MP6-03 TOWARD BETTER RADIOGRAPHIC STAGING OF MEN WITH EARLY-STAGE PROSTATE CANCER

Abstract

INTRODUCTION AND OBJECTIVES: Nationally endorsed prostate cancer quality of care measures are thought to be reflective of quality prostate cancer care. Therefore, it is possible that healthcare systems performing well on these measures will have better outcomes. However, some feel that these measures represent a low bar and thus may not be tightly linked with outcomes. We assessed relationships between healthcare system performance on nationally endorsed prostate cancer quality of care measures and outcomes of prostate cancer treatment. METHODS: We used Surveillance Epidemiology and End Results e Medicare linked data on 48,050 Medicare beneficiaries diagnosed with localized prostate cancer between 2004 and 2009. Based on a composite quality measure incorporating five nationally endorsed individual measures, we categorized healthcare systems into 1-star (bottom 20%), 2-star (middle 60%), and 3-star (top 20%) systems. We assessed relationships between star-ranking and outcomes of treatment with logistic and Cox proportional hazards regression, adjusting for patientand market-level covariates. RESULTS: Patients who underwent prostatectomy in 3-star versus 1-star healthcare systems had a lower risk of perioperative complications (odds ratio 0.80, 95% confidence interval [CI] 0.64-1.00). However, these patients were more likely to undergo a procedure addressing treatment-related morbidity (e.g., 11.3% vs. 7.8% treated for sexual morbidity, p1⁄40.043, Figure). Among patients who underwent radiotherapy, healthcare system quality was not associated with undergoing procedures addressing treatment-related morbidity (Figure). Among all patients, star-ranking was not significantly associated with all-cause mortality (Hazard Ratio [HR] 0.99, 95% CI 0.84-1.15) or secondary cancer therapy (HR 1.04, 95% CI 0.91-1.20). CONCLUSIONS: We found no consistent associations between healthcare system quality and outcomes. Our findings highlight the need for development of quality measures that are more tightly linked to outcomes. Source of Funding: American Cancer Society PF-12-118-01CPPB.