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Sandy Srinivas, MD
Sandy Srinivas, MD
Posted: Thursday, August 31, 2023
Although some studies have demonstrated variations in quality of care during active surveillance of low-risk prostate cancer, there remains a lack of research employing validated quality indicators. Thus, Shabbir M.H. Alibhai, MD, MSc, of the University of Toronto, Ontario, Canada, and colleagues developed and applied such evidence-based metrics in a population of patients with low-risk prostate cancer. Their findings, which were published in JNCCN–Journal of the National Comprehensive Cancer Network, may identify areas for targeted quality improvement initiatives.
“This study establishes a foundation for quality-of-care assessments and monitoring during active surveillance implementation at a population level,” the investigators remarked. “Considerable variations appeared with quality indicators related to process of care by physician volume and quality indicators related to outcome by patient age group.”
This population-based retrospective analysis focused on 33,454 patients (median age, 65 years; median prostate-specific antigen level, 6.2 ng/mL) who were diagnosed with low-risk prostate cancer between 2002 and 2014. Using a modified Delphi approach, a multidisciplinary panel of Canadian specialists developed quality indicators for structure (n = 1), process of care (n = 13), and outcomes (n = 6); of these indicators, 17 were deemed applicable at the population level.
According to the investigators, compliance varied for 10 process quality indicators, with rates ranging from 36.6% to 100%; of note, 6 of these indicators were found to have reached the 80.0% threshold. Active surveillance was initially adopted for 36.6% of patients; this rate seemed to increase over time. Significant variations in outcome indicators were reported based on patient age group (10-year metastasis-free survival, 65–74 years: 95.0%; < 55 years: 97.5%) and physician average annual active surveillance patient volume (10-year metastasis-free survival, 1–2: 94.5%; ≥ 6: 95.8%).
Disclosure: The study authors reported no conflicts of interest.
JNCCN–Journal of the National Comprehensive Cancer Network
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