Prostate cancer and quality of care: a major analysis


Spencer et al. have evaluated the quality of cancer care received by patients diagnosed with prostate cancer based on nationally representative samples. The “New” Prostate Cancer InfoLink considers this paper to be a critically important publication, defining issues that need to be addressed by hospitals, by the American Urological Association, and by the American Society for Therapeutic Radiation Oncology. It is clear from this paper that greater consistency in quality of care is essential, even if steps are already being taken in this direction.

The authors drew on information about early-stage prostate cancer cases diagnosed in 2000 through 2001 from the American College of Surgeons National Cancer Data Base and carefully reviewed the medical records of 2,775 men treated with radical prostatectomy or external-beam radiation therapy.  Their goal was to assess compliance with 29 disease-specific structure and process indicators for quality of care developed by the RAND Corporation, stratified by race, geographic region, and hospital type.

The authors state the following results of their investigation:

  • Overall compliance was > 70 percent for structural and pretherapy disease assessment indicators.
  • Compliance was lower for documentation of pretreatment functionality (46.4 to 78.4 percent), surgical pathology (37.1 to 86.3 percent), radiation technique (62.6 to 88.3 percent), and follow-up (55 percent).
  • Geographic variations were observed between the South Atlantic division and the New England division, with greater compliance in the South Atlantic division for
    • involvement of at least one board-certified urologist or radiation oncologist
    • the appropriate use of Gleason grading
    • the administration of a total radiation dose ≥ 70 Gy
  • Teaching/research hospitals and Comprehensive Cancer Centers had higher compliance than Community Cancer Centers
  • Racial differences were not observed for any indicator.

The authors’ conclusion pulls no punches: “The significant and unwarranted variations observed for these quality indicators by census division and hospital type illustrate the inconsistencies in prostate cancer care and represent potential targets for quality improvement.” They do, however, add that, “The lack of racial disparities suggests equity in care once a patient initiates treatment.”

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