Quality objectives for the Prostate Cancer Registry
The health care patients receive should follow recommendations found in the National Action Programme with guidelines for diagnosis, treatment and follow-up of prostate cancer.
One goal of establishing a quality registry is for the data to be used to improve the health service and, among other things, to provide knowledge that contributes to improving the quality of the health service. Improved treatment, prevention, health surveillance and new research are some of the contributions of a quality registry. If information from the quality register shows visible differences in the quality of treatment, this will be a good reason to initiate projects to improve the quality.
The Cancer Registry of Norway, in collaboration with, among others, the pharmaceutical industry and the Norwegian Cancer Society, has joined forces in a project to establish a better overview of current drug cancer treatment, both with the existing and the new cancer drugs. The project has been named INSPIRE and aims to obtain data on drug treatment directly from professional systems in hospitals.
Medical cancer treatment is now reported regularly from the three largest health regions: South-Eastern Norway Regional Health Authority, Western Norway Regional Health Authority and Central Norway Regional Health Authority-Norway. For these three regions, data collection is largely complete for all local health authorities from 2019 onwards. Northern Norway Regional Health Authority is not included in the data collection, but will do so as soon as they have introduced a new professional system for drug cancer treatment. Medical cancer treatment that the patient takes at home, and which is prescribed on an H-prescription, is reported from NPR to the Cancer Registry. Here are complete data from 2019 onwards for the entire country.
Radiation data are not dependent on manual reporting, and complete vintages are sent to the Cancer Registry of Norway directly from the country's ten radiation units. The Cancer Registry of Norway has complete information on radiation therapy in Norway up to and including 2022.
The quality indicators in the Prostate Registry are measurable quantities intended to provide indications of the quality of prostate cancer care. When a threshold value for the quality indicators has been defined, this is a quality measure that the Academic Council has arrived at on the basis of international literature and national assessments.
To date, the Professional Council has selected six quality objectives that deal with the treatment of prostate cancer (process indicators). In addition, there are quality measures for clinical coverage for assessment reports, surgery reports and radiation notifications. The quality objectives are evaluated every year and adjusted in accordance with the latest knowledge.
In this year's report, the Academic Council publishes a new quality measure; compliance in clinical and postoperative stage assessment. The comparison of the tumour stage at diagnosis and in the surgical specimen must be made with the proviso that available diagnostic aids have limited sensitivity to the details included in the stage indications. Although a realistic measure of compliance is well away from 100%, the hope is that this will stimulate higher quality and even more accurate diagnostics.
Based on the quality goals that have been set, there is a basis for saying that Norwegian men generally receive equal and good diagnostics and treatment. This year's report also includes more data on the treatment of patients with advanced metastatic prostate cancer. Obtaining data on medical cancer treatment has long been particularly demanding, but the INSPIRE project has given us a better data basis.
In November 2017, the national quality indicator for prostate cancer was updated from five-year relative survival after prostate cancer to five-year relative survival after high-risk prostate cancer. This is because high-risk prostate cancer often carries a greater risk of premature death from the disease, and 5-year relative survival for this patient group is likely to reflect treatment effort and quality to a greater extent.
The quality register's annual report publishes results at institutional level for selected variables reported to the registry. This will form the basis for local improvement measures, so that patients can be ensured equal treatment regardless of place of residence. The registry engages in dialogue with departments that have divergent results both to clarify that the data are correct, but also to enter into dialogue about causes and possible measures.
The proportion of patients with a free resection margin after pT2 tumour surgery is one of the quality measures, and something that has been followed closely in recent years.
The hospital in Telemark, Skien, has had a negative change in 2022 from 14.7–25.8% non-free rand. The hospital has reviewed all patients by a non-free margin, and it turned out that almost all of them are in small lengths in apex. They take note of it and will adapt operational techniques accordingly. NB! These are small numbers and it takes little to make a statistical difference. The hospital will adapt surgical techniques, and results can only be described in next year's report.
In 2021, Østfold Hospital, Kalnes, had a proportion of non-free rand of 28.1 % (low goal attainment). They were then in the early stages of offering surgery for prostate cancer, and they were aware of the results. In order to increase competence in surgical technique, the hospital had specialist visits from OUS in September 2022.
The results for 2022 show a large improvement compared to 2021 (from 28.1% to 13.9%) as a result of this measure.
Innlandet Hospital, Hamar, has had a negative change from 12.5–17.9 % non-free rand. The surgeon has taken a closer look at the patients and pointed out that the majority have focal non-free rim. They also see that there is variation in pathology assessments (many of which of the patients have focal non-free rim; less than 3 mm.) Surgeons are also considering the use of nerve-sparing techniques to a greater extent.
St. Olav's Hospital has had a negative change from 13.1 – 22.6 % non-free rand. The contact person at the hospital has been contacted, but has not responded to the inquiry.
OUS has had a negative change from 9–18 % non-free rand. The contact person at the hospital has been contacted, but has not responded to the inquiry.
Furthermore, we have looked at the non-free resection rim, pT3 (Fig. 3.22 in the annual report), operating year 2022.
Telemark Hospital, Skien, has had a negative change in 2022 from 52.2–76.9% non-free rand. Here, too, as on pT2, almost all had small non-free lengths in the apex. The hospital will adapt surgical techniques.
Compliance ISUP (Fig. 3.8 of the Annual Report), Year of Operations 2022:
Since 2015 (formally 2017), pathologists at the Department of Pathology in Ålesund have had the main part of the education at St. Olavs Hospital. Compliance for 2022 has increased from 44% to 61% and this is considered a direct result of the training. The Academic Council will focus more on this indicator in the future, including quality assurance and potential focus on quality improvement.
In the annual report for 2021 , results for 5-year relative survival high-risk locally advanced prostate cancer showed that Telemark HF had a significantly lower survival rate. The hospital was given quality assurance lists and reviewed all the patients associated with the analysis. About half of the deaths were not related to the prostate cancer diagnosis. In particular, the hospital has reviewed the patients who died from their prostate cancer diagnosis to look at the various courses of the disease.
Active efforts are being made to obtain Patient Reported Outcome Measures (PROMs). Adverse reactions after treatment are a factor of considerable importance when assessing the type of treatment and whether treatment should be initiated for the individual patient.
The National Quality Registry for Prostate Cancer started routinely collecting PROMs/PREMs in 2020. In order to distinguish between common ailments in the population and ailments related to prostate cancer, a random sample of persons without prostate cancer are also invited to submit a questionnaire. Results for urinary continence, bowel function and sexual function immediately after diagnosis and after one year can be found in the Annual Report for Prostate Cancer 2022 (Norwegian only).