ASCO issues guidelines on physician-patient communication

Your sitemaster is uncertain whether to feel delighted or seriously concerned by the fact that the American Society for Medical Oncology (ASCO) has decided to issue guidelines for its members on how to communicate with patients. … READ MORE …

New guidance on treatment of localized prostate cancer from AUA and others

Over the weekend, the American Urological Association (AUA), together with the Society for Urologic Oncology (SUO), and the American Society for Radiation Oncology (ASTRO) issued new guidance on the treatment of localized prostate cancer. … READ MORE …

Revised ASCO/CCO brachytherapy guidelines

The publication of the ASCENDE-RT clinical trial (discussed here) has led to a revision in the brachytherapy guidelines (available here) issued jointly by the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO). The guidelines are for patients who choose radical therapy rather than active surveillance. … READ MORE …

Treating metastatic prostate cancer in very elderly men: a review

A helpful review article on the treatment of metastatic and metastatic, castration-resistant prostate cancer (mCRPC) in very elderly men appears in last month’s issue of Clinical Interventions in Aging. … READ MORE …

The language of denial of access to high-quality prostate cancer care today

If you look at the corporate web site for eviCore Healthcare, the company describes itself as follows: … READ MORE …

Formal comment from ASTRO on the results of the ProtecT trial

The following official statement was issued on September 15 by the American Society for Radiation Oncology (ASTRO): … READ MORE …

Improvements in the quality of prostate cancer care (in Australia)

One of the most critical issues for many in the prostate cancer community is whether patients actually receive treatment according to standard guidelines. While getting treatment according to standard guidelines may not imply that a patient is getting the very best possible care, we know that getting treatment according to standard guidelines does at least mean that physicians are seeking to meet or surpass the quality of care that is recommended.

A new paper by Sampurno et al. in the Medical Journal of Australia has provided us with data from the Prostate Cancer Outcomes Registry–Victoria (PCOR-Vic), a state-wide prostate cancer outcomes registry in Victoria (one of Australia’s most highly populated states).

The authors collected and analyzed data on 4,708 men diagnosed with prostate cancer over a 5-year period (from 1 January 2009 and 31 December 2013). The goal was to assess how well prostate cancer care was being delivered when measured against three predefined quality indicators:

  • Alignment with the modified Prostate Cancer Research International Active Surveillance (PRIAS) protocol guideline (QI-1)
  • Timeliness of prostate cancer care for men with high-risk and locally advanced disease (QI-2)
  • The presence of positive surgical margins (PSMs) among men treated surgically for organ-confined, pT2 disease (QI-3)

The entire text of this paper is available on line for interested readers, so we will focus on the “top-line” results of the study, as follows:

  • Over the 5 years of the study there was
    • A downward trend in the percentage of men with low-risk disease who underwent active treatment (from 45 to 34 percent; P = 0.024)
    • An upward trend in the percentage of men with high-risk and locally advanced disease who received active treatment within 12 months of diagnosis (from 88 to 93 percent; P = 0.181)
    • A decline in PSM rate among men with pT2 disease after radical prostatectomy (from 21 to 12 percent; P = 0.036)

The authors note that a limitation of the study is that the improvement in the quality indicators was detected using PCOR-Vic as a single population, but that there could still be institutional variations in quality improvement.

With that reservation, the authors conclude that, over the period 2009 t0 2013

the performance of the Victorian health system improved according to the three processes of care indicators reported by the PCOR-Vic.

The “New” Prostate Cancer InfoLink sees this as an important study because it offers (a) validation of the processes being used in Australia to set and then achieve certain standards of care and (b) a significant set of improvements over 5 years toward achieving such standards of care.

By comparison, in much of America, there are no predefined goal being set by anyone as to levels of acceptable outcomes, nor are there clear educational processes in most states designed to ensure that physicians are seeking to meet or exceed such outcomes.