Explanatory notes Annual Report 2019

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 2017 and the 31st March 2018.

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 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.

Proportion of men with metastatic disease receiving docetaxel in combination with standard ADT

This process indicator provides information about the use of docetaxel for newly diagnosed metastatic prostate cancer.

Proportion of men having radical radiotherapy for intermediate- or high-risk/locally advanced disease receiving a hypofractionated regimen

This process indicator provides information about the use of hypofractionated radiotherapy.

Proportion of men having radical radiotherapy for high-risk/locally advanced disease receiving a brachytherapy boost

This process indicator provides information about the use of a brachytherapy boost in addition to radiotherapy.

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.

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.