Improved adherence to prostate cancer guidelines concomitant with public reporting. Nationwide population-based study
DOI:
https://doi.org/10.2340/sju.v60.43107Keywords:
Prostate cancer, adherence to guidelines, trend analysis, treatmentAbstract
Background: Swedish national guidelines provide evidence-based recommendations for standard of care; however, little is known about adherence to them. The aim of this study was to assess adherence to management guidelines for prostate cancer (PCa).
Materials and methods: Data in the National Prostate Cancer Register (NPCR), that includes 98% of all incident PCa cases in Sweden, were used to analyse adherence to national PCa guidelines for men diagnosed between 2010 and 2023. A selection of quality indicators displayed on the public web page of NPCR were assessed.
Results: Active surveillance in men with low-risk PCa and an estimated life expectancy >10 years increased from 44% in 2010 to 88% in 2023. Radical treatment for men with localised high-risk PCa and life expectancy >10 years increased from 60% in 2010 to 86% in 2023 and for men with locally advanced PCa and life expectancy >5 years from 37% in 2010 to 64% in 2023. The proportion of radical prostatectomies for low- or intermediate-risk PCa performed with nerve-sparing technique increased from 61% in 2015 to 87% in 2023. Use of adjuvant androgen deprivation therapy after radiotherapy for men with high-risk or locally advanced PCa increased five-fold from 14% in 2010 to 73% in 2022.
Conclusion: Adherence to recommendations in national guidelines improved in Sweden between 2010 and 2023. Public, open reporting of NPCR data on adherence to guidelines down to department level is likely to have contributed to these improvements.
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References
EAU Guidelines. Presented at the EAU Annual Congress; Milan; 2023. ISBN 978-94-92671-19-6
National Board of Health and Welfare. National Swedish guidelines on prostate cancer [Internet]. Available from: https://cancercentrum.se/samverkan/cancerdiagnoser/prostata/vardprogram/ [cited 15.12.2024]
Stattin P. How to improve cancer care by use of guidelines and quality registers. Scand J Urol. 2024;59:190–192. https://doi.org/10.2340/sju.v59.42272 DOI: https://doi.org/10.2340/sju.v59.42272
Stranne J. 2023/2024 update of the national prostate cancer guidelines in Sweden. Scand J Urol. 2024;59:210–211. https://doi.org/10.2340/sju.v59.42656 DOI: https://doi.org/10.2340/sju.v59.42656
Stattin P, Sandin F, Loeb S, et al. Public online reporting from a nationwide population-based clinical prostate cancer register. BJU Int. 2018;122:8–10. https://doi.org/10.1111/bju.14213 DOI: https://doi.org/10.1111/bju.14213
The National Prostate Cancer Register. Koll på läget [Internet]. Available from: https://npcr.se [cited 15.12.2024]
Stattin P, Sandin F, Sandbäck T, et al. Dashboard report on performance on select quality indicators to cancer care providers. Scand J Urol. 2015;50:1–8. https://doi.org/10.3109/21681805.2015.1063083 DOI: https://doi.org/10.3109/21681805.2015.1063083
The National Prostate Cancer Register of Sweden. Data register for diagnosis and treatment of prostate cancer [Internet]. Available from: www.npcr.se [cited 15.12.2024]
National Prostate Cancer Register of Sweden. RATTEN – online reporting system [Internet]. Available from: https://statistik.incanet.se/npcr/ [cited 15.12.2024]
Tomic K, Berglund A, Robinson D, et al. Capture rate and representativity of The National Prostate Cancer Register of Sweden. Acta Oncol (Madr). 2015;54:158–163. https://doi.org/10.3109/0284186X.2014.939299 DOI: https://doi.org/10.3109/0284186X.2014.939299
