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Quality of prostate cancer care improving in Victoria

Research published in Medical Journal of Australia has found that the overall quality of care for prostate cancer patients has improved in Victoria.

Associate Professor Sue Evans and colleagues from several institutions in Melbourne, including Monash University and The Peter MacCallum Cancer Centre, conducted a 5-year study between 2009 and 2013 on the quality of care for men diagnosed with prostate cancer, using three quality indicators reported by the Prostate Cancer Outcomes Registry – Victoria.

The Prostate Cancer Research International Active Surveillance (PRIAS) protocol guideline suggests men with low risk disease should be under active surveillance rather than receive immediate invasive treatment.

The Victorian research found the proportion of men with low risk disease who underwent active treatment declined during the study period.

“The mean percentage of PRIAS non-compliance had increased non-significantly from 45% in 2009 to 55% (2010) and 50% (2011), but a downward trend was evident in 2012 (40%) and 2013 (34%); this achieved statistical significance in 2013 (P = 0.024),” the authors wrote.

The second quality indicator was for men with high risk or locally advanced disease to receive treatment within 12 months of diagnosis, a rate which increased across the 5 years of the study.

“Eighty-eight percent of men in these risk groups received immediate active treatment in 2009, rising to 89% in 2010, 91% in 2011 and 2012, and 93% in 2013,” the authors reported.

The third quality indicator relates to risk-adjusted percentages of positive surgical margins (PSM) following radical prostatectomy.

“A significant decline was first measured in 2011 (7 percentage point reduction in pT2 prostatectomy PSM; P = 0.031).

Further significant improvements were measured for radical prostatectomies performed in 2012 and 2013, when the PSM rate remained steady at 12%,” the authors explained.

In a linked editorial, Dr Paul Craft from the Australian National University and Canberra Hospital wrote that measuring quality in cancer care helps enable improvement by health services and clinicians.

“Combined, if possible, with assessment of outcomes, quality indicators may provide reassurance that cancer care is good and achieving the outcomes predicted. Alternatively, the results may provide an impetus for change and innovation.”

He wrote that there are at least ten ongoing large randomised controlled trials around the world are assessing long term outcomes of prostate cancer care, including two in Australia

“With active cooperative trials groups in Australia and the development of the national outcomes registry initiative, some optimism about improving the outcomes for men with prostate cancer care is justified,” he concluded.

Article: Quality of care achievements of the Prostate Cancer Outcomes Registry – Victoria, Fanny Sampurno, Arul Earnest, Patabendi B Kumari, Jeremy L Millar, Ian D Davis, Declan G Murphy, Mark Frydenberg, Paul A Kearns, Sue M Evans, Medical Journal of Australia, doi: 10.5694/mja15.01041, published 2 May 2016.

Editorial: Improving quality in prostate cancer, Paul S Craft, Medical Journal of Australia, doi: 10.5694/mja16.00161, published 2 May 2016.