends in prostate cancer incidence, hospital utilization and surgical procedures, Canada, 1981-2000.

BACKGROUND: Numbers of new prostate cancer cases in Canada continue to increase because of increasing prostate cancer incidence, population growth, aging of the population, and earlier detection methods such as PSA (prostate-specific antigen) testing. Concern has been expressed that PSA-related increases in incidence will make unaffordable demands on Canadian hospital resources. Our objective is to relate increases in prostate cancer incidence to trends in hospitalizations and in- patient treatment. METHODS: Hospitalizations with prostate cancer as primary diagnosis were obtained from the Hospital Morbidity Database, estimates of prostate cancer day surgery from the Discharge Abstract Database, newly diagnosed cases from the Canadian Cancer Registry, and prostate cancer deaths from the Vital Statistics Mortality Databases--all for the years 1981-2000. RESULTS: Between 1981-2000, the number of new cases rose from 7,000 to 18,500 with a transient peak, 1991-1994. Hospitalizations rose parallel to the incidence until 1991 but then fell sharply in spite of further increasing incidence. The use of radical prostatectomy (RP) increased steadily, but transurethral prostatectomy and bilateral orchiectomy decreased in the 1990s. Decreases in length of stay and in number of hospitalizations resulted in considerably decreased annual hospital days for all prostate cancer in-patient procedures except RP, which remained level since 1993. CONCLUSIONS: A net decrease in number of in-patient days occurred, despite the increasing number of new prostate cancer cases and the increasing use of radical prostatectomy. We concluded that increases in hospital utilization due to early detection programs, such as PSA testing, are unlikely to overwhelm in-patient services of Canadian hospitals.

Trends in in-patient hospital utilization and surgical procedures for breast, prostate, lung and colorectal cancers in Canada.

OBJECTIVE: To analyse population-based trends of in-patient surgical procedures for breast (female), prostate, lung and colorectal cancers. METHODS: The Hospital Morbidity Files supplied hospital data and the Canadian Cancer Registry, incidence data. Age-adjusted rates were standardized to the 1991 Canadian population. RESULTS: All four cancers showed major changes in trends of surgical procedures. For breast cancer, the rate of in-patient breast conservation surgery (BCS) increased from 1981 to the early 1990s while the rate of mastectomy decreased. Because day surgery was not included, the subsequent in-patient BCS rate stayed level. For prostate cancer, the rate of transurethral prostatectomy was initially high but decreased after 1990, while the rate of radical prostatectomy increased rapidly, only minimally affected by the PSA-related peak in incidence. The lung cancer lobectomy rate in men remained at 10/100,000 after 1986, but in women rose from 3/100,000 to 7/100,000, reflecting increasing lung cancer incidence. For colorectal cancer, right hemicolectomies and anterior resections increased, especially in men. CONCLUSIONS: Surgery trends reflected changes in incidence and treatment preferences. Canadian trends were generally similar to US trends, although the timing of some of the changes differed. Canadians tended to use less invasive procedures such as BCS and anterior resection.

Proportion of cancer deaths occurring in hospital, Canada, 1994-2000.

BACKGROUND: Most terminally ill cancer patients would prefer not to die in hospital, but only a minority achieve their wish. Our objective was to examine the proportion of cancer deaths occurring in Canadian hospitals. METHODS: The two sources of data (1994-2000) were: 1) all hospital separations (HS) with a primary diagnosis of cancer and discharge as 'dead'; 2) all death certificates (DC) with cancer as underlying cause of death. Proportions of hospital deaths were estimated with two different numerators: 1) hospital cancer deaths from HS data, and 2) deaths with hospital as location from DC data; the denominator for both were all cancer deaths identified from the DC data. RESULTS: Proportions of hospital deaths from HS data decreased from 55% to 40% over 1994-2000, was slightly lower for females, decreased with age, but varied widely among provinces. Proportions of hospital deaths from DC data started at 80% and showed a small downward trend over the years. While age, sex, and cancer site distributions stayed the same, the proportion of hospital deaths from DC date again varied among provinces. For provinces with the home category completed on the DC data, 1999-2000, Alberta had most home deaths at 15.6% and PEI least at 5.7%. INTERPRETATION: This is the first Canada-wide data on place of death for terminal cancer, which is important for determining and comparing present-day practices, as well as for planning for the future.

Declining use of mastectomy for invasive breast cancer in Canada, 1981-2000.

OBJECTIVE: To evaluate the rate and magnitude of change in surgical practice for breast cancer in Canada in relation to publication dates of clinical trials and consensus conferences. METHODS: Hospital separations with a diagnosis of invasive breast cancer were extracted from the Hospital Morbidity File from 1981 to 2000. Age-standardized rates of in-patient procedures for breast-conserving surgery and mastectomy were analyzed by province and age group and by geographic region. RESULTS: In Canada, mastectomy rates decreased from 62.2 to 37.9 per 100,000 between 1981 and 2000; declines were largest between 1984 and 1985, following publication of the NSABP B-06 clinical trial in March 1985, and between 1991 and 1993, after the US NIH Consensus Conference in February 1991. Mastectomy rates plateaued between 1985 and 1991, and from 1993 to 2000; the transitory peak in 1988 corresponded to publicity surrounding Nancy Reagan's choice of mastectomy in 1987. Regional variations from the main pattern led to increasingly divergent mastectomy rates over time. Women aged 80+ were less likely to be treated by any surgery. INTERPRETATION: Publication of clinical trial results and consensus conferences were associated with changes in surgical treatment for breast cancer in Canada. However, divergent mastectomy rates among Canadian regions point to inconsistent adoption of less invasive therapy despite a publicly-funded health care system and national consensus guidelines.

Developing palliative care surveillance in Canada: results of a pilot study.

OBJECTIVE: A pilot study compiled data from six palliative care centres across Canada to assess the feasibility of developing a national surveillance system. METHODS: Data provided for the three-year period between 1993-1997 were combined into a comparative minimum data set. Analyses included 6,369 care episodes from five centres, plus 948 patients from one centre. RESULTS: Care was provided in various settings including acute care wards, dedicated palliative care units, tertiary care, chronic care, and at home. Palliative care patients comprised equal numbers of men and women, with a median age of 69 years; 92% had cancer diagnoses. Median length of stay (LOS) for each care episode was 13 days, increasing to 40-43 days for a patient's entire time in care. LOS varied greatly, by care setting, from seven days (dedicated unit), to 19 days (tertiary unit), 37 days (home), and 54 days (chronic care). Our findings are similar to those reported from national surveys in Australia and the United Kingdom. SUMMARY: This study generated useful baseline data and identified key issues requiring resolution before establishing a national surveillance system, including the need to track patients across care settings.