My colleague, Matt Garabrant, recently attended a symposium on prostate cancer treatment hosted by Memorial Sloan Kettering Cancer Center and he wrote up this summary of his findings I wanted to share:
The speaker--a urologist and co-director of the MSKCC robotic surgery program--presented some intriguing information about the history of their prostate cancer program and how the role of robotic surgery has evolved over the years. MSKCC has seen dramatic growth in robotic radical prostatectomy volumes over the past decade. However, the growth they have seen has largely been fueled by later stage, more advanced prostate cancer cases. As robotic prostatectomy volumes have increased, the proportion of patients treated for early stage prostate cancer within the program has actually fallen substantially. This is intriguing because one of the major drivers of growth in prostate cancer treatments on a national level has been the increased use of PSA testing, which was rolled out as a cancer screening method over two decades ago and has driven an uptick in the number of prostate cancer cases diagnosed each year. While this test clearly enables diagnosis of all stages of prostate cancer, it has unearthed a massive population of men with early stage prostate cancer who arguably would not have otherwise been diagnosed as early--if at all.
Bucking the Robotic Radical Prostatectomy Trend?
Recently we've received several questions from members about the best way to measure productivity in the infusion center. It's a difficult question because there are so many variables. Ideally you would take into account not just number of visits, but also procedure type and patient acuity, which dramatically impact nursing time.
The problem is that there is no single approach to measuring patient acuity in the infusion center. In fact, we don't think it is possible to create a single acuity scale that would be workable for all infusion centers because there is so much variation in clinical practice and patient populations. That is why, when we designed our Acuity-Based Infusion Center Staffing Tool, we didn't provide an acuity scale, but rather provided instructions for individual institutions to create their own acuity scale.
The Challenge of Measuring Infusion Center Productivity
Recently we've rececived several questions from members about how to evaluate the different clinical pathways programs (like Innovent, Via Oncology, and P4) currently on the market. At their core, all pathways programs entail some methodology that helps providers to determine the most effective, least toxic and least costly treatment for any one patient. In addition, they all include some mechanism for monitoring the use of recommended pathways and incentives to encourage physicians to adhere to the pathways. The goal is to increase evidence-based care, reduce unnecessary variation, and control costs. Given the commonalities across vendors, how do you choose between programs?
My colleague Marie Copoulos, who led our research on pathways this year, was kind enough to share her thoughts about some of the key questions that cancer providers should be asking. According to her research, there are significant differences between pathways programs. Here are her suggestions for questions to raise with vendors:
Evaluating Clinical Pathways Programs