Quality of care and economic considerations of active surveillance of men with prostate cancer

• Type of Material: Article
• Authors: Christopher Filson, Emory University
• Language: English
• Date: 2018-04-01
• Publisher: AME Publishing Company
• Publication Version: Final Published Version
• Copyright Statement: © Translational Andrology and Urology.
• Final Published Version (URL): http://dx.doi.org/10.21037/tau.2017.08.08
• Title of Journal or Parent Work: Translational andrology and urology
• ISSN: 2223-4691
• Volume: 7
• Issue: 2
• Start Page: 203
• End Page: 213
• Keywords: Science & Technology; cost-effectiveness; COMPLICATIONS; cost analysis; Active surveillance; RADICAL PROSTATECTOMY; FOLLOW-UP; Endocrinology & Metabolism; UNITED-STATES; OUTCOMES; MANAGEMENT; BIOPSY; Urology & Nephrology; Life Sciences & Biomedicine; prostate cancer; COHORT; COST; RISK; Andrology; quality of care
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.