MP-4 Quality of care during active surveillance in low risk prostate cancer patients: a population-based approach
Thursday June 27, 2019 from 21:45 to 22:15

Narhari Timilshina, Canada

Research Associate

Division of Urology

University of Toronto


Quality of care during active surveillance in low risk prostate cancer patients: A population-based approach

Narhari Timilshina1,5, Shabbir M. Alibhai1,5, George Tomlinson4, Beate Sander4, Antonio Finelli1,2,3.

1Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada; 2Division of Urology, University Health Network, Toronto, ON, Canada; 3Department of surgical Oncology, University Health Network, Toronto, ON, Canada; 4Toronto Health Economics and Technology Assessment (THETA), University Health Network, Toronto, ON, Canada; 5Department of Medicine, University Health Network, Toronto, ON, Canada

[The Princess Margaret Cancer Centre Quality of Care Initiative on Active Surveillance].

Introduction: Active surveillance (AS) is now worldwide recognized as the preferred management strategy for most of low risk prostate cancer (PC) to minimize risks of overtreatment. Despite increasing use of AS in worldwide, wide variability of care during follow up has been observed, and these variations in quality of care have not been well described. Furthermore, choosing appropriate quality indicators is a point of ongoing debate. We measured quality of AS care using structure-process-outcome-based quality indicators (QIs) using Canadian administrative databases.

Methods: We developed n=20 quality indicators (QIs) targeting measure quality of AS at population level. Quality indicators were identified using literature search from current guidelines on AS, and further refined through a modified Delphi process. Selected (n=20) AS-specific QIs were used to measure quality of  AS care among low-risk PC between 2002-2014 using population-level cancer registry databases. We assessed adherence to clinical guidelines using QIs, and compared with health care system-related characteristics.

Results: In this cohort study of 31,102 low risk PC men with a mean (SD) age at diagnosis of 65.0 (8.8) years who are included in the Ontario Cancer Registry. The mean (IQR) PSA level at diagnosis was 6.2 (4.7-8.6) ng/mL, mean positive core (SD) was 2.6 (1.9). A total of 25126 men (79%) were primarily managed by a Urologist. Overall use of Initial AS was 40.8% in 31102 eligible men with low risk disease. 82.3% of patients underwent at least 8 or more core diagnostic biopsy. 51.9% of low volume patients (defined as ≤3 positive cores and <50% of max. percent core) went on AS and 75.9% had regular follow up with urologist as per guidelines. Only 48.1% patients on AS underwent confirmatory biopsy within 6-12months from diagnosis, and 82.3% patients had a biopy prior to receiving definitive therapy. 89.4% of patients who eventually received definitive therapy did so after upgrade in clinical stage or Gleason score.  Specific to outcomes indicators, 45.6% of patients discontinued AS within 5 years from diagnosis, the 5- and 10- year metastases free survival rates were 98.5% and 95.4% respectively. 5- and 10- year PC specific survival rates were 99.6% and 98.3% respectively. Overall survival at 10 years was 90.9% with median follow up 9 years.

Conclusion: This study establishes a foundation on which to build quality of care assessment to monitor the quality of AS patients at population level. In this Canadian population based cohort study based on OCR database, although the use of AS increased, considerable quality of AS care variation appeared with QIs related to process of care and outcome of AS care.

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