[Urinary incontinence after radical prostatectomy for prostate cancer-data from 17,149 patients from 125 certified centers]

BACKGROUND

In addition to erectile dysfunction, urinary incontinence is the most common functional limitation after radical prostatectomy (RPE) for prostate cancer (PCa). The German S3 guideline recommends informing patients about possible effects of the therapy options, including incontinence. However, only little data on continence from routine care in German-speaking countries after RPE are currently available, which makes it difficult to inform patients.

OBJECTIVE

The aim of this work is to present data on the frequency and severity of urinary incontinence after RPE from routine care.

MATERIALS AND METHODS

Information from the PCO (Prostate Cancer Outcomes) study is used, which was collected between 2016 and 2022 in 125 German Cancer Society (DKG)-certified prostate cancer centers in 17,149 patients using the Expanded Prostate Cancer Index Composite Short Form (EPIC-26). Changes in the "incontinence" score before (T0) and 12 months after RPE (T1) and the proportion of patients who used pads, stratified by age and risk group, are reported.

RESULTS

The average score for urinary incontinence (value range: 0-worst possible to 100-best possible) was 93 points at T0 and 73 points 12 months later. At T0, 97% of the patients did not use a pad, compared to 56% at T1. 43% of the patients who did not use a pad before surgery used at least one pad a day 12 months later, while 13% use two or more. The proportion of patients using pads differs by age and risk classification.

CONCLUSION

The results provide a comprehensive insight into functional outcome 12 months after RPE and can be taken into account when informing patients.

Identifying patient profiles and mapping the patient journey across three countries in a large-scale, fully digital survey of patients with prostate cancer

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Background: A survey of patients with prostate cancer (PCa) was conducted to map their experiences, expectations and attitudes, and to identify challenges and unmet needs in diagnosis, therapy patterns, care teams, quality of life (QoL), patient organizations and resources. Here, we describe the initial survey results and explore differences in diagnosis and therapy patterns between 3 countries. Methods: Don’tBePatient Intelligence conducted a large survey in patients with non-metastatic (M−) and metastatic (M+) PCa in Germany (DE), the UK and the US from Feb 9–Apr 10, 2021 in collaboration with patient organizations and medical experts. Recruitment was through social media advertising and patient organizations. Data were evaluated using descriptive and advanced statistics. Results: Of 33,882 survey starters, 15,824 completed, split 50.1%/49.9% in rural/urban areas. In DE/US, diagnosis through healthcare screening was more frequent than in the UK (M−/M+: DE 77%/58%; UK 42%/21%; US 77%/63%) where a higher percentage of symptomatic diagnosis was recorded (M−/M+: DE 18%/39%; UK 49%/75%; US 12%/31%). Prostatectomy was the predominant therapy in M− PCa in DE/US (71%/57%). In the UK, radiotherapy was slightly more frequent than prostatectomy (48% vs. 41%) and active surveillance was more common than in DE/US (14% vs. 6%/9%). Hormone therapy was the most common therapy in M+ PCa in all countries (DE 65%; UK 77%; US 73%). Chemotherapy was received by < 2% of patients with M− PCa in all countries but was more frequent in M+ PCa in the UK than DE/US (38% vs. 21%/27%; table). Satisfaction levels were generally high (> 80%) for all therapies in all countries. Conclusions: To our knowledge this is the largest digital survey conducted in patients with PCa, allowing identification of unmet needs in the patient journey. Preliminary data suggest that rates of screening are lower in the UK than DE/US; this may correlate with the higher rate of symptomatic and potentially later-stage diagnosis, highlighting the role of routine screening. Relatively low active surveillance rates in DE/US may reflect a lower likelihood of men with M− versus M+ PCa to respond to the survey. Further analyses will include impact of differences in patient journey, trust in healthcare professionals, access to information, involvement with patient advocacy groups and QoL. [Table: see text]

[Methodological Standard for the Development of Quality Indicators within Clinical Practice Guidelines - Results of a structured consensus process]

BACKGROUND

Recommendations of evidence- and formally consensus-based clinical practice guidelines (CPGs) represent a valuable source of quality indicators (QIs). Nevertheless, a standardized methodological procedure for developing QIs in the context of CPGs does not yet exist in Germany for all CPGs. For this reason, a methodological standard for the guideline-based development of QIs (QI Standard) was developed based on a structured consensus process involving multiple key stakeholders.

