American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Special Study Targeting Cancer Surveillance to Start April 17

Prostate cancer is the most common cancer in men, currently affecting around 3 million American survivors, with another 180,000 men diagnosed each year. After prostate cancer treatment, Prostate-specific antigen (PSA) testing is the standard method for surveillance and early detection of recurrence. It is unknown how often PSA surveillance testing is needed. Optimizing post-treatment surveillance was identified as the highest priority topic by patients, clinicians and policy makers in a stakeholder-driven research prioritization effort, based on its impact, uncertainty about the optimal approach, and potential to significantly change practice.

In order to achieve the intended impact on clinical practice and benefit patients, a Commission on Cancer (CoC) Special Study will be launched April 17, 2017, to investigate post-treatment surveillance and recurrence after prostate cancer treatment.

Thanks to the hard work and dedication of the registrars at the CoC accredited institutions across the country, results from the 2015 Special Study studying post-treatment surveillance breast, colorectal, and lung cancers have helped to inform changes made to recurrence data items in the FORDS manual for implementation in 2018. Initial results from these studies have been published and can be made available by request by emailing specialstudy@facs.org.

The 2017 prostate Special Study will involve analyzing data from the National Cancer Database (NCDB) to assess optimal post-treatment surveillance testing for the detection of new primary cancer and local/regional and distant recurrence in prostate cancer. The CoC has deemed this Special Study a priority area and an important initiative for improving patient centered care. The goal of this study is to identify the benefits (improved survival) and harms (more procedures, more treatment, side effects, and quality of life impact) from the different surveillance frequencies (every three vs. six vs. 12 months). Registrars will collect data on post-treatment surveillance (e.g., PSA and testosterone results, imaging scans, biopsies) and recurrence on 12 patients total diagnosed between 2005 and 2007. Based on feedback received from registrars during a pilot of this study, minor changes have been made for users’ ease and clarity, and to minimize the burden of the study on cancer registrars.

The collection of follow-up PSA testing and recurrence information is particularly critical to the success of this study. As many of you know, patients often receive follow-up care outside of the institution where their cancer was diagnosed or initially treated. As a result, for this study, as during the 2015 Special Study, it is likely that for many patients, registrars will need to go outside their institution to other providers or hospitals to collect patient medical records that comprehensively capture patient health care use following active treatment for their cancer. You will be provided with a letter template that can be used to contact outside providers to request information about these patients.

During this period staff members with the Alliance/American College of Surgeons Clinical Research Program will be available as a resource for registrars and CLPs. In the near future, instruction documents will be sent to the main Hospital Registrar’s attention via USPS and electronically. We ask that the main Hospital Registrar at each facility confirm/update his/her current mailing address in Datalinks at this time to receive the instructions documents. We will also hold a series of webinars to help registrars gain familiarity with the study and the study staff. These webinars will be eligible for NCRA Continuing Education credit. Upon completion of the study, sites will receive credit for Standard 5.7, provided the data is complete and submitted by the deadline. Send any questions or comments to specialstudy@facs.org. Thank you in advance for your participation in this study.

Sincerely,

Ronald C. Chen, MD MPH
Principal Investigator

Lawrence N. Shulman, MD
Chair, Commission on Cancer

David Winchester, MD
Medical Director, Cancer Programs

This work was in part supported through Patient-Centered Outcomes Research Institute (PCORI) Program Award CER-1503-29220.