Is there a clinical benefit from prostate cancer center certification? An evaluation of functional and oncologic outcomes from 22,649 radical prostatectomy patients

Butea-Bocu, Marius Cristian; Müller, Guido; Pucheril, Daniel; Kröger, Eckhard; Otto, U.

doi:10.1007/s00345-020-03411-9

Cited by 23 publications

(18 citation statements)

References 16 publications

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“…Our findings, which demonstrate no significant differences in SUI and PSM between CCs and nCCs, are partially in contrast to a recent publication that analyzed 22,649 patients treated at a German rehabilitation center [26]. The authors observed a higher frequency of SUI and PSM in patients treated at nCCs, while NS was significantly more common in CCs.…”

Section: Comparison Of Certified and Noncertifiedcontrasting

confidence: 99%

Patient Benefits of Radical Prostatectomy in Certified Prostate Cancer Centers: Comparative Results from the Multicenter IMPROVE Study

Sikic,

Fiebig,

Wullich

et al. 2023

Urol Int

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Introduction: We investigated differences in treatment outcomes following radical prostatectomy (RP) between certified centers (CCs) and noncertified centers (nCCs) within the IMPROVE study group. Methods: A validated survey assessing various factors, including stress urinary incontinence (SUI) and decision regret (DR), was administered to 950 patients who underwent RP across 19 hospitals (12 CCs and 7 nCCs) at a median follow-up of 15 months after RP (interquartile range: 11–20). The response rate was 74%, with 703 patients participating, including 480 (68%) from CCs. Multivariate binary regression models were used to analyze differences between CCs and nCCs regarding the following binary endpoints: nerve-sparing (NS), positive surgical margins (PSM), SUI (defined as >1 safety pad), complications based on the Clavien-Dindo classification (grade ≥1, grade ≥3) and DR (>15 points indicating critical DR). Results: Considering the multivariate analysis, the rate of NS surgery was lower in CCs than in nCCs (OR = 0.52; p = 0.004). No significant differences were observed in the PSM rate (OR = 1.67; p = 0.051), SUI (OR = 1.03; p = 0.919), and DR (OR = 1.00; p = 0.990). SUI (OR 0.39; p < 0.001) and DR (OR 0.62; p = 0.026) were reported significantly less frequently by patients treated with robotic-assisted RP, which was significantly more often performed in CCs than in nCCs (68.3% vs. 18%; p < 0.001). The total complication rate was 45% lower in CCs (OR = 0.55; p = 0.004), although the number of complications requiring intervention (Clavien-Dindo classification ≥3) did not differ significantly between CCs and nCCs (OR = 2.52; p = 0.051). Conclusion: Within the IMPROVE study group, similarly favorable outcomes after RP were found in both CCs and nCCs, which, however, cannot be transferred to the general treatment landscape of PCA in Germany. Of note, robotic-assisted RP was more often performed in CCs and associated with less SUI and DR, while open prostatectomy was the treatment of choice in low-volume nCCs. Future prospective and region wide studies should also investigate the surgeon caseload and experience as well as a spillover effect of the certification process on nCCs.

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Section: Comparison Of Certified and Noncertifiedcontrasting

confidence: 99%

Patient Benefits of Radical Prostatectomy in Certified Prostate Cancer Centers: Comparative Results from the Multicenter IMPROVE Study

Sikic,

Fiebig,

Wullich

et al. 2023

Urol Int

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“…Currently, there are 1038 GCS-certified centers for different types of cancer, including pancreatic cancer. Previous studies provide some evidence for better patient outcomes in GCS certified cancer centers for colorectal and prostate cancer [ 12 , 15 – 18 ], and mixed results for breast cancer [ 19 – 21 ]. This evidence is restricted due to limited regional and time coverage, relatively small sample sizes, and missing relevant covariates at patient and hospital level.…”

