Quality of active surveillance (AS) care received by an aging population in low risk prostate cancer: Applying quality indicators to understand quality of care at the population level

2021 ◽  
Vol 12 (8) ◽  
pp. S4
Author(s):  
N. Timilshina ◽  
A. Finelli ◽  
M. Komisarenko ◽  
G. Tomlinson ◽  
B. Sander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Quality Indicators ◽  
Active Surveillance ◽  
Population Level ◽  
Aging Population ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

scholarly journals The Quality of Life among Men Receiving Active Surveillance for Prostate Cancer: An Integrative Review

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 14 ◽  
Author(s):  
Sabrina L. Dickey ◽  
Ciara J. Grayson
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Active Surveillance ◽  
The United States ◽  
Low Risk ◽  
Integrative Review ◽  
Treatment Modalities ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Prostate cancer is very common among men in the United States. The current literature on active surveillance (AS) suggests that it is a promising treatment option for men with low-risk prostate cancer. The purpose of this manuscript is to provide a thorough integrative review regarding the effects of AS on the quality of life (QoL) of men with prostate cancer. Utilizing a methodological strategy, electronic databases were reviewed for empirical articles during the time frame of January 2006 to December 2016. A total of 37 articles met the inclusion criteria wherein 20 focused on the QoL among men only receiving AS and 16 reported QoL among men undergoing AS and other forms of treatment for prostate cancer. The review highlights the purpose, common instruments, race and ethnicity, and strengths and limitations of each article. The majority of articles indicated low levels of anxiety and depression and decreased incidences of bladder, bowel and sexual functioning among men undergoing AS in comparison to men who received other treatment modalities. The results indicated that additional research is needed to determine the QoL among men receiving AS on a longitudinal basis. The results support previous literature that indicated the positive impact of AS on low-risk prostate cancer.

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

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 16-16
Author(s):  
Narhari Timilshina ◽  
Antonio Finelli ◽  
George A. Tomlinson ◽  
Beate Sander ◽  
Shabbir M.H. Alibhai
Keyword(s):  
Prostate Cancer ◽  
Quality Indicators ◽  
Active Surveillance ◽  
Clinical Guidelines ◽  
Literature Search ◽  
Population Level ◽  
High Volume ◽  
Low Risk ◽  
Community Settings

16 Background: Active surveillance (AS) has become a widely accepted management strategy for low-risk (Gleason score ≤6) prostate cancer (PC). Given the large proportion of low-risk PC (60-90%) patients who currently receive AS, adherence to clinical guidelines on AS and variations in care at the population level remain surprisingly poorly understood. Further, it is presently unclear how often patients receive high quality AS care in community settings (almost all published data come from academic centers), yet the majority of AS occurs in community settings. Thus, there is significant interest in developing system-level quality indicators (QIs). We sought to develop structure-process-outcome-based QIs to enable benchmarking during AS follow-up using data available in Canadian administrative databases. Methods: We performed a detailed literature search on QIs in PC as well as broader theoretical concepts on QIs and consulted with clinical leaders from a major cancer centre. Current guidelines on AS and potential quality indicators were identified from a literature search. AS-specific QIs were tested among low-risk PC who were managed with AS between 2002-2011 using population-level cancer registry databases. We assessed adherence to clinical guidelines using QIs, and compared with health care system-related characteristics. Results: 25 indicators were proposed [structure of care (n = 5), process of care (n = 16) and health outcomes (n = 4)]. Overall 39% received AS, with 88% managed by a urologist. Only 43% of low volume (≤3 positive cores) patients underwent AS. Adherence of confirmatory biopsy with guidelines was performed on only 32% of patients, and adherence was better in higher volume institutions, among higher volume physicians, and in cancer centers. 5-and 10-year PC specific survival were significantly better among high volume physicians. Conclusions: We have proposed a set of QIs for measuring AS care. Initial data show that higher volume institution or higher volume physician and cancer center had better adherence to quality of AS care. Long term survival was better among patients treated by high volume physicians. Further validation of these QIs is ongoing.

