Open Access

ARTICLE

Controversies in prostate cancer staging implementation at a tertiary cancer center

Tracy Sexton^1,2, George Rodrigues^1,2,3, Ed Brecevic^1,2, Laura Boyce¹, Denise Parrack¹, Michael Lock^1,2, David D’Souza^1,2

1 Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Center, London, Ontario, Canada
2 Department of Oncology, University of Western Ontario, London, Ontario, Canada
3 Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
Address correspondence to Dr. George Rodrigues, London Regional Cancer Program, 790 Commissioners Road East,London, Ontario N6A 4L6 Canada

Canadian Journal of Urology 2006, 13(6), 3327-3334.

Abstract

Objective:To assess accuracy of recorded prostate cancer stage after implementation of a quality assurance staging improvement plan.
Methods and materials:Genitourinary multidisciplinary TNM staging guidelines were prospectively implemented. Educational programs for health records technicians (HRT) and clinicians preceded implementation of the new guidelines. Patient stage information was entered into the Oncology Patient Information System (OPIS) as part of the usual operations of the cancer center by an HRT. Physician and HRT auditors performed a subsequent quality assurance audit on 97 prostate cancer patients seen over a 2-month period. Assessment of staging accuracy and reasons for discrepancies between the OPIS stage and auditor stage were analyzed and reported.
Results: Fifty-four (52%) charts showed discrepancies between auditors. Of the fifty-four, twelve (22%) had discrepancies between OPIS and auditor, thirty (56%) showed discrepancies between auditors, and twelve (22%) had discrepancies between OPIS, physician auditor, and HRT auditor. Forty-three (41%) cases had no discrepancies. Reasons for discrepancies included: misinterpretation of the digital rectal examination (16/54), inappropriate use of TRUS/MRI (9/54) in staging, stage not assigned at initial diagnosis (9/54), misinterpretation of pathology (7/54), TNM staging confusion (4/54), OPIS update not performed (3/54), inappropriate use of biopsy data (3/54), disagreement between consultants (2/54), and misinterpretation of TURP result (1/54). Overall staging accuracy was 76% for OPIS, 65% for the physician auditor and 62% for the HRT auditor.
Conclusions: Despite guidelines and educational interventions, computer registry staging accuracy remains an issue. On-going audit procedures are proposed to identify and correct both published and institutional staging guidelines.

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