Albert Bang

Contemporary radical cystectomy outcomes in patients with invasive bladder cancer: a population‐based study

To determine the contemporary survival outcomes from a whole population and identify significant predictors of survival, as contemporary population‐based survival outcomes after radical cystectomy (RC) for the treatment of bladder cancer (BC) are sparse. Reports suggest a large disparity between population outcomes and those of centres of excellence.

Predictors of surgical approach for the management of renal cell carcinoma: a population-based study from New South Wales

The simultaneous adoption of laparoscopy and partial nephrectomy (PN) has been reported to result in unintended consequences. We aim to examine the contemporary (2001–2009) trends in use of PN and laparoscopy within a population‐wide database.

Poor survival of females with bladder cancer is limited to those aged 70 years or over: a population-wide linkage study, New South Wales, Australia.

Although men are diagnosed with bladder cancer (BC) with a rate three times higher than women, women experience poorer survival. The cause of this gender difference is not clear. The aim of this study was to investigate the discrepancy in survival from BC by gender and explore potential explanations for the difference using a population‐wide linkage study. Using the New South Wales (NSW) Central Cancer Registry, all invasive BC cases diagnosed between 2001 and 2009 were identified. Records were linked to the NSW Admitted Patient Data Collection (APDC), to retrieve treatment details, and to the Registry of Births Deaths and Marriages and Australian Bureau of Statistics to obtain death details. A total of 5377 new cases of BC were identified. No differences were identified in the proportions of patients presenting at different stages between genders. However, disease‐specific survival (DSS) was worse for females compared to males with localized and regional disease (P < 0.05). This difference was only apparent in individuals aged ≥70 years and no difference was identified in those younger. Multivariable Cox‐regression analysis of the cohort of individuals aged ≥70 years revealed that stage, age, comorbidity, and sex remained independent variables (P < 0.05) predicting DSS. In a population wide analysis, females aged 70 years or more suffer worse DSS compared to males. The differences are not accounted for by stage at presentation or comorbidity and are independent of age. BC in postmenopausal females may be biologically more aggressive.

Long-term health care costs for patients with prostate cancer: a population-wide longitudinal study in New South Wales, Australia

Prostate cancer (PCa) is the most commonly diagnosed cancer in Australian males. There are limited data on the long‐term health system costs associated with PCa. The aim of this study is to estimate long‐term health care costs of PCa.

Cytoreductive nephrectomy for metastatic renal cell carcinoma: inequities in access exist despite improved survival

The use of cytoreductive nephrectomy (CRN) in the targeted therapy era is still debated. We aimed to determine factors associated with reduced use of CRN and determine the effect of CRN on overall survival in patients with metastatic renal cell carcinoma (RCC). All advanced RCC diagnosed between 2001 and 2009 in New South Wales, Australia, were identified from the Central Cancer Registry. Records of treatment and death were electronically linked. Follow‐up was to the end of 2011. Multivariable logistic regression analysis was used to determine factors associated with the receipt of CRN. Cox proportional hazards model was used to determine factors associated with survival. A total of 1062 patients were identified with metastatic RCC of whom 289 (27%) received CRN. There was no difference in the use of CRN over the time period of the study. Females (OR 0.68 (95% CI: 0.48–0.96)), unmarried individuals (OR 0.68 (95% CI: 0.48–0.96)), treatment in a nonteaching hospital (OR 0.26 (95% CI: 0.18–0.36)) and individuals without private insurance (OR 0.29 (95% CI: 0.20–0.41)) all had reduced likelihood of receiving CRN. On multivariable analysis, not receiving CRN resulted in a 90% increase in death (HR 1.90 (95% CI: 1.61–2.25)). In addition, increasing age (P < 0.001), increasing Charlson comorbidity status (P = 0.002) and female gender also had a significant independent association with death. Despite a strong association with improved survival, individuals who are elderly, female, have treatment in a nonteaching facility or have no private insurance have a reduced likelihood of receiving CRN.

Volume‐outcome relationship in penile cancer treatment: a population based patterns of care and outcomes study from Australia

To study the patterns of care of penile cancer diagnosed in the state of New South Wales (NSW) over a 10 year period and determine factors that are associated with differences in survival.

