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

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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References

  1. Krupski TL, Kwan L, Afifi AA, Litwin MS. Geographic and socioeconomic variation in the treatment of prostate cancer. J Clin Oncol. 2005;23:7881–8.

    Article  PubMed  Google Scholar 

  2. Holmes JA, Bensen JT, Mohler JL, Song L, Mishel MH, Chen RC. Quality of care received and patient-reported regret in prostate cancer: analysis of a population-based prospective cohort. Cancer. 2017;123:138–43.

    Article  CAS  PubMed  Google Scholar 

  3. Harlan L, Brawley O, Pommerenke F, Wall P, Kramer B. Geographic, age, and racial variation in the treatment of local/regional carcinoma of the prostate. J Clin Oncol. 1995;13:93–100.

    Article  CAS  PubMed  Google Scholar 

  4. Penson DF. Assessing the quality of prostate cancer care. Curr Opin Urol. 2008;18:297–302.

    Article  PubMed  Google Scholar 

  5. Hoffman KE, Penson DF, Zhao Z, Huang L-C, Conwill R, Laviana AA, et al. Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA. 2020;323:149.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Albert JM, Das P. Critical Review Quality Indicators in Radiation Oncology. Radiat Oncol Biol. 2013;85:904–11.

    Article  Google Scholar 

  7. Zelefsky MJ, Lee WR, Zietman A, Khalid N, Crozier Rn C, Owen Phd J, et al. Evaluation of adherence to quality measures for prostate cancer radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey. PRRO. 2013;3:2–8.

    Google Scholar 

  8. Lee DJ, Barocas DA, Zhao Z, Huang LC, Koyama T, Resnick MJ, et al. Contemporary prostate cancer radiation therapy in the United States: Patterns of care and compliance with quality measures. Pr Radiat Oncol. 2018;8:307–16.

    Article  Google Scholar 

  9. Sohn W, Resnick MJ, Greenfield S, Kaplan SH, Phillips S, Koyama T, et al. Impact of Adherence to Quality Measures for Localized Prostate Cancer on Patient-reported Health-related Quality of Life Outcomes, Patient Satisfaction, and Treatment-related Complications. Med Care. 2016;54:738–44.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Reisz PA, Laviana AA, Zhao Z, Huang L-C, Koyama T, Conwill R, et al. Assessing the Quality of Surgical Care for Clinically Localized Prostate Cancer: Results from the CEASAR Study. J Urol. 2020;204:1236–41.

    Article  PubMed  Google Scholar 

  11. Barocas DA, Chen V, Cooperberg M, Goodman M, Graff JJ, Greenfield S, et al. Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study. J Comp Eff Res. 2013;2:445–60.

    Article  PubMed  Google Scholar 

  12. National Comprehensive Cancer Network. The NCCN Clinical Practice Guidelines in Oncology Prostate Cancer (Version 3.2020). http://www.nccn.org.

  13. Davis BJ, Horwitz EM, Lee WR, Crook JM, Stock RG, Merrick GS, et al. American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy. Brachytherapy. 2012;11:6–19.

    Article  PubMed  Google Scholar 

  14. Efstathiou JA, Nassif DS, McNutt TR, Bogardus CB, Bosch W, Carlin J, et al. Practice-Based Evidence to Evidence-Based Practice: Building the National Radiation Oncology Registry. J Oncol Pr. 2013;9:e90–e95.

    Article  Google Scholar 

  15. Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and Validation of an Abbreviated Version of the Expanded Prostate Cancer Index Composite Instrument for Measuring Health-related Quality of Life Among Prostate Cancer Survivors. Urology. 2010;76:1245–50.

    Article  PubMed  Google Scholar 

  16. Skolarus TA, Dunn RL, Sanda MG, Chang P, Greenfield TK, Litwin MS, et al. Minimally Important Difference for the Expanded Prostate Cancer Index Composite Short Form. Urology. 2015;85:101–6.

    Article  PubMed  Google Scholar 

  17. Litwin MS, Greenfield S, Elkin EP, Lubeck DP, Broering JM, Kaplan SH. Assessment of prognosis with the total illness burden index for prostate cancer. Cancer. 2007;109:1777–83.

    Article  PubMed  Google Scholar 

  18. Hall WA, Deshmukh S, Bruner DW, Michalski JM, Purdy JA, Bosch W, et al. Quality of Life Implications of Dose-Escalated External Beam Radiation for Localized Prostate Cancer: Results of a Prospective Randomized Phase 3 Clinical Trial, NRG/RTOG 0126. Int J Radiat Oncol. 2022;112:83–92.

    Article  Google Scholar 

  19. Rubin HR, Pronovost P, Diette GB. The advantages and disadvantages of process-based measures of health care quality. Int J Qual Heal Care. 2001;13:469–74.

    Article  CAS  Google Scholar 

  20. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56:899–905.

    Article  CAS  PubMed  Google Scholar 

  21. Hagan M, Kapoor R, Michalski J, Sandler H, Movsas B, Chetty I, et al. VA-Radiation Oncology Quality Surveillance Program. Int J Radiat Oncol. 2020;106:639–47.

    Article  Google Scholar 

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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).

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Authors and Affiliations

Authors

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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