Dr Gayasha Batheegama Gamarachchige
About
My research project
Data-driven solutions to address inequalities in Prostate Cancer: Using a UK-representative primary-care databaseProstate cancer identified as the most common type of cancer among the males in the UK is strongly affected by inequalities due to age, ethnicity, and deprivation. The burden on people and healthcare systems is expected to increase with ageing populations and environmental factors. Hence, data-driven, and evidence-based solutions are needed to combat inequalities and make necessary plans to improve healthcare services.
This study investigates inequalities in adherence to clinical guidelines to find which groups of men do not receive the recommended, high standard of healthcare and to understand the underlying factors affecting such disparities in diagnosis and treatment. The objectives of this study include developing a cohort profile to describe the cohort characteristics and inequalities in cancer diagnosis, clinical presentation and outcomes across age, ethnicity, geographical locality, socio-economic status, service delivery, and usage followed by the investigations of disparities and risk factors in each aspect of diagnosis, treatment, and outcomes of prostate cancer. Through this research, we will also propose recommendations for healthcare commissioners and policymakers on how to improve healthcare equality in this arena of prostate cancer.
This will be a population-based, observational research where retrospective cohort studies or matched case-control studies will be conducted to uncover trends in data. This secondary data project will utilize data from the Clinical Practice Research Datalink (CPRD), provided by the Brighton and Sussex Medical School, and will consist of 1.6 million primary-care longitudinal medical records and demographics with linkages for Cancer Registration (NCRAS), Hospital Episodes Statistics (HES) and Mortality data (ONS).
Supervisors
Prostate cancer identified as the most common type of cancer among the males in the UK is strongly affected by inequalities due to age, ethnicity, and deprivation. The burden on people and healthcare systems is expected to increase with ageing populations and environmental factors. Hence, data-driven, and evidence-based solutions are needed to combat inequalities and make necessary plans to improve healthcare services.
This study investigates inequalities in adherence to clinical guidelines to find which groups of men do not receive the recommended, high standard of healthcare and to understand the underlying factors affecting such disparities in diagnosis and treatment. The objectives of this study include developing a cohort profile to describe the cohort characteristics and inequalities in cancer diagnosis, clinical presentation and outcomes across age, ethnicity, geographical locality, socio-economic status, service delivery, and usage followed by the investigations of disparities and risk factors in each aspect of diagnosis, treatment, and outcomes of prostate cancer. Through this research, we will also propose recommendations for healthcare commissioners and policymakers on how to improve healthcare equality in this arena of prostate cancer.
This will be a population-based, observational research where retrospective cohort studies or matched case-control studies will be conducted to uncover trends in data. This secondary data project will utilize data from the Clinical Practice Research Datalink (CPRD), provided by the Brighton and Sussex Medical School, and will consist of 1.6 million primary-care longitudinal medical records and demographics with linkages for Cancer Registration (NCRAS), Hospital Episodes Statistics (HES) and Mortality data (ONS).
Publications
Abstract IntroductionGonadotropin-releasing hormone (GnRH) agonists are the most commonly used form of androgen deprivation therapy (ADT) for advanced prostate cancer, often prescribed with radiotherapy or chemotherapy. This study examined national trends in the prescribing of injectable GnRH agonists in England from 2015 to 2024, by formulation type and demographic factors (age, ethnicity, and deprivation). We hypothesised that the use of longer-acting formulations has been increasing over time, specifically during the COVID-19 pandemic when access to face-to-face appointments was limited, and that variation over time and by demographics could inform future service delivery.MethodsWith the approval of NHS England, we conducted a cohort study using the OpenSAFELY-TPP database of 24 million adults. Monthly prescription counts and rates (per 100,000 men with prostate cancer) were visualised over time. Generalised linear models were used to estimate the impact of the COVID-19 pandemic.ResultsThe cohort included 390,265 men with prostate cancer (mean age 69.8 years, SD 13.5). Overall, 1,535,725 prescriptions were issued to 208,010 participants (53%). Monthly prescription counts increased by 40%, from 11,787 in 2015 to 16,697 in 2024, while rates declined from 8,453 to 7,721. During 2020–2021, prescribing of 1- and 3-monthly formulations decreased, whereas 6-monthly formulations increased from 437 per month (245 per 100,000 men) in 2019 to 755 (349 per 100,000 men) in 2024, an excess of 29%.ConclusionsBefore the pandemic, 6-monthly formulations were rarely prescribed. Their uptake during the pandemic suggested a shift towards longer-acting formulations, reducing treatment burden. Declining GnRH rates may reflect earlier diagnosis and evolving treatment guidelines. Divergence between prescription counts and rates, and variation by demographic factors, reflected challenges faced by healthcare systems.Keywords: androgen deprivation therapy, ADT, gonadotropin-releasing hormone agonist, GnRHa, luteinising hormone-releasing hormone agonist, LHRHa, prostate cancer, COVID-19, healthcare provision