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From: J on 3 Aug 2008 05:37
http://www.medicalnewstoday.com/articles/117026.php
Disparities In Prostate Cancer Treatment Suggest Ways To Improve Care
Article Date: 02 Aug 2008 - 1:00 PDT

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 treatment protocols, according to a new study that was published
in the Aug. 1 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
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
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 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.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in
basic, pre-clinical and clinical research, in medical and health sciences
education, and in patient care. The medical center trains future leaders
and includes the dedicated work of many physicians, scientists, public
health professionals, dentists, and nurses at the College of Physicians &
Surgeons, the Mailman School of Public Health, the College of Dental
Medicine, the School of Nursing, the biomedical departments of the
Graduate School of Arts and Sciences, and allied research centers and
institutions. Established in 1767, Columbia's College of Physicians &
Surgeons was the first institution in the country to grant the M.D. degree
and is now among the most selective medical schools in the country.
Columbia University Medical Center is home to the largest medical research
enterprise in New York City and state and one of the largest in the United
States. For more information, please visit http://www.cumc.columbia.edu.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital, based in New York City, is the nation's
largest not-for-profit, non-sectarian hospital, with 2,242 beds. The
Hospital has nearly 2 million inpatient and outpatient visits in a year,
including more than 230,000 visits to its emergency departments -- more
than any other area hospital. NewYork-Presbyterian provides
state-of-the-art inpatient, ambulatory and preventive care in all areas of
medicine at five major centers: NewYork-Presbyterian Hospital/Weill
Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University
Medical Center, Morgan Stanley Children's Hospital of
NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and
NewYork-Presbyterian Hospital/Westchester Division. One of the largest and
most comprehensive health-care institutions in the world, the Hospital is
committed to excellence in patient care, research, education and community
service. It ranks sixth in U.S.News & World Report's guide to "America's
Best Hospitals," ranks first on New York magazine's "Best Hospitals"
survey, has the greatest number of physicians listed in New York
magazine's "Best Doctors" issue, and is included among Solucient's top 15
major teaching hospitals. The Hospital's mortality rates are among the
lowest for heart attack and heart failure in the country, according to a
2007 U.S. Department of Health and Human Services (HHS) report card. The
Hospital has academic affiliations with two of the nation's leading
medical colleges: Weill Cornell Medical College and Columbia University
College of Physicians and Surgeons. For more information, visit
http://www.nyp.org.

NewYork-Presbyterian Hospital
627 W 165th St., SB-621
New York, NY 10032
United States
http://www.nyp.org



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