Presentation Authors: Ravi M. Kumar*, Luke T. Lavallée, Christopher Morash, Ilias Cagiannos, Dean Fergusson, David Sands, Sonya Cnossen, Ranjeeta Mallick, Michael Horrigan, Dawn Stacey, Rodney H. Breau, Ottawa, Canada
Introduction: Goals of radical prostatectomy include complete tumor resection, optimization of urinary function, and maintenance of erectile function. In this Surgical Report card (SuRep) study, we aimed to closely monitor cancer, urinary, and sexual outcomes and provide surgeons with report cards assessing their performance.
Methods: Prospective radical prostatectomy patients at The Ottawa Hospital were consented for participation in SuRep. All 8 prostate cancer surgeons at The Ottawa Hospital also consented to participation. Feasibility goals for the study were 95% patient enrollment, with 80% participation at 6-months follow-up, and 70% participation at 12-months. At enrollment and follow-up, patient reported outcomes were assessed using validated questionnaires (EPIC and EQ-5D). Patients were defined as potent if they had no erectile dysfunction and continent if they had no incontinence. The patient data was analyzed and report cards were provided to surgeons every 3 months starting approximately 1 year after the first patient was enrolled.
Results: During the study period, 422 of 436 (97%) radical prostatectomy patients participated in the study. Follow-up data was available for 358 (85%) patients at 6-months and 356 (84%) patients at 12-months following surgery. Two-hundred and ten (50%) patients were included in the first year (pre-report card) and 212 (50%) patients were included in the second year (post-report card). Baseline characteristics were similar in the pre- and post-report card cohorts. Almost all patients were continent (98%) and the majority were potent (61%) prior to surgery. Nerve sparing surgery increased from 148 (70%) pre-report card to 173 (82%) post-report card. There was a non-statistically significant increase in the proportion of patients with a positive surgical margin post-report cards (32% pre-report card vs 39% post-report card; p=0.09). There was no difference in post-operative erectile function (24% vs 26%; p=0.69) and a decrease in continence (76% vs 63.2%; p=0.01).
Conclusions: A surgical report card program including patient reported outcomes is feasible. The data was used to accurately counsel patients about their expected outcomes following radical prostatectomy. With one year of surgical report cards, overall patient outcomes did not improve. We believe that specific initiatives and longer duration of feedback are needed for positive change to occur.
Source of Funding: Funded in part by Prostate Cancer Canada (Discovery 2014 D2014-2), The Ottawa Hospital Academic Medical Organization, and the Prostate Cancer Fight Foundation & TELUS Ride For Dad. All statements in this report are solely those of the authors.