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New health care delivery model for prostate cancer care results in better patient outcomes

Population-based approach includes safety-net program, improved surgical procedures to help improve patient outcomes

A comprehensive, population-based regional health care management program for men with prostate cancer who are members of Kaiser Permanente Southern California has led to improved outcomes, according to a Kaiser Permanente study published in the journal Urology Practice.

“While prostate cancer is the second-leading cause of cancer death among men, providing high quality care for men living with prostate cancer presents a challenge,” said study lead author Ronald K. Loo, MD, regional chief of urology, Southern California Permanente Medical Group. “Increased survival rates have made prostate cancer similar to other chronic conditions, which means we need ongoing management strategies that span the natural history and clinical course of the disease.”

Kaiser Permanente Southern California developed the prostate cancer care program in 2003. It is focused on screening and prevention, shared decision making for treatment following diagnosis and care improvement for men with localized and advanced disease. Specifically, the improvements made to the health care delivery model include:

  • A successful intervention to reduce inappropriate prostate cancer screening for men over the age of 75 where the harms of screening may outweigh the benefits. This was in response to U.S. Preventative Services Task Force recommendations that indicated screening was not appropriate for this patient population. The intervention resulted in a 50 percent reduction of prostate cancer screening for men in this age group, from 30 percent in 2009 to 15 percent in 2012.
  • The development of a new prostate cancer safety-net program in response to the potential impact of a missed diagnosis of the disease. The program identified 9,381 men with an elevated screening serum prostate-specific antigen (PSA) level who had not been evaluated by a urologist within 12 weeks of receiving results. Of these men, 3,377 received a biopsy procedure and about one-third of these men were diagnosed with prostate cancer.
  • The introduction of robotic technology to assist surgeons conducting laparoscopic prostatectomy procedures, a surgery that involves the removal of the prostate and that traditionally has been associated with an increased risk of impotence and urinary incontinence. Researchers created a regional group that established standardized protocols and operative procedures and instrumentation throughout the process along with peer-review and innovative mentoring processes. Following successful implementation, the researchers found that men who underwent this robot-assisted procedure versus traditional surgery had lower rates of blood loss and were more likely to report return of sexual function.
  • Researchers also addressed the increased risk of osteoporosis for men with prostate cancer who underwent extensive androgen-deprivation hormonal therapy. While this therapy is effective in controlling the cancer, the treatments have significant potential side effects. The new program offered improved drug management and patient follow-up care, including standardized osteoporosis screening. Researchers found that the men who were screened in this program were four times less likely to experience a hip fracture than those who were not screened during the study period.

“This comprehensive, regional care management program has proven to deliver reliable improvement in the way a health care organization approaches prostate cancer care,” said Dr. Loo. “We believe that other health care providers and organizations may wish to adopt aspects of this program, as clinicians treating men with prostate cancer aim to provide the highest quality, affordable care.”

This research is part of Kaiser Permanente’s continuing efforts to broaden the medical community’s understanding of prostate cancer. Last fall, a Kaiser Permanente study found that men who are overweight or obese when they are diagnosed with prostate cancer are more likely to die from the disease than men who are of healthy weight. Also last year, Kaiser Permanente researchers discovered that measurements taken over time of PSA, the most commonly used screening test for prostate cancer in men, improve the accuracy of aggressive prostate-cancer detection when compared to a single measurement of PSA.

Source

Other authors of the paper include: Charles Shapiro, MD and Gary Chien, MD, of the Kaiser Permanente Los Angeles Medical Center Department of Urology; Steven J. Jacobsen, MD, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation; Kirk Tamaddon, MD, of the Southern California Permanente Medical Group Department of Urologic Surgery; and Eugene Rhee, MD, of the Southern California Permanente Medical Group Department of Urology.

Kaiser Permanente