KD NEWS SERVICE
SRINAGAR, Aug 15: Despite the importance of quality care for patients with prostate cancer, significant gaps exist in healthcare delivery, including diagnosis and treatment, a study conducted on Quality of Care for Prostate Cancer in Kashmir has revealed.
The objective of the study was to assess the quality of care (QoC) using retrospective data from prostate care patients and a retrospective study of prostate cancer patients registered at a dedicated cancer care center in the Kashmir region from 2012 to 2020 was performed.
As per study set of 15 quality indicators representing crucial facets of diagnosis, pathology, and treatment was identified from a comprehensive list developed and validated by other researchers.
The study demonstrated a lack of compliance with many QoC indicators at the diagnostic and therapeutic levels. However, as per study large-scale, population-based studies are needed to establish the compliance of prostate cancer QoC in Kashmir.
“The final analysis of all indicators was conducted on 46 patients with a median age of 70 years (52-92 years). In the majority of patients, the diagnosis (89.1%) was made through a prostatic biopsy, while only five patients were diagnosed solely based on the prostate-specific antigen. Transrectal ultrasound (TRUS) or transurethral resection (TURP)-guided biopsy was documented in 84.8% of patients, with Gleason grading documented in 87.5% of patients. However, the number of positive cores was mentioned for only 25.7% of patients. Radical prostatectomy was the primary treatment for most patients with localized prostate cancer (58.3%). The majority of patients with metastatic prostate cancer were treated with orchidectomy (55%), owing to easy access and the lower cost of surgical castration,” reads the study.
“Family history was available for 29 patients (29/46, 63%). A positive family history of any cancer was present in 11 patients (11/29, 37.9%). However, the family history of a specific PC was not documented in the records. A digital rectal examination (DRE) was conducted in five patients (5/46, 10.8%), while prostate-specific antigen (PSA) levels were measured in all 46 patients. However, in five patients, the diagnosis of PC was based only on elevated PSA levels (5/46, 10.8%). The diagnosis was based on a biopsy in 42 patients (42/46, 91.3%), including two patients (2/46, 4.3%) who had biopsy samples collected from an unknown site. Transrectal ultrasound (TRUS)-guided biopsy was conducted in 35 patients (35, 35/46, 76.1%), while transurethral resection (TURP) was conducted in five patients (5/46, 10.9%),” It reads.
As per study, the pathological type of PC was available for 42 patients, while the data for four patients did not indicate the pathological type of cancer. The majority of patients had conventional adenocarcinoma (33/46, 71.7%) as the histopathological type. Based on the World Health Organization (WHO) definition, the histological features of the tumor were detailed in the pathology reports (TRUS or TURP) in only five patients (5/40, 12.5%), and the Gleason grading system for histology was followed in 35 patients (35/40, 87.5%).
“Out of the 35 patients who had TRUS-guided biopsy, the number of cores was documented in 14 patients (14/35, 40%), and the number of positive cores was mentioned in nine patients (9/35, 25.7%). The proportion of tissue involved was not mentioned in any of the patients who had TURP,” it reads further.
Localized prostatic cancer was seen in 12 patients (12/42, 28.6%). Among these patients, four patients were treated with radical prostatectomy (4/42, 9.5%), three patients with androgen deprivation therapy (ADT, 3/42, 7.1%), two patients with radiotherapy (RT) + ADT (2/42, 4.7%), and one patient with radical prostatectomy + hormone therapy (HT) (1/42, 2.4%). Among the patients with localized PC, two patients (2/42, 4.7%) had received no further treatment after diagnosis of the primary disease and were on active surveillance.
Thirty patients (30/42, 76.2%) had de novo metastatic disease, and six of the 12 patients (6/12, 50%) who presented with localized disease developed metastasis subsequently. Among patients with metastasis, only 10 patients (10/36, 27.7%) had complete staging before treatment initiation. Only five patients (5/42, 11.9%) had undergone prostate-specific membrane antigen (PSMA) scanning (two for localized disease and three for metastasis). Microsatellite instability status was checked in one patient (1/42, 2.4%), and germline testing for the breast cancer gene (BRCA) was done in one patient (1/42, 2.4%).
Treatment for metastasis included bilateral orchidectomy in 21 patients (21/36, 58.3%), HT in three patients (3/36, 8.3%), and luteinizing hormone-releasing hormone (LHRH) agonist therapy in nine patients (9/36, 25%). One patient each (1/36, 2.7%) had received abiraterone and docetaxel, enzalutamide and docetaxel, as well as docetaxel and abiraterone.
None of the patients had local RT if a low-burden metastatic disease was found. During follow-up, a dual x-ray absorptiometry (DEXA) scan was done in two patients (2/42, 4.7%) only once, and none of the patients had a regular DEXA scan. No specific bone health interventions had been used in 21 patients (21/42, 50%). Bisphosphonate with calcium supplementation was used in 19 patients (19/42, 45.2%), and vitamin D3 with calcium supplementation was used in the other two patients (2/42, 4.8%). Moreover, none of our patients received chemotherapy 30 days before their deaths.
Notably this retrospective study identified PC patients from the hospital database. Eligible patients were men who were diagnosed with PC from 2012 to 2020 and were registered at Hakim Sanaullah Specialist Hospital and Cancer Center (HSSHCC), Sopore, Kashmir, or its satellite center, Dr. Shad Salim’s Oncology Center in Srinagar, Kashmir, India. The patients were diagnosed or registered for follow-up or palliative care at HSSHCC, Sopore, or the satellite center in Srinagar. The patients registered for follow-up or palliative care had received initial care in other healthcare facilities. At the time of registration at HSSHCC, Sopore, or the satellite center, all such patients were expected to present documentation of their prior clinical contacts, admission information, investigations, and interventions.
This retrospective study was approved by the Institutional Ethics Committee of the hospital (Approval No. IEC/2021-02/21.7.21). Patient consent was waived as this was a retrospective chart review and patient data was anonymous—(KNO)