Section: Introductionmentioning

confidence: 99%

Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study

et al. 2022

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Background Treatment of cancer patients in certified cancer centers, that meet specific quality standards in term of structures and procedures of medical care, is a national treatment goal in Germany. However, convincing evidence that treatment in certified cancer centers is associated with better outcomes in patients with pancreatic cancer is still missing. Methods We used patient-specific information (demographic characteristics, diagnoses, treatments) from German statutory health insurance data covering the period 2009–2017 and hospital characteristics from the German Standardized Quality Reports. We investigated differences in survival between patients treated in hospitals with and without pancreatic cancer center certification by the German Cancer Society (GCS) using the Kaplan–Meier estimator and Cox regression with shared frailty. Results The final sample included 45,318 patients with pancreatic cancer treated in 1,051 hospitals (96 GCS-certified, 955 not GCS-certified). 5,426 (12.0%) of the patients were treated in GCS-certified pancreatic cancer centers. Patients treated in certified and non-certified hospitals had similar distributions of age, sex, and comorbidities. Median survival was 8.0 months in GCS-certified pancreatic cancer centers and 4.4 months in non-certified hospitals. Cox regression adjusting for multiple patient and hospital characteristics yielded a significantly lower hazard of long-term, all-cause mortality in patients treated in GCS-certified pancreatic centers (Hazard ratio = 0.89; 95%-CI = 0.85–0.93). This result remained robust in multiple sensitivity analyses, including stratified estimations for subgroups of patients and hospitals. Conclusion This robust observational evidence suggests that patients with pancreatic cancer benefit from treatment in a certified cancer center in terms of survival. Therefore, the certification of hospitals appears to be a powerful strategy to improve patient outcomes in pancreatic cancer care. Trial registration ClinicalTrials.gov (NCT04334239).

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“…Measuring more patient outcomes directly would require other instruments, for example, by collecting follow-up data on the patient level or by analysing care research data comparing outcomes of patients from certified cancer centres with patients treated in other structures of care. Transferring patient-reported outcomes into data sheets in future and making it a practicable instrument of data collection are important subjects of studies supported by the DKG [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Including QIs as a crucial part of the quality cycle in oncology (shown in Fig. 1) has proven to be an adequate instrument for improving quality of care over time [21,[23][24][25][26][27][28][29][30][31]. Especially for rare cancer types such as kidney and bladder cancer, systematic QI implementation and evaluation may help to generate broader databases and thus expand knowledge.…”

Section: Discussionmentioning

confidence: 99%

Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation

et al. 2021

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Introduction: As part of the development of the evidence-based (S3) clinical practice guidelines for kidney and bladder cancer by the German Guideline Program in Oncology, quality indicators (QIs) were defined to measure the quality of care. Based on these guidelines and QIs, the German Cancer Society (DKG) developed two new certification systems. The aim of this article is to show the process of development and implementation of QIs in certified cancer centres. Methods: Based on strong recommendations of each guideline and an additional systematic literature review for national and international QIs, two sets of QIs were derived in a multistep standardized approach. These QIs were implemented in the centres in certification data sheets to measure their outcomes. First results of treatment years 2018 and 2019 are available. Results: The final sets include 9 QIs for kidney cancer and 12 QIs for bladder cancer. Two-thirds of the QIs were transferred to the data sheets. In 2018 and 2019, the results of all but one QI are within the plausibility limits. From 2020 on, they are replaced by stricter target values that will challenge centres to improve their outcomes. Conclusions: Guideline-derived QIs make relevant aspects of patient care measurable and consequently improvable. The first QI results are encouraging. However, the DKG certification system and the methods of measuring quality are under ongoing development. Systematic QI implementation and evaluation may help to generate broader databases and thus expand knowledge.

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Is there a clinical benefit from prostate cancer center certification? An evaluation of functional and oncologic outcomes from 22,649 radical prostatectomy patients

Cited by 23 publications

References 16 publications

Patient Benefits of Radical Prostatectomy in Certified Prostate Cancer Centers: Comparative Results from the Multicenter IMPROVE Study

Patient Benefits of Radical Prostatectomy in Certified Prostate Cancer Centers: Comparative Results from the Multicenter IMPROVE Study

Is treatment in certified cancer centers related to better survival in patients with pancreatic cancer? Evidence from a large German cohort study

Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation

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