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Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer

Prostate Cancer and Prostatic Diseases volume 26, pages 80–87 (2023)Cite this article

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A Correction to this article was published on 13 March 2023

This article has been updated

Abstract

Background

Prior studies have shown significant variability in the quality of prostate cancer care in the US with questionable associations between quality measures and patient reported outcomes. We evaluated the impact of compliance with nationally recognized radiation therapy (RT) quality measures on patient-reported health-related quality of life (HRQOL) outcomes in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) cohort.

Methods

CEASAR is a population-based, prospective cohort study of men with localized prostate cancer from which we identified 649 who received primary RT and completed HRQOL surveys for inclusion. Eight quality measures were identified based on national guidelines. We analyzed the impact of compliance with these measures on HRQOL assessed by the 26-item Expanded Prostate Index Composite at pre-specified intervals up to 5 years after treatment. Multivariable analysis was performed controlling for demographic and clinicopathologic features.

Results

Among eligible participants, 566 (87%) patients received external beam radiation therapy and 83 (13%) received brachytherapy. Median age was 69 years (interquartile range: 64–73), 33% had low-, 43% intermediate-, and 23% high-risk disease. 28% received care non-compliant with at least one measure. In multivariable analyses, while some statistically significant associations were identified, there were no clinically significant associations between compliance with evaluated RT quality measures and patient reported urinary irritative, urinary incontinence, bowel, sexual or hormonal function.

Conclusions

Compliance with RT quality measures was not meaningfully associated with patient-reported outcomes after prostate cancer treatment. Further work is needed to identify patient-centered quality measures of prostate cancer care.

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Funding

This study was supported by the Agency for Healthcare Research and Quality (1R01HS019356 and 1R01HS022640); the Patient-Centered Outcomes Research Institute (CE-12-11-4667); and the National Cancer Institute (National Institutes of Health/National Cancer Institute grant R01CA230352). Data management was facilitated by Vanderbilt University’s Research Electronic Data Capture (REDCap) system, which is supported by the Vanderbilt Institute for Clinical and Translational Research grant (UL1TR000011 from National Center for Advancing Translational Sciences/National Institute of Health).

Author information

Authors and Affiliations

  1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

    Jacob E. Tallman, Christopher J. D. Wallis, David F. Penson & Daniel A. Barocas

  2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Li-Ching Huang, Zhiguo Zhao & Tatsuki Koyama

  3. Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Ralph Conwill

  4. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Michael Goodman

  5. Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA

    Ann S. Hamilton

  6. Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA

    Xiao-Cheng Wu

  7. Department of Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Lisa E. Paddock & Antoinette Stroup

  8. Department of Urology, University of California, San Francisco, CA, USA

    Matthew R. Cooperberg

  9. Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Mia Hashibe

  10. Department of Urology, University of Utah Health, Salt Lake City, UT, USA

    Brock B. O’Neil

  11. Department of Medicine, University of California Irvine, Irvine, CA, USA

    Sherrie H. Kaplan & Sheldon Greenfield

  12. Department of Radiation Oncology, University of Texas M. D. Anderson Center, Houston, TX, USA

    Karen E. Hoffman

Authors
  1. Jacob E. Tallman
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  2. Christopher J. D. Wallis
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  4. Zhiguo Zhao
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  7. Ralph Conwill
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  8. Michael Goodman
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  9. Ann S. Hamilton
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  11. Lisa E. Paddock
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  13. Matthew R. Cooperberg
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Contributions

JET, MD: Conception or design of the work, Data analysis and interpretation, Drafting the paper, Critical revision of the paper, Final approval of the version to be published; CJDW, MD, PhD, FRCSC: Conception or design of the work, Data analysis and interpretation, Drafting the paper, Critical revision of the paper, Final approval of the version to be published; L-CH, PhD: Conception or design of the work, Data analysis and interpretation, Critical revision of the paper, Final approval of the version to be published; ZZ, MS: Conception or design of the work, Data analysis and interpretation, Critical revision of the paper, Final approval of the version to be published; DFP, MD, MPH: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; TK, PhD: Conception or design of the work, Data analysis and interpretation, Critical revision of the paper, Final approval of the version to be published; RC, BS: Conception or design of the work, Data analysis and interpretation, Critical revision of the paper, Final approval of the version to be published; MG, MD, MPH: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; ASH, PhD, MA: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; X-CW, MD, MPH: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; LEP, PhD, MPH: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; AS, PhD: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; MRC, MD, MPH: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; MH, PhD:Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; BBO’N, MD: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; SHK, PhD, MS, MPH: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; SG, MD: Conception or design of the work, Data collection, Critical revision of the paper, Final approval of the version to be published; DAB, MD, MPH: Conception or design of the work, Data collection, Data analysis and interpretation, Drafting the paper, Critical revision of the paper, Final approval of the version to be published; KEH, MD, MHSc, MPH: Conception or design of the work, Data collection, Data analysis and interpretation, Drafting the paper, Critical revision of the paper, Final approval of the version to be published.

Corresponding author

Correspondence to Jacob E. Tallman.

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Competing interests

Dr DAB reports grants from AHRQ, grants from PCORI, and grants from NCATS/NIH during the conduct of the study. Dr KEH reports grants from Varian Medical Systems and grants from Janssen, outside the submitted work. All other authors have none to report.

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The original online version of this article was revised: In this article the statement in the Funding information section was incorrectly given as ‘5T32CA106183’ and should have read ‘R01CA230352’. The original article has been corrected.

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Tallman, J.E., Wallis, C.J.D., Huang, LC. et al. Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer. Prostate Cancer Prostatic Dis 26, 80–87 (2023). https://doi.org/10.1038/s41391-022-00518-5

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