Mohler J, Bahnson RR, Boston B, et al. NCCN clinical practice guidelines in oncology: prostate cancer. J Natl Compr Canc Netw. 2010;8:162–200. https://doi.org/10.6004/jnccn.2010.0012 DOI: https://doi.org/10.6004/jnccn.2010.0010
Van Hemelrijck M, Ventimiglia E, Robinson D, et al. Population-based estimates of age and comorbidity specific life expectancy: a first application in Swedish males. BMC Med Inform Decis Mak. 2022;22:35. https://doi.org/10.1186/s12911-022-01766-0 DOI: https://doi.org/10.1186/s12911-022-01766-0
Westerberg M, Irenaeus S, Garmo H, et al. Development and validation of a multi-dimensional diagnosis-based comorbidity index that improves prediction of death in men with prostate cancer: nationwide, population-based register study. PLoS One. 2024;19:e0296804. https://doi.org/10.1371/journal.pone.0296804 DOI: https://doi.org/10.1371/journal.pone.0296804
Westerberg M, Garmo H, Robinson D, et al. Target trial emulation using new comorbidity indices provided risk estimates comparable to a randomized trial. J Clin Epidemiol. 2024;174:111504. https://doi.org/10.1016/j.jclinepi.2024.111504 DOI: https://doi.org/10.1016/j.jclinepi.2024.111504
Gedeborg R, Sund M, Lambe M, et al. An aggregated comorbidity measure based on history of filled drug prescriptions: development and evaluation in two separate cohorts. Epidemiology. 2021;32: 607–615. https://doi.org/10.1097/EDE.0000000000001358 DOI: https://doi.org/10.1097/EDE.0000000000001358
Gedeborg R, Garmo H, Robinson D, et al. Prescription-based prediction of baseline mortality risk among older men. PLoS One. 2020;15:1–16. https://doi.org/10.1371/journal.pone.0241439 DOI: https://doi.org/10.1371/journal.pone.0241439
Tomic K, Sandin F, Wigertz A, et al. Evaluation of data quality in the National Prostate Cancer Register of Sweden. Eur J Cancer. 2015;51:101–111. https://doi.org/10.1016/j.ejca.2014.10.025 DOI: https://doi.org/10.1016/j.ejca.2014.10.025
Tanaka T, Suda K, Uyama I. ASO author reflections: chronological or biological age – which is more important for making clinical decisions in geriatric patients? Ann Surg Oncol. 2019;26:810–811. https://doi.org/10.1245/s10434-019-07994-5 DOI: https://doi.org/10.1245/s10434-019-07994-5
Franck Lissbrant I, Hjälm Eriksson M, Lambe M, et al. Set-up and preliminary results from the patient-overview prostate cancer. Longitu-dinal registration of treatment of advanced prostate cancer in the National Prostate Cancer Register of Sweden. Scand J Urol. 2020;54:227–234. https://doi.org/10.1080/21681805.2020.1756402 DOI: https://doi.org/10.1080/21681805.2020.1756402
Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2023;388:1547–1558. https://doi.org/10.1056/NEJMoa2214122 DOI: https://doi.org/10.1016/j.eururo.2023.08.014
Widmark A, Klepp O, Solberg A, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373: 301–308. https://doi.org/10.1016/S0140-6736(08)61815-2 DOI: https://doi.org/10.1016/S0140-6736(08)61815-2
Mason MD, Parulekar WR, Sydes MR, et al. Final report of the intergroup randomized study of combined androgen-deprivation therapy plus radiotherapy versus androgen-deprivation therapy alone in locally advanced prostate cancer. J Clin Oncol. 2015;33:2143–2150. https://doi.org/10.1200/JCO.2014.57.7510 DOI: https://doi.org/10.1200/JCO.2014.57.7510
González Serrano A, Tapia CM, de la Taille A, et al. Adherence to treatment guidelines and associated survival in older patients with prostate cancer: a prospective multicentre cohort study. Cancers (Basel). 2021;13:4694. https://doi.org/10.3390/cancers13184694 DOI: https://doi.org/10.3390/cancers13184694