An initial melanoma diagnosis may increase the subsequent risk of prostate cancer: Results from the New South Wales Cancer Registry

Emerging evidence suggests that a diagnosis of cutaneous melanoma (CM) may be associated with prostate cancer (PC) incidence. We examined if the incidence of CM was associated with an increased subsequent risk of PC. We used data from the New South Wales Cancer Registry for all CM and PC cases diagnosed between January 1972 and December 2008. We calculated the age standardized incidence ratio (SIR) and 95% confidence intervals (95% CI) for PC incidence following a CM diagnosis, applying age- and calendar- specific rates to the appropriate person years at risk. We determined rate ratio (RR) and 95% CI of PC incidence according to specified socio-demographic categories and disease related characteristics, using a negative binomial model. There were 143,594 men diagnosed with PC or CM in the study period and of these 101,198 and 42,396 were diagnosed with PC and CM, respectively, as first primary cancers. Risk of PC incidence increased following CM diagnosis (n = 2,114; SIR = 1.25; 95% CI:1.20.8-1.31: p < 0.0001), with the increased risk apparent in men diagnosed with localised CM (n = 1,862;SIR = 1.26; 95% CI:1.20–1.32). CM diagnosis increased the subsequent risk of PC incidence. This raises the potential for future PC risk to be discussed with newly diagnosed males with CM.

Factors associated with prostate specific antigen testing in Australians: Analysis of the New South Wales 45 and Up Study

Australia has one of the highest incidence rates of prostate cancer (PC) worldwide, due in part to widespread prostate specific antigen (PSA) testing. We aimed to identify factors associated with PSA testing in Australian men without a diagnosis of prostate cancer or prior prostate disease. Participants were men joining the 45 and Up Study in 2006–2009, aged ≥45 years at recruitment. Self-completed questionnaires were linked to cancer registrations, hospitalisations, health services data and deaths. Men with a history of PC, radical prostatectomy or a “monitoring” PSA test for prostate disease were excluded. We identified Medicare reimbursed PSA tests during 2012–2014. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) for the association between having PSA tests and factors of interest. Of the 62,765 eligible men, 51.8% had at least one screening PSA test during 2012–2014. Factors strongly associated with having a PSA test included having 27+ general practitioner consultations (versus 3–9 consultations; OR = 2.00; 95%CI = 1.90–2.11), benign prostatic hyperplasia treatment (versus none; OR = 1.59(95%CI = 1.49–1.70), aged 60–69 years (versus 50–59 years; OR = 1.54; 95%CI = 1.48–1.60). These results emphasise the important role of primary care in decision making about PSA testing.

Cystectomy outcomes in NSW: a population based study

Introduction: Ureteric stent placement is oft en associated with morbidity ranging from mild generalised discomfort to signifi cant storage urinary symptoms and loin pain. Our unit identifi ed a high rate of patients re-presenting with side eff ects aft er placement of a ureteric stent. Whilst most re-presentations for common side eff ects only require conservative management they can lead to potentially unnecessary emergency department (ED) consultations, additional investigations and out-of-hours admissions for symptomatic control. All these events result in potentially avoidable increased healthcare costs. Objectives: Prospective single institution audit to assess whether the provision of a written information pamphlet detailing common expected side-eff ects of ureteric stents at the time of discharge in newly stented patients would reduce the rate of re-presentation to hospital related to benign side eff ects and therefore reduce the costs associated with unnecessary emergency room attendances, investigations and occasional hospital admission. Methods: A local stent register was used to identify patients who had ureteric stents inserted 1 year preand post-introduction of the stent information pamphlet. Th e stent information pamphlet was introduced on 5th July 2013. A total of 194 patients had a ureteric stent(s) inserted from 5th July 2012 to 4th July 2013 (Group 1) and a total of 226 patients had a ureteric stent(s) inserted from 5th July 2013 to 5th July 2014 (Group 2). All patients who had ureteric stents inserted during this period were included in the audit, regardless of the initial indication for ureteric stent insertion. Results: Th ere was a 50/194 (25%) and 34/226 (15%) rate of re-presentations preand postimplementation of the stent information pamphlet respectively. Th is refl ected a clinically and statistically signifi cant 10% decrease in the percentage of re-presentations ( P = 0.006) with patients in the pre-implementation group also showing a 1.96 times increased likelihood of re-presenting to hospital (OR = 1.961, 96%CI: 1.206–3.189). Th ere was an average cost saving of

An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high?

899 per ED re-presentation and an additional average cost saving of