Using patient-reported outcomes to assess and improve prostate cancer brachytherapy
- Research support: USA Army Medical Research and Material Command Grants DAMD17-02-1-0090 and W81XWH-05-1-0093
- Earlier results presented in abstract form at the Annual Meeting of the American Society of Clinical Oncology, 2007
- To describe a successful quality improvement process that arose from unexpected differences in control groups' short-term patient-reported outcomes (PROs) within a comparative effectiveness study of a prostate brachytherapy technique intended to reduce urinary morbidity.
Patients and Methods
- Patients planning prostate brachytherapy at one of three institutions were enrolled in a prospective cohort study.
- Patients were surveyed using a validated instrument to assess treatment-related toxicity before treatment and at pre-specified intervals.
- Unexpectedly, urinary PROs were worse in one of two standard brachytherapy technique control populations (US-BT1 and US-BT2). Therefore, we collaboratively reviewed treatment procedures, identified a discrepancy in technique, made a corrective modification, and evaluated the change.
- The patient groups were demographically and clinically similar.
- In the first preliminary analysis, US-BT2 patients reported significantly more short-term post-treatment urinary symptoms than US-BT1 patients.
- The study's treating physicians reviewed the US-BT1 and US-BT2 treatment protocols and found that they differed in whether they used an indwelling urinary catheter.
- After adopting the US-BT1 approach, short-term urinary morbidity in US-BT2 patients decreased significantly. Brachytherapy procedures were otherwise unchanged.
- Many procedures in cancer treatments are not evaluated, resulting in practice variation and suboptimal outcomes. Patients, the primary medical consumers, provide little direct input in evaluations of their care.
- We used PROs, a sensitive and valid measure of treatment-related toxicity, for quality assessment and quality improvement (QA/QI) of prostate brachytherapy. This serendipitous patient-centred QA/QI process may be a useful model for empirically evaluating complex cancer treatment procedures and for screening for substandard care.