Active surveillance initiative raises adoption of strategy

June 3, 2016

An academic center/community practice collaboration increases use of surveillance among prostate cancer patients “through use of provider education and a standardized report card,” a study author said.

A urologist-led education and comparative reporting initiative to enhance active surveillance for prostate cancer adoption did just that, according to a recent study.

“Active surveillance is a strategy that is recommended by physician and quality organizations to avoid the overtreatment of slow-growing prostate cancer,” senior author Christopher Kane, MD, of the University of California, San Diego said in a press release from that institution.

“Acceptance of this strategy by patients and urologists, however, has lagged for a number of reasons. What we have developed is a safe method to enhance acceptance and use of this disease management approach,” added Dr. Kane.

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An expert who discussed the study with Urology Times commented that while surveillance adoption has increased in the U.S., it lags behind other countries.

Next: How the initiative was created

 

The authors measured past active surveillance adoption rates, launched the physician-led quality initiative based on best practices, and measured active surveillance adoption rates after the initiative’s implementation for the next 3 years.

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Urologists at UCSD and Genesis Healthcare Partners, a San Diego-based independent multispecialty group, developed the reporting mechanism to improve the process of tracking patients with prostate cancer. Based on the literature, the authors developed standardized selection criteria for patients eligible for active surveillance according to tumor characteristics, including clinical cancer staging and Gleason and PSA scores. They also developed comparative dashboards to compare individual physician’s active surveillance adoption rates to their peers’.

As part of the initiative, between 2013 and 2014, urologists at Genesis Healthcare Partners underwent an educational training program on active surveillance best practices for low-risk prostate cancer management. The physicians were graded on their active surveillance adoption and received comparative reporting, according to the study, which was published online ahead of print in Urology (Feb. 12, 2016).

“With this new model, we were able to increase rates of surveillance to benefit patients through use of provider education and a standardized report card,” study author Franklin Gaylis, MD, of Genesis Healthcare, said in the press release. “With this university and private-practice research collaboration, we were able to monitor 190 patients undergoing active surveillance while evaluating the effectiveness of our own individual clinical practices.”

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Active surveillance increased for the 3 years of the study. Active surveillance adoption for low-risk prostate cancer patients went from 31.90% the first year of the study to 58.46% the third year. Active surveillance adoption among the very low-risk prostate cancer patients increased from 43.75% the first year to 82.61% the third year of the educational and comparative reporting approach.

Next: Stacy Loeb, MD, MSc, comments on initiative

 

Urology Times Editorial Council member Stacy Loeb, MD, MSc, explained that surveillance has been under-used in the United States.

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“Historically, active surveillance was underutilized in the United States, and the vast majority of patients received radical treatment,” Dr. Loeb, of New York University Langone Medical Center, told Urology Times.

As of 2006, only about 10% of patients with low-risk disease were managed conservatively in this country and the rest underwent treatment, according to Dr. Loeb, who was not involved with the study.

“More recently, a greater number of men with low-risk disease are deferring upfront radical treatment,” she said. “As of 2013, data from several sources suggests that approximately 40% to 50% of low-risk patients in the U.S. were managed with surveillance.”

While an improvement, these rates are much lower than has been reported in other countries.

“Our group recently presented new data from Sweden at the 2016 American Urological Association meeting, showing that 91% of very low-risk and 74% of low-risk patients across the entire country did active surveillance in 2014. It is noteworthy that the National Prostate Cancer Register of Sweden tracks all treatment trends with public reporting and feedback to individual providers, so this may be one of the factors promoting more expanded use,” Dr. Loeb said. “The current study found a significant increase in the use of active surveillance for low-risk and very low-risk prostate cancer through targeted education, tracking of outcomes, and comparative feedback to providers.

“The authors should be congratulated on this important initiative to expand the use of active surveillance in guideline-concordant patients,” she said.

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