METHODS

The proposed content of the QI Standard was derived from evidence, drawing upon results of reviews and qualitative studies, and considered German manuals for guideline-based QI development of two guideline programs. A multi-perspective consensus panel, broadly representing key stakeholders from the German healthcare system with expertise in CPGs and/or quality management, was nominated to vote on recommendations for guideline-based development of QIs. The iterative, structured consensus process included a two-stage online survey based on the Delphi method ("preliminary voting") and a moderated final stakeholder conference where all those recommendations were definitely included in the QI Standard that received approval of more than 75 % (consensus criterion) of the consensus panel.

RESULTS

Based on the agreed QI Standard, the QI development process starts with a criteria-based selection of "potential" QIs which - in case of adoption - are published in CPGs as "preliminary" QIs and can achieve the status "final" after successful testing. The QI Standard is composed of a total of 30 recommendations, which are allocated to six areas: A) preparatory work steps for the guideline-based recommendation of QIs, B) QI development group and cooperation with the CPG group, C) development of potential QIs, D) critical appraisal of potential QIs, E) formal adoption and publication as well as F) piloting/testing of preliminary QIs and conversion into final QIs.

DISCUSSION

Before the QI Standard can be recommended for implementation in future CPGs, it should have been successfully tested in selected German CPG projects. In addition to methodological requirements for the QI development, it must be ensured that guideline groups have adequate resources for the implementation of the QI Standard.

CONCLUSION

By using the QI Standard, scientifically sound and healthcare-relevant QIs can be expected.

[DNVF Memorandum Health Services Research in Oncology]

Health services research in oncology deals with all situations which cancer patients face. It looks at the different phases of care, i. e. prevention / early detection, prehabilitation, diagnostics, therapy, rehabilitation and palliative care as well as the various actors, including those affected, the carers and self-help. It deals with healthy people (e. g. in the context of prevention / early detection), patients and cancer survivors. Due to the nature of cancer and the existing care structures, there are a number of specific contents for health services research in oncology compared to general health services research while the methods remain essentially identical. This memorandum describes the subject, illustrates the care structures and identifies areas of health services research in oncology. This memorandum has been prepared by the Oncology Section of the German Network for Health Services Research and is the result of intensive discussions.

Use of psycho-oncological services by prostate cancer patients: A multilevel analysis

Background

Cancer patients often suffer from psychological distress. Psycho‐oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs).

Methods

Center‐reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted.

Results

Model 1 showed that utilization of POS in PCCs is associated with patients’ age (OR = 0.98; 95%‐CI = 0.96‐0.99; P < .001), number of comorbidities (1‐2 vs 0, OR = 1.27; 95%‐CI = 1.00‐1.60; P=.048), disease staging (localized high‐risk vs localized intermediate risk, OR = 1.41; 95%‐CI = 1.14‐1.74; P < .001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%‐CI = 0.10‐0.34; P < .001), and hospital teaching status (university vs academic, OR = 0.09; 95%‐CI = 0.02‐0.55; P = .009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%‐CI = 0.03‐0.10; P < .001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%‐CI = 0.02‐0.15; P < .001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high‐risk vs localized intermediate risk, OR = 1.31; 95%‐CI = 1.05‐1.62; P = .02) and teaching status (university vs academic, OR = 0.08; 95%‐CI = 0.01‐0.65; P = .02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics.

Conclusions

Future research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects – for example, less need following radiotherapy – or because access to POS is more difficult for those receiving radiotherapy.