Patient inclusion and data sources
Patients are eligible for inclusion in the prospective audit if they are newly diagnosed with an ICD-10 diagnostic code of “C61” (malignant neoplasm of the prostate) according to the English cancer registry.
The data collection period reported here includes men diagnosed between 1st April 2016 and the 31st March 2017.
Medium-term indicators (severe genitourinary or gastrointestinal complications) require longer follow-up (up to two years post-treatment) so the cohort reported for these indicators are patients diagnosed between 1st January and 31st December 2015.
PROMs and PREMs indicators also require longer follow-up with surveys being completed at least 18 months after diagnosis. PREMs results are presented for all men who underwent or were candidates for radical treatment, and PROMs for all men who underwent either a radical prostatectomy, or radical radiotherapy. The cohort reported for these indicators are patients diagnosed between 1st April 2015 to 30th September 2016.
Data quality
Data completeness for six key items is presented. The denominator for the corresponding percentages is the number of relevant records in the national cancer registry.
Disease presentation
Proportion of men diagnosed with metastatic prostate cancer
This process indicator provides information on the potential late diagnosis of prostate cancer.
Management
Proportion of men with low-risk localised prostate cancer undergoing radical prostate cancer therapy
This process indicator provides information about the ‘potential over-treatment’ of men with low-risk prostate cancer.
Proportion of men with locally advanced prostate cancer undergoing radical prostate cancer therapy
This process indicator provides information about ‘potential under-treatment’ of men with locally advanced prostate cancer.
Patient experience of care
The NPCA Patient Survey included selected questions from the National Cancer Patient Experience Survey (NCPES) – a national survey commissioned by NHS England to determine patients’ views of their experience of care
Proportion of patients who were given the ‘right amount’ of information about their condition and treatment.
Proportion of patients who were involved as much as they wanted to be in decisions about their treatment and care.
Proportion of patients who were given the name of a clinical nurse specialist (QS1).
Proportion of patients rating their overall care as eight or above (on a scale of 0 – 10, where 0 = ‘very poor’ and 10 = ‘very good’)
These patient-reported experience measures (PREMs) are presented at the level of the specialist MDT and men who could not be allocated to a specific Trust at diagnosis were excluded.
Treatment outcomes
Proportion of patients who had an emergency readmission within 90 days of radical prostate cancer surgery
This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. Emergency readmission may reflect that patients experienced a complication related to radical prostate cancer surgery after discharge from hospital. Data are presented for each radical prostatectomy centre in England.
Proportion of men experiencing a severe genitourinary (GU) complication requiring an intervention following radical prostatectomy
This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. Severe genitourinary complications reflect those patients who required a genitourinary procedure within 2 years of their radical prostatectomy. Data are presented for each radical prostatectomy centre in England and Wales.
Proportion of men experiencing a severe gastrointestinal (GI) complication requiring an intervention following radical radiotherapy
This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. Severe gastrointestinal complications reflect those patients who required a gastrointestinal procedure within 2 years of their radical radiotherapy. Data are presented for each radical radiotherapy centre in England and Wales.
Patient-reported outcomes
The NPCA patient survey included The Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) – a validated instrument to measure prostate cancer related quality of life after radical treatments for prostate cancer including urinary, bowel and sexual functioning.
Mean urinary incontinence score after radical prostatectomy
Mean sexual function score after radical prostatectomy
Mean bowel function score after radical radiotherapy
Mean sexual function score after radical radiotherapy
These patient-reported outcome measures (PROMs) are presented at the level of the surgical or radiotherapy centre. Treatment centres which performed less than 10 procedures per year were excluded. The validated summary score for each EPIC-26 domain ranges from 0 to 100 with higher scores representing better function.
Comparing outcomes by provider
Funnel plots were generated for all performance indicators using control limits defining differences corresponding to two standard deviations (inner limits) and three standard deviations (outer limits) from the national average population.
Multivariable logistic regression was carried out with adjustment for patient age, socio-economic status, comorbidity and disease status at diagnosis to determine adjusted treatment outcomes. Multivariable linear regression was carried out with adjustment for the same case-mix factors to determine adjusted patient-reported outcomes.
Comorbidity was captured using the Royal College of Surgeons (RCS) Charlson comorbidity score using ICD-10 diagnosis codes in HES/PEDW. The Index of Multiple Deprivation (IMD) was used to categorise patients into five socioeconomic groups (1=least deprived; 5=most deprived) based on the areas in which they lived. The five categories were fifths of the national IMD ranking of these areas. Disease status category was defined according to their TNM stage, Gleason score and PSA using a previously developed algorithm.
Surgical and radiotherapy treatment centres outside the outer funnel for the adjusted performance indicators were considered as potential ‘alarm’ outliers and contacted according to the NPCA Outlier Policy.
Low volume (<10 patients) treatment centres are excluded from the funnel plots.
Last updated: 9 January 2020, 2:56pm