Steineck G, Bjartell A, Hugosson J, et al. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol. 2015;67:559–568. https://doi.org/10.1016/j.eururo.2014.10.011 DOI: https://doi.org/10.1016/j.eururo.2014.10.011
Baack Kukreja J, Bathala TK, Reichard CA, et al. Impact of preoperative prostate magnetic resonance imaging on the surgical management of high-risk prostate cancer. Prostate Cancer Prostatic Dis. 2020;23:172–178. https://doi.org/10.1038/s41391-019-0171-0 DOI: https://doi.org/10.1038/s41391-019-0171-0
Bratt O, Carlsson S, Fransson P, et al. The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease. Scand J Urol. 2022;56:265–273. https://doi.org/10.1080/21681805.2022.2094462 DOI: https://doi.org/10.1080/21681805.2022.2094462
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342: 1317–1322. https://doi.org/10.1016/0140-6736(93)92244-N DOI: https://doi.org/10.1016/0140-6736(93)92244-N
Gómez-Veiga F, Rodríguez-Antolín A, Miñana B, et al. Diagnosis and treatment for clinically localized prostate cancer. Adherence to the European Association of Urology clinical guidelines in a nationwide population-based study – GESCAP group. Actas Urol Esp. 2017;41:359–367. https://doi.org/10.1016/j.acuro.2016.10.009 DOI: https://doi.org/10.1016/j.acuroe.2017.05.006
Dell’Oglio P, Abou-Haidar H, Leyh-Bannurah S-R, et al. Assessment of the rate of adherence to international guidelines for androgen depri-vation therapy with external-beam radiation therapy: a population-based study. Eur Urol. 2016;70:429–435. https://doi.org/10.1016/j.eururo.2016.02.057 DOI: https://doi.org/10.1016/j.eururo.2016.02.057
Hessulf F, Herlitz J, Rawshani A, et al. Adherence to guidelines is associated with improved survival following in-hospital cardiac arrest. Resuscitation. 2020;155:13–21. https://doi.org/10.1016/j.resuscitation.2020.07.009 DOI: https://doi.org/10.1016/j.resuscitation.2020.07.009
Ferrannini G, Biber ME, Abdi S, et al. The management of patients with heart failure in Sweden: a survey conducted among physicians in Sweden. Eur Heart J. 2023;44:ehad655.974. https://doi.org/10.1093/eurheartj/ehad655.974 DOI: https://doi.org/10.1093/eurheartj/ehad655.974
Ögmundsdottir Michelsen H, Sjölin I, Schlyter M, et al. Cardiac rehabilitation after acute myocardial infarction in Sweden – evaluation of programme characteristics and adherence to European guidelines: the Perfect Cardiac Rehabilitation (Perfect-CR) study. Eur J Prev Cardiol. 2020;27:18–27. https://doi.org/10.1177/2047487319865729 DOI: https://doi.org/10.1177/2047487319865729
Herberts P, Malchau H. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register com-paring 160,000 cases. Acta Orthop Scand. 2000;71:111–121. https://doi.org/10.1080/000164700317413067 DOI: https://doi.org/10.1080/000164700317413067
MacLennan S, Duncan E, Skolarus TA, et al. Improving guideline adherence in urology. Eur Urol Focus. 2022;8:1545–1552. https://doi.org/10.1016/j.euf.2021.10.007 DOI: https://doi.org/10.1016/j.euf.2021.10.007
Demetriou C, Hu L, Smith TO, Hing CB. Hawthorne effect on surgical studies. ANZ J Surg. 2019;89:1567–1576. https://doi.org/10.1111/ans.15475 DOI: https://doi.org/10.1111/ans.15475
Brausi M, Hoskin P, Andritsch E, et al. ECCO essential requirements for quality cancer care: prostate cancer. Crit Rev Oncol Hematol. 2020;148:102861. https://doi.org/10.1016/j.critrevonc.2019.102861 DOI: https://doi.org/10.1016/j.critrevonc.2019.102861
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