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INTRODUCTION AND OBJECTIVE:Active surveillance (AS) is now worldwide recognized as the preferred management strategy for most of low risk prostate cancer (PC) to minimize risks of overtreatment. De...

INTRODUCTION AND OBJECTIVE:Active surveillance (AS) is a widely accepted management strategy for low-risk prostate cancer (PC), but limited data exist regarding long-term outcomes after initial AS ...

Purpose: Health related quality of life is important in bladder cancer care and clinical decision making because patients must choose between diverse treatment modalities with unique morbidities. A patient reported outcome measure of overall health related quality of life for bladder cancer regardless of disease severity and treatment could benefit clinical care and research.Materials and Methods: Prospective questionnaire development was completed in 3 parts. In study 1 the BUSS (Bladder Utility Symptom Scale) questions were created by experts using a conceptual framework of bladder cancer health related quality of life generated through patient focus groups. In study 2 patients with bladder cancer, including those treated with surgery, radiation and chemotherapy, completed the BUSS and 5 health related quality of life instruments at baseline and 4 weeks to assess validity and test-retest reliability. External validity was then explored in study 3 by administering the BUSS to 578 patients online and at c...

Outcomes of complex surgical procedures tend to be better for high volume providers, although this has not been clearly established for renal cell carcinoma. We determined the relationship of provider volume with partial nephrectomy and morbidity for renal cell carcinoma treatment.We performed a population based, observational study using data on 24,579 patients treated surgically for a renal mass from April 1998 to March 2008. Surgeon and hospital volume quartiles were created using the total number of nephrectomies during the 10-year observation period. The effect of provider volume on partial nephrectomy use, complications and mortality was determined by multivariable logistic regression adjusted for covariates.Partial nephrectomy was done by 10.9% of low vs 24.7% of very high volume surgeons (p0.0001). A modest decrease in complications was observed with increasing surgeon volume (low vs very high 37.6% vs 34.5%, p0.0001). The effect of in-hospital mortality was more dramatic with a 1.71%, 1.20%, 0.97% and 0.92% rate for low, intermediate, high and very high volume surgeons, respectively (p0.0001). After adjusting for covariates, compared to low volume surgeons patients treated by very high volume surgeons had 1.54 times the odds of undergoing partial nephrectomy (95% CI 1.37-1.72, p0.0001), 0.84 times the odds of an in-hospital complication (95% CI 0.77-0.92, p0.0001) and 0.69 times the odds of in-hospital death (95% CI 0.47-1.01, p=0.16).Higher volume surgeons perform partial nephrectomy more often, show a lower complication rate and may have a lower in-hospital mortality rate than lower volume surgeons.

Previous reports of the morbidity of renal surgery have been primarily from academic tertiary referral centers and, thus, they may not reflect general clinical practice. We determined the effect of age and comorbidity on in-hospital surgical morbidity for radical and partial nephrectomy on a population level.Data were obtained from a Canadian national discharge abstract database. From April 1998 to March 2008 information was available on 20,286 radical and 4,292 partial nephrectomies. Complications were identified using specific ICD-9 and 10 diagnosis and procedure codes. Complication rates were estimated by procedure type and by various explanatory variables, including patient age and Charlson comorbidity score. Multivariate logistic regressions were constructed for radical and partial nephrectomy to determine associations between explanatory variables and complications.Overall complications developed in 34.1% of radical and 34.3% of partial nephrectomy cases. Patients were more likely to have cardiac, respiratory, vascular and surgical complications after radical nephrectomy while they were more likely to experience genitourinary and nephrectomy specific complications after partial nephrectomy. On multivariate logistic regression after radical and partial nephrectomy complications increased with age and Charlson score. After adjusting for other covariates patients with a Charlson score of greater than 2 were approximately 6 times more likely to experience a complication than patients with a Charlson score of 0 for radical and partial nephrectomy (OR 6.22, 95% CI 5.18-7.48 and OR 5.68, 95% CI 3.72-8.66, respectively).In our population based study radical nephrectomy and partial nephrectomy were associated with higher morbidity than previously reported, particularly in the elderly population and in patients with comorbidity.

The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy. We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003-2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.

INTRODUCTION AND OBJECTIVES: Volume-outcome relationships have been noted in a number of major surgical procedures. Outcomes of these complex procedures tend to be better for high volume hospitals and providers. The aim of our study was to determine the relationship between provider volume, and partial nephrectomy (PN) use and morbidity in the treatment of renal masses. METHODS: Using data from a national discharge abstract database, we performed a population-based, retrospective, observational study. Data were available on 24,579 patients treated surgically for a renal mass from April 1998 to March 2008. Surgeon volume quartiles were created using the total number of nephrectomies during the 10-year observation period. In-hospital complications and comorbidity were identified using specific ICD-9 and 10 diagnosis and procedure codes. The Charlson-Deyo Index was used to adjust for comorbidity. PN use, complication rates, and 30-day mortality were compared between surgeon volume quartiles using the Chi-square test. The effect of surgeon volume on our outcome variables was determined using multivariable logistic regressions, adjusted for covariates (including hospital volume). RESULTS: Overall, PN use, in-hospital complications and mortality occurred in 4,292 (17.5%), 8,406 (34.2%) and 295 (1.2%) patients, respectively. PN use occurred in 10.9% of low volume, compared with 24.7% of very high volume surgeons (p .0001). A modest decrease in complications was observed with increasing surgeon volume (37.6% among low vs. 34.5% among very high volume, p .0001). The effect of in-hospital mortality was more dramatic, with rates of 1.71%, 1.20%, 0.97% and 0.92% observed among low, intermediate, high and very high volume surgeons, respectively (p .0001). After adjusting for covariates, compared with low volume surgeons, patients treated by very high volume surgeons had 1.54 the odds of being treated with PN (95% CI 1.37–1.72, p .0001), 0.84 the odds of experiencing an in-hospital complication (95% CI 0.77–0.92, p .0001), and 0.69 the odds of dying in-hospital (95% CI 0.47–1.01, p 0.16). CONCLUSIONS: Our large, population-based study suggests that surgeon volume-outcome relationships exist in kidney surgery for renal masses. Higher volume surgeons use PN more often, experience lower complication rates, and may have lower in-hospital mortality rates than lower volume surgeons. Understanding the factors contributing to these differences would facilitate knowledge transfer initiatives, and would likely improve surgical outcomes.

Background Although utility-based quality-of-life instruments are often used in economic evaluations and psychometric instruments in treatment evaluations, these are complementary approaches to assessing outcomes. In this study we developed and tested these two forms of quality-of-life instruments, both based on a single, validated, health classification system. Objectives To assess the measurement properties (reliability and validity) of two newly developed psychometric and utility-based instruments for assessing outcomes associated with prostate cancer. Methods 141 men with cancer of the prostate (CaP), treated with radical prostatectomy, radiation therapy, hormonal therapy, and/or chemotherapy were assessed with both instruments and other standard psychometric and utility-based instruments. Results Analyses indicate the test instruments are reliable and valid. Full-scale correlations between the instruments and standard instruments indicate validity, as do correlations of key subscales, and an evaluation of linear associations with the UCLA-Prostate Cancer Symptom Scales. Conclusion Evidence from this study supports the reliability and construct validity of the tested instruments. Prostate cancer outcomes can now be assessed by a combination of psychometric and utility-based methods, allowing a ready comparison of derived outcomes.