Audit of prostate cancer: validity and feasibility of registry-based staging.
The sample consisted of 251 prostate cancer patients who were newly registered during 1994 from a Regional Cancer Registry. It was possible for 96% of cases to be staged by Registry clerical staff, but none had been formally staged by clinicians. In 45% of cases tumour extent was based only on Digital Rectal Examination (DRE), and on 32% there was no assessment found. 81% had no investigation of nodal status and 16% of cases had echography other than trans-rectal ultrasound. To find metastases 18% had scintigraphy and 13% had a plain chest X Ray while 61% had no investigation. Cox regression gave age-adjusted hazard ratios relative to stage A (95% CI) of 2.94 (1.59 to 5.44) for Stage B, 6.43 (3.37 to 12.24) for Stage C, and 9.03 (5.12 to 15.95) for stage D. Key lessons were: Registry clerical staff can abstract stage-related information from a high proportion of case-notes even if stage is not explicitly recorded by clinicians; The validity of registry based staging information is supported by survival analysis; This activity has resource implications and would be more appropriately performed by a member of the clinical team.
Silcocks
P
P
Trent Institute for Health Services Research, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Needham
P
P
Hemsley
F
F
D004739:England; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008485:Medical Audit; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D011897:Random Allocation; D012042:Registries; D015203:Reproducibility of Results; D016019:Survival Analysis