The quality of surgical pathology care for men undergoing radical prostatectomy in the U.S.

Miller, David C.; Spencer, Benjamin A.; Shah, Rajal B.; Ritchey, Jamie; Stewart, Andrew K.; Dunn, Rodney L.; Wei, John T.; Litwin, Mark S.

doi:10.1002/cncr.22698

Cited by 10 publications

(6 citation statements)

References 52 publications

(79 reference statements)

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“…As stated for QI3 and QI4, also the standardization of the pathological evaluation of the prostatectomy specimen plays a central role in the PC patients’ care, the adequate treatment decision planning, such as an eventual adjuvant therapy and the prognosis estimation. In the literature we found only two American studies assessing the quality of surgical pathology reporting [ 48 , 49 ]. As shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland

et al. 2018

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BackgroundQuality of cancer care (QoCC) has become an important item for providers, regulators and purchasers of care worldwide. Aim of this study is to present the results of some evidence-based quality indicators (QI) for prostate cancer (PC) at the population-based level and to compare the outcomes with data available in the literature.MethodsThe study included all PC diagnosed on a three years period analysis (01.01.2011–31.12.2013) in the population of Canton Ticino (Southern Switzerland) extracted from the Ticino Cancer Registry database. 13 QI, approved through the validated Delphi methodology, were calculated using the “available case” approach: 2 for diagnosis, 4 for pathology, 6 for treatment and 1 for outcome. The selection of the computed QI was based on the availability of medical documentation. QI are presented as proportion (%) with the corresponding 95% confidence interval.Results700 PC were detected during the three-year period 2011–2013: 78.3% of them were diagnosed through a prostatic biopsy and for 72.5% 8 or more biopsy cores were taken. 46.5% of the low risk PC patients underwent active surveillance, while 69.2% of high risk PC underwent a radical treatment (radical prostatectomy, radiotherapy or brachytherapy) and 73.5% of patients with metastatic PC were treated with hormonal therapy. The overall 30-day postoperative mortality was 0.5%.ConclusionsResults emerging from this study on the QoCC for PC in Canton Ticino are encouraging: the choice of treatment modalities seems to respect the international guidelines and our results are comparable to the scarce number of available international studies. Additional national and international standardisation of the QI and further QI population-based studies are needed in order to get a real picture of the PC diagnostic-therapeutic process progress through the definition of thresholds of minimal standard of care.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4604-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland

et al. 2018

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“…In the genitourinary malignancy literature, Miller et al. [23] evaluated prostate cancer reporting after radical prostatectomy. Overall, these authors found good compliance with standards, although stage and tumour size descriptions were absent in half of the reports.…”

Section: Discussionmentioning

confidence: 99%

“…The study by Miller et al. [23] was conducted among only Commission on Cancer designated programmes, whereas the present study included sites without a relationship to a national standards‐setting body.…”

Section: Discussionmentioning

confidence: 99%

Quality of pathological reporting for renal cell cancer: implications for systemic therapy, prognostication and surveillance

Shuch¹,

Pouliot²,

Finley³

et al. 2010

BJU International

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Study Type – Prognosis (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Pathology reporting is an important aspect of cancer care for all solid malignancies and the College of American Pathologists has set forth specific guidelines. Many prognostic nomograms for kidney cancer rely on important pathologic characteristics but it is unknown if current reporting practices permit use of these models. This study shows limitations in the current pathological reporting practices for kidney cancer. Guidelines set forth by the College of American Pathologists are frequently not met and this could limit the use of prognostic models and enrollment into adjuvant trials. Efforts should be made to improve reporting practices by methods such as standard template reporting. OBJECTIVE To evaluate whether current nephrectomy pathology reports are sufficient to allow clinicians to use prognostic nomograms, tailor surveillance, enroll patients into adjuvant trials and select systemic therapy for renal cell carcinoma (RCC). PATIENTS AND METHODS Nephrectomy pathology reports were obtained from the LA County Tumor Registry. Key reporting elements identified by the College of American Pathology (CAP) and utilized in RCC prognostic models were abstracted. Hospital type was coded as community, teaching or cancer centre. Reporting quality was assessed across hospital type and year. RESULTS A total of 317 of 344 sampled reports (92.2%) met the inclusion criteria. Tumour size and margin status were commonly reported. Some 90.2% and 84.2% of reports provided data on histology and Fuhrman grade. Tumour classification was omitted in 27.8%. Microvascular invasion and necrosis were infrequently reported (44.5% and 25.6%, respectively). Only 59.9% of reports met CAP guidelines for tumour classification, margin, size, histology and grade. Two prognostic nomograms (Stage, Size, Grade and Necrosis system and Kattan) could rarely be utilized (15.8% and 12.3%, respectively), whereas the UCLA Integrated Staging System could be used frequently (65.6%). There were discrepancies satisfying CAP guidelines between community, teaching and cancer centre hospitals, with 54.7%, 70.5% and 75% of reports meeting CAP criteria (P= 0.0102). CONCLUSIONS Current RCC pathology reporting fails to satisfy CAP guidelines, does not permit the use of prognostic systems, and may hinder enrollment into adjuvant trials and the selection of systemic therapy. Important reporting discrepancies exist between hospital types, with cancer centres performing best. Quality improvement initiatives to encourage consistent, comprehensive and clinically relevant pathology reports would improve the quality of RCC patient care.

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“…Although there are ample data to demonstrate a relationship between quality of care and outcomes in the treatment of prostate cancer, no previous comparative effectiveness study in prostate cancer has attempted to control for the quality of the intervention [26,52,60,61]. The CEASAR study is unique in this regard and we anticipate that patients will be able to use our results to guide not only treatment decisions, but also provider and facility decisions.…”

Section: Commentmentioning

confidence: 99%

Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study

Barocas

Chen

Cooperberg

et al. 2013

J. Compar. Effect. Res.

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Background While randomized controlled trials represent the highest level of evidence we can generate in comparative effectiveness research, there are clinical scenarios where this type of study design is not feasible. The Comparative Effectiveness Analyses of Surgery and Radiation in localized prostate cancer (CEASAR) study is an observational study designed to compare the effectiveness and harms of different treatments for localized prostate cancer, a clinical scenario in which randomized controlled trials have been difficult to execute and, when completed, have been difficult to generalize to the population at large. Methods CEASAR employs a population-based, prospective cohort study design, using tumor registries as cohort inception tools. The primary outcome is quality of life after treatment, measured by validated instruments. Risk adjustment is facilitated by capture of traditional and nontraditional confounders before treatment and by propensity score analysis. Results We have accrued a diverse, representative cohort of 3691 men in the USA with clinically localized prostate cancer. Half of the men invited to participate enrolled, and 86% of patients who enrolled have completed the 6-month survey. Conclusion Challenging comparative effectiveness research questions can be addressed using well-designed observational studies. The CEASAR study provides an opportunity to determine what treatments work best, for which patients, and in whose hands.

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The quality of surgical pathology care for men undergoing radical prostatectomy in the U.S.

Cited by 10 publications

References 52 publications

Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland

Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland

Quality of pathological reporting for renal cell cancer: implications for systemic therapy, prognostication and surveillance

Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study

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