Quality of care varies greatly for the treatment of men with early-stage prostate cancer by region of the country and category of health care facility, suggesting the potential for improved patient outcomes with more standard prostate cancer treatment protocols, according to a new prostate cancer study that was published in the Aug. 1, 2008 issue of the Journal of Clinical Oncology (2008: Vol. 26, Issue 22).

The inconsistencies in care also suggest that there is much to do before quality improvement initiatives, such as pay-for-performance, can be instituted nationwide, according to Benjamin A. Spencer, M.D., M.P.H., the lead author of the study. Dr. Spencer is a urologic oncologist at NewYork-Presbyterian Hospital/Columbia University Medical Center and an assistant professor of urology at the Columbia University College of Physicians and Surgeons.

"We found significant variations for early-stage prostate cancer quality indicators. There were differences in care from community hospitals to prostate cancer centers to teaching hospitals. There were also disparities in care from one region of the country to another. But there were no racial disparities, suggesting equity in care once a patient initiates prostate cancer treatment," says Dr. Spencer. "If these variations in care can be eliminated, thereby providing uniform quality, it may lead to improved outcomes for patients."

The study reviewed national databases and individual patient charts to identify gaps in care for prostate cancer using comprehensive quality measures developed by RAND.

All therapies for localized prostate cancer can significantly impact the patient's quality of life. Improving the quality of care throughout the health care system could greatly improve quality-of-life issues for men treated for the disease.

Compliance with structural measures, such as having more than one board-certified urologist and board-certified radiation oncologist on staff, was high at near or greater than 90 percent. In contrast, compliance with standards for pre-therapy assessments of sexual and bowel function was low, at less than 52 percent.

Comprehensive prostate cancer centers and teaching/research hospitals had higher compliance rates than community cancer centers across the board on nearly all compliance measures. Compliance rates varied greatly throughout the country on several measures, including board-certified urologists and radiation oncologists, communication with primary care physician and conformal total radiation dose.

High-quality care is possible, as evidenced by the near or greater than 80 percent compliance with pre-therapy disease severity assessment and counseling indicators. However, compliance was substantially lower for pre-therapy functional assessment and post-treatment follow-up indicators.

Using the National Cancer Data Base, the study sampled early-state prostate cancer cases diagnosed in 2000 through 2001 and explicitly reviewed medical records from 2,775 men treated with radical prostatectomy or external-beam radiation therapy. The researchers determined compliance with 29 quality-of-care disease-specific structure and process indicators developed by RAND, stratified by race, geographic region and hospital type.

About Prostate Cancer

Prostate cancerr is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes.

Many factors, including genetics and diet, have been implicated in the development of prostate cancer. Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer.

• difficulty starting and maintaining a steady stream of urine,
• frequent urination,
• increased urination at night,
• blood in the urine,
• painful urination and
• erectile dysfunction

Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms. The most common symptom being bone pain, often in vertebrae (bones of the spine), pelvis or ribs. Spread of cancer into other bones such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.