In the Late Breaking News section of the concluding Plenary Session of the 30th EAU Anniversary Congress in Madrid, the role and usefulness of a standardised set of patient-centered outcomes for advanced prostate cancer came under close scrutiny with the critical view that questionnaire outcomes must undergo vigorous assessment.
“ICHOM is an excellent initiative, but I am worried about the accuracy of the data shown in the introduction about the functional results of radical prostatectomy in different countries such as Germany, Sweden, and in certain expert centres.,” said Prof. Manfred Wirth (DE) in response to the presentation of medical oncologist Dr. Alicia Morgans (USA).
“This data should have been independently assessed. The problem is how to accurately measure; and then you have the requirement that results must be independently reviewed,” added Wirth.
Morgans presented the usefulness of the initiative from the international group ICHOM, which formulated the Standard Set for Advanced Prostate Cancer, a tool which aims to measure value and compare health care outcomes across systems.
“I appreciate the comment and it is indeed important that we had to have independent reviews. We aim to implement further development, and I do hope that the patients (in their response) are not influenced,” said Morgans referring to companies, institutes and physicians, and in response to Wirth’s critique.
The critique focused on the morbidity measures following radical prostatectomies which he said showed, for instance, a high rate in urinary incontinence. “We get these high rates of incontinence, but we have to be aware that many of elderly patients (above 65 years of age) have already pre-existing urinary continence problems. Thus, the high rate after radical prostatectomies may be further magnified by these pre-existing conditions,”he said underscoring that a rigorous questionnaire is obligatory. According to Wirth, incontinence depends on various factors, with surgical technique being only one of them.
“Is the evaluation of incontinence done independently by questionnaire?” asked Wirth, to which session Chairman Chris Chapple noted it is a pre-requisite to first implement an unbiased, formal survey and complemented by an independent review.