THE QUALITY OF ACTIVE SURVEILLANCE FOR MEN WITH LOW-RISK PROSTATE CANCER

2009 ◽  
Vol 181 (4S) ◽  
pp. 179-179
Author(s):  
Mya E Levy ◽  
Stephanie Meyers ◽  
David P Wood ◽  
James E Montie ◽  
David C Miller ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Low Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

scholarly journals Prospective quality-of-life outcomes for low-risk prostate cancer: Active surveillance versus radical prostatectomy

Cancer ◽  
2015 ◽  
Vol 121 (14) ◽  
pp. 2465-2473 ◽  
Author(s):  
Claudio Jeldres ◽  
Jennifer Cullen ◽  
Lauren M. Hurwitz ◽  
Erika M. Wolff ◽  
Katherine E. Levie ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Low Risk ◽  
Life Outcomes ◽  
Quality Of Life Outcomes ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

scholarly journals National consensus quality indicators to assess quality of care for active surveillance in low-risk prostate cancer: An evidence-informed modified Delphi survey of Canadian urologists/radiation oncologists

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Narhari Timilshina ◽  
Antonio Finelli ◽  
George. Tomlinson Tomlinson ◽  
Anna Gagliardi ◽  
Beate Sander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Clinical Guidelines ◽  
Expert Panel ◽  
Low Risk ◽  
Modified Delphi ◽  
Radiation Oncologists ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Introduction: Although many low-risk prostate cancer (PCa) patients worldwide currently receive active surveillance (AS), adherence to clinical guidelines on AS and variations in care at the population level remain poorly understood. We sought to develop system-level quality indicators (QIs) and performance measures for benchmarking the quality of care during AS. Methods: Convenient sampling method was used to identify an expert panel among practicing urologists and radiation oncologists across Canada. QI development involved two phases: 1) proposed QIs were identified through a literature search and published clinical guidelines on AS; and 2) indicators were selected through a modified Delphi process during which each panelist independently rated each indicator based on clinical importance. QI items were chosen as appropriate measures for quality of AS care if they met prespecified criteria (disagreement index <1 and median importance of 7 or greater on a nine-point scale). Results: Among 42 invited expert panel members, the response rate was 45% (n=19). Expert panel members were well-represented by type of physician (84% urologists, 16% radiation oncologists) and practice setting (79% academic, 21% non-academic). The expert panel endorsed 20 of 27 potential indicators as appropriate for measuring quality of AS care. Conclusions: We developed a set of QIs to measure AS care using published guidelines and clinical experts. Use of the indicators will be assessed for feasibility in healthcare databases. Reporting quality of care with these AS indicators may enhance adherence, reduce variation in care, and improve patient outcomes among low-risk PCa patients on AS.

scholarly journals Assessment of PSIM (Prostatic Systemic Inflammatory Markers) Score in Predicting Pathologic Features at Robotic Radical Prostatectomy in Patients with Low-Risk Prostate Cancer Who Met the Inclusion Criteria for Active Surveillance

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 355
Author(s):  
Matteo Ferro ◽  
Gennaro Musi ◽  
Deliu Victor Matei ◽  
Alessandro Francesco Mistretta ◽  
Stefano Luzzago ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Inflammatory Markers ◽  
Low Risk ◽  
Inclusion Criteria ◽  
Robotic Radical Prostatectomy ◽  
Lymphocyte Ratio ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Background: circulating levels of lymphocytes, platelets and neutrophils have been identified as factors related to unfavorable clinical outcome for many solid tumors. The aim of this cohort study is to evaluate and validate the use of the Prostatic Systemic Inflammatory Markers (PSIM) score in predicting and improving the detection of clinically significant prostate cancer (csPCa) in men undergoing robotic radical prostatectomy for low-risk prostate cancer who met the inclusion criteria for active surveillance. Methods: we reviewed the medical records of 260 patients who fulfilled the inclusion criteria for active surveillance. We performed a head-to-head comparison between the histological findings of specimens after radical prostatectomy (RP) and prostate biopsies. The PSIM score was calculated on the basis of positivity according to cutoffs (neutrophil-to-lymphocyte ratio (NLR) 2.0, platelets-to-lymphocyte ratio (PLR) 118 and monocyte-to-lymphocyte-ratio (MLR) 5.0), with 1 point assigned for each value exceeding the specified threshold and then summed, yielding a final score ranging from 0 to 3. Results: median NLR was 2.07, median PLR was 114.83, median MLR was 3.69. Conclusion: we found a significantly increase in the rate of pathological International Society of Urological Pathology (ISUP) ≥ 2 with the increase of PSIM. At the multivariate logistic regression analysis adjusted for age, prostate specific antigen (PSA), PSA density, prostate volume and PSIM, the latter was found the sole independent prognostic variable influencing probability of adverse pathology.

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