In a national study, UK researchers investigated how prostate cancer patient choice, mobility, and hospital competition policies, impact hospital policies.
Several countries including those in the United Kingdom have implemented policies which enable patients to choose a specific healthcare centre in a bid to improve the efficiency in the delivery of healthcare services. The result is that many patients opt to travel to centres further away than their closest hospital for treatment. One main factor attracting many patients undergoing prostate cancer surgery in England is the availability of new technology such as robotic systems and hospital reputation.
In a study recently published in the Lancet Oncology, UK researchers mapped 19,256 patients who underwent radical prostatectomy surgery in England between 2010 and 2014 in 65 National Health Service (NHS) centres. They investigated the locations that patients chose to have their surgery and the factors which affected this decision. The researchers also looked at the impact these patient choices and hospital competition had on the closure of centres providing radical prostatectomy services.
The results showed that of the 65 radical prostatectomy centres open at the beginning of the study period, one third (23) of the centres reported a significant net gain in their number of patients choosing these centres for prostate cancer surgery. For some centres this net gain was up to as much as 400 to 500 additional procedures performed, which was much higher than expected. Ten of these centres were established robotic centres. On the other hand, 37 of the 65 centres, only two of which were robotic centres, reported having a significant net loss of patients. These centres reported a decrease in the number of procedures expected to be performed by approximately 200. The remaining five centres reported no net loss or gain of patients during this time. During the study period, ten centres were closed which provided radical prostatectomy services.
Despite some robotic centres reporting a net loss of patients, none were closed during the study period. The radical prostatectomy centres that were closed were typically located in areas where there was strong competition and patients had numerous choices of healthcare centres within a 60-minute drive. The closures occurred mainly due to the fact these centres were no longer performing a sufficient number of procedures to keep their services open, however, the researchers of the study noted these closures were never the intended outcome of the hospital competition policies.
These outcomes suggest that patient choice, allowing them to travel to the centre they think will provide them with the best treatment and overall service and hospital competition have been the main drivers when it comes to where patients receive prostate cancer surgery. Given the mobility of patients, they appear to be driven by competitive factors such as the availability of innovative surgical technology despite no evidence of superior outcomes. Patients were attracted to hospitals that offered advanced technology, shorter waiting lists, and better service quality than other hospitals.
There is not, however reliable evidence demonstrating the superiority of robotic systems in clinical outcomes of prostate cancer. Due to the absence of clinical data outcomes, the researchers warned these results, and hence policies could threaten the health services delivery of affordable and efficient cancer care. Patient choice, instead of clinical outcomes, is driving hospital policies and investments. It is therefore vital to have quality clinical evidence available to patients, such as those with prostate cancer to help them make informed decisions when choosing which healthcare centre to receive treatment at instead of relying on potentially misleading factors.
Written by Lacey Hizartzidis, PhD
Aggarwal A, Lewis D, Mason M, Purushotham A, Sullivan R, van der Meulen J. Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study. Lancet Oncol. 2017 Oct 3. pii: S1470-2045(17)30572-7. doi: 10.1016/S1470-2045(17)30572-7.
Mayor S. New technologies attract patients with prostate cancer to treatment centres, study finds. BMJ. 2017 Oct 5;359:j4621. doi: 10.1136/bmj.j4621. PubMed PMID: 28982939.