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 and Welsh cancer registry data.
The data collection period reported here includes men diagnosed between 1st April 2018 and the 31st March 2019.
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 2017.
Data completeness for five key items is presented. The denominator for the corresponding percentages is the number of relevant records in the national cancer registry.
Percentage of men diagnosed with metastatic prostate cancer.
This process indicator provides information on the late diagnosis of prostate cancer.
Percentage 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.
Percentage 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.
Percentage 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.
Percentage of men having radical radiotherapy for high-risk disease receiving whole pelvis irradiation
This process indicator provides information by diagnosis Trust about the use of irradiation to both the prostate and pelvic lymph nodes, as opposed to prostate-only irradiation for men with high-risk disease. Data were available for English providers only.
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
Percentage of patients who were given the name of a clinical nurse specialist (QS1).
Percentage 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.
Percentage 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.
Percentage of men experiencing at least one genitourinary (GU) complication requiring a procedural/surgical intervention within 2 years of radical prostatectomy (presented at the level of the surgical centre)
This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. These 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.
Percentage of men receiving a procedure of the large bowel and a diagnosis indicating radiation toxicity (gastrointestinal [GI] complication) following radical radiotherapy
This outcome indicator was derived from linkage with Hospital Episode Statistics Inpatient data. These gastrointestinal complications reflect those patients who required a procedure of the large bowel and a diagnosis indicating radiation toxicity within 2 years of their radical radiotherapy. A toxicity event requires evidence of both a diagnostic endoscopic procedure (e.g. colonoscopy or sigmoidoscopy) in addition to a diagnostic code consistent with radiation toxicity equivalent to Grade 2 toxicity or above according to the National Cancer Institute Common Toxicity Criteria for Adverse Events (CTCAE). Data are presented for each radical radiotherapy centre in England and Wales.
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 using risk adjustment
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 small areas in which they lived at the time of diagnosis. 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 (specified on p.15 of the NPCA Annual Report 2016)
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.
More details can be found within the 2020 methodology supplement.
Last updated: 20 January 2021, 12:38pm