Addressing inequalities in access to care for PCa in Europe Ian Banks, President European Men’s Health Forum (EMHF)

1. Inequalities in cancer care
Prostate Cancer
EPAD Brussels 2017
Ian Banks
European Society of Medical Oncologists
Leeds University Medical School
European Cancer Organisation
European Mens Health Forum
Royal Society Public Health
University of Ulster
Queens University

2. Inequalities in Prostate Cancer
Prostate Cancer UK identifies five inequalities
facing men with or are at risk of prostate cancer:
• Diagnosis, awareness, information and support
• Inequalities by ethnicity – Black men with
prostate cancer
• Variation in quality of care across the UK/Europe
• Age
• Access to treatments
Men United v Prostate Cancer: Five Inequalities, five solutions. 2014

3. Diagnosis, awareness, information and support
• Awareness of signs and symptoms amongst men
is still low - A Prostate Cancer UK study in 2013
revealed that:
Only 40% of people know that being 50 or over
increases a man’s risk of prostate cancer
Only 5% of people know that being a black man
increases your risk
46% of people could identify where the prostate
is
63% of people have never heard of the PSA test

4. Inequalities in Prostate Cancer –
Black men with prostate cancer
• Black men in the UK have double the risk of developing
prostate cancer than white men and are diagnosed at a
younger age.
• Prostate cancer mortality rates are 30% higher for
black men than white men.
• National Cancer Patient Experience Survey 2013 – for
all cancers black respondents reported overall poorer
experiences of care compared to white respondents
• Deprivation based health inequalities are inextricably
linked with ethnicity.
• Lack of data by ethnicity fuels inequalities

5. Variation in quality of care across the UK
Treatment & Age
• Significant variation in the proportion of prostate cancer
patients who said they had been given information about how
to get financial help or benefits
• Wide variations in access to a specialist nurse – Average 88%
and only five Trusts reported 100%.
• Older men diagnosed with prostate cancer are far less likely to
be told about side effects of treatment and at times have
fewer treatment options offered to them than younger men.
• Age alone may limit the options for some men regardless of
their physical fitness

6. Cancer Inequalities in Europe
Data from the European Cancer Patient Coalition – Survey
of patient organisations 2015
Main reasons for inequalities in access to cancer care:
• 78% cited lack of adequate information about different
treatment options because doctors/physicians are not
always aware of new available treatments (40%)
• Cost of treatment and price affordability
• Geographical variations in access to new treatments
• Geographical variations in access to screening
• Geographical variations in access to medicines

7. Prostate Cancer Inequalities in Europe
• Generally cancer survival rates are 40% higher in Western
Europe than in Eastern Europe
• Differences in Prostate Cancer survival range from 88% in
Central Europe to 72% in Eastern Europe.

8. Prostate Cancer Inequalities in Europe
• A man in Italy has a 90% chance of being alive
5 years after diagnosis compared to 71%
chance for a man in Croatia.
• Disparities in Prostate Cancer outcomes in
Europe are wider than other cancers.
(Prostate 35%, Testis 28%, Breast 18%) (Ira
Nathanson. Cancer results of treatment. NEJM 1943: 468-480)

9. Recommendation #1 EAU
White Paper
European institutions and Member States
need to ensure that PCa patients receive
high quality, standardized, and integrated
care with a focus on a patient-centred
multidisciplinary approach.