Socioeconomic and Geographic Disparities in Anorectal and Urinary Procedures Following Radiotherapy for Prostate Cancer

Background and Purpose: Evidence on how treatment outcomes vary by patient characteristics helps to inform clinical practice. In this study, we measured socioeconomic and geographic disparity in post-radiotherapy procedures, as an indication of short-term radiotherapy adverse effects, among men with prostate cancer. 

Materials and Methods: We studied 8344 South Australian diagnosed men with prostate cancer (2002–2020) who received external beam radiotherapy. The outcomes were anorectal and urinary procedures, identified using hospital admission procedure codes and Medicare Benefits Schedule item codes. Crude rates per 1000 person-time were estimated at two years post-radiotherapy. Socioeconomic and geographic disparities were identified through multivariable adjusted zero-inflated Poisson regression. 

Results: Fifteen percent of men underwent at least one post-radiotherapy procedure within two years. The rates of anorectal, urinary and overall (both anorectal and urinary) procedures were 18, 66 and 81 per 1000 person-years, respectively. Men in the highest socioeconomic quintile had lower rates of overall (incidence rate ratio [IRR] 0.70, 95% CI: 0.61–0.81), anorectal (IRR 0.32, 95% CI: 0.20–0.52) and urinary (IRR 0.69, 95% CI: 0.56–0.86) procedures than men in the lowest socioeconomic quintile. Men from non-metropolitan areas had higher rates of anorectal procedures (IRR 1.36, 95% CI: 1.05–1.77) than men from metropolitan areas, which was further compounded by low socioeconomic advantage. Receiving radiotherapy in more recent years was associated with lower rates of post-radiotherapy procedures. 

Conclusion: Anorectal and urinary procedures following radiotherapy significantly vary across different population subgroups. Observed differences in procedure rates may suggest socioeconomic and geographic disparities in radiotherapy adverse effects for prostate cancer. This underscores the importance of follow-up care for at-risk population subgroups.