Peer review, patient advocates highlight program
An innovative approach to treating prostate cancer in Buffalo, NY, has not only won national recognition but also benefited patients through peer reviews of diagnoses, enhanced entrée into clinical studies, improved odds of survival, and achieved a reduction of unnecessary procedures.
The Buffalo Niagara Prostate Cancer Consortium (BNPCC), located at Roswell Park Cancer Institute (RPCI), includes community urologists, academic institutions, patient support groups, insurance carriers, and RPCI. Men with newly diagnosed prostate cancer are offered a number of treatment options, including surgery, observation, three-dimensional conformal radiation therapy, brachytherapy (radiation implant), hormone therapy, chemotherapy, biological therapies, or a combination of those therapies.
The BNPCC, founded in January 2001, has been recognized as a national model by the National Comprehensive Cancer Network (NCCN), a nationwide group of experts that reviews clinical trials and makes evidence-based recommendations on diagnosis, work-up, treatment, and follow-up, and the Oncology Roundtable of the Washington, DC-based Advisory Board Company, a 2,000-member group of health systems and medical centers that identifies best and worst practices.
One of the aspects that make the BNPCC approach unique is its peer review process, says Susan Walsh, RN, clinical data manager/program development, for the consortium. Walsh manages the consortium, including the design and management of its clinical database.
"Normally, if you have prostate cancer, you will see a urologist," she says. "According to the literature, 93% of them will tell you that you need surgery. A radiation oncologist will say you need radiation. With our peer review process, we bring all the disciplines to one table."
The peer review group meets on the first and third Tuesday of every month, Walsh says. All clinical information is presented anonymously, protecting the identities of physicians and patients. The group includes community urologists, radiation oncologists from RPCI, specialized support staff, and protocol managers, to heighten the odds that if the patient were presented, he or she would qualify for a protocol.
Every consortium meeting also includes one or more patient advocates — another critical component of the process, Walsh says.
"In peer review, they act as clinical police, helping to ensure that no physicians’ biases come out," she explains. The advocates make sure all options are considered. The consortium follows NCCN guidelines, which have both patient and physician sections.
During the first patient consult, which is done prior to peer review, the patients also are informed about support groups that are available. "The patient advocates also accompany us to outside events and insurance meetings," Walsh adds.
The BNPCC’s pathology review is also noteworthy, says Walsh. "According to the literature, up to 47% of patients are being underscored in terms of their Gleason scores [a grade given cancer cells, in which a higher number is a more severe rating]," she notes. "That is clinically significant, because theoretically [with a lower score] you get less treatment."
BNPCC has all pathology reviewed by local and national experts in urologic pathology. "We send out a certain percentage to centers of excellence around the country, and they peer review us," says Walsh. "We’ve found that about 11% of the patients’ scores change, and the majority are understaged."
Data gathering extensive
Detailed collection and sharing of data help ensure an ongoing high quality of treatment at BNPCC. "When a patient first comes in for a consult, we try to collect as much previous data as possible, as well as data from the consult itself," Walsh says.
This information is combined, entered onto a template created by the consortium for consults, and then put directly into the database.
"There are several other areas of data we track," she says. "There’s pathology — both the original, and reviewed pathology from other centers; treatment; and follow-up information, which is ongoing." Also tracked is dosimetry, which involves how radiation is dosed and delivered, as well as the scans used to make such determinations.
BNPCC regularly compares its data with similar data at other prostate cancer Centers for Excellence, including M.D. Anderson in Houston and Wash-ington University Medical Center in St. Louis.
Much of the data also are sent to the National Institutes of Health and National Cancer Institute government clinical trials.
"About 80% of our eligible patients go on to the trials, while the national average is anywhere from 3% to 5%," Walsh says. "This reflects extremely well on us because national clinical trials are really what drive clinical data."
BNPCC and its patients already are reaping the benefits of the consortium/peer review model. For example, unnecessary procedures are being reduced drastically.
"According to NCCN, CTN bone scans are not required for all prostate cancer patients," she notes. "Because we monitor closely and teach our physicians that they do not need them for low-risk patients, we have cut unnecessary’ bone scans from 15% to single digits; the national average is 40%."
This, in turn, has impressed insurance companies and enhanced reimbursements for BNPCC physicians. "We have case rates with the insurance companies and collaborate with them," Walsh says. "We present our clinical data on outcomes twice a year. When we show them how through the consortium we are reducing unnecessary procedures, they see us as providing higher value and we can negotiate higher reimbursement rates."
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BNPCC Goals |
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The Need for Clinical Trials |
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Key Points
- Benchmarking national centers for excellence hones diagnoses.
- Patient advocates help achieve balanced approach to treatment.
- Nearly 80% of eligible patients go on to national clinical trials.
For more information, contact:
- Susan Walsh, RN, Buffalo Niagara Prostate Cancer Consortium, Elm & Carlton Streets, Buffalo, NY 14263. Telephone: (716) 845-3173. Fax: (716) 845-7616. E-mail: [email protected].
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