Quality of Prostate Cancer Care in Kashmir: A Retrospective Analysis

Kashmir – In a recent study conducted at Hakim Sanaullah Specialist Hospital and Cancer Center (HSSHCC) in Sopore, Kashmir, researchers have shed light on the quality of care provided to prostate cancer patients in the region. The study, which spanned from 2012 to 2020, aimed to assess the quality of care (QoC) received by these patients through a comprehensive analysis of retrospective data.

Prostate cancer is a significant health concern globally, including in Kashmir, where data on cancer epidemiology and burden is limited. To address this gap, the study focused on evaluating the QoC delivered to prostate cancer patients, encompassing various aspects of diagnosis, pathology, and treatment.

Key Findings:

• Diagnosis: The study revealed that the majority of patients (89.1%) were diagnosed through prostatic biopsies, while only 10.8% received their diagnosis based solely on prostate-specific antigen (PSA) levels. Transrectal ultrasound (TRUS) or transurethral resection (TURP)-guided biopsies were documented in 84.8% of patients, with Gleason grading noted in 87.5% of cases. However, the number of positive cores was mentioned for only 25.7% of patients.
• Pathology: The pathological type of prostate cancer was identified in 71.7% of patients, with conventional adenocarcinoma being the most common type. Histological features of the tumor were detailed in pathology reports for only 12.5% of patients, and the Gleason grading system was reported in 87.5% of cases.
• Treatment: For localized prostate cancer, the primary treatment modality was radical prostatectomy for 58.3% of patients. However, none of these patients received local radiotherapy (RT). Among patients with metastatic prostate cancer, 55% were treated with orchidectomy due to its easy accessibility and lower cost. Additionally, hormone therapy (HT) was administered to 8.3% of metastatic patients, while luteinizing hormone-releasing hormone (LHRH) agonist therapy was used in 25% of cases.
• Bone Health: The study highlighted concerns regarding bone health management, with only 4.7% of patients undergoing dual x-ray absorptiometry (DEXA) scans. Furthermore, half of the patients did not receive any bone health interventions, despite the increased risk of skeletal-related events associated with prostate cancer and its treatment.

Discussion and Implications:

The study underscores the importance of evaluating the QoC for prostate cancer patients in Kashmir and identifies several areas for improvement. While family history documentation and access to healthcare facilities were relatively positive, the study revealed limitations in the use of DRE for diagnosis, histopathological reporting, and the number of biopsy cores taken during diagnostic procedures. Additionally, the lack of adherence to bone health interventions raises concerns about patient well-being.

The study serves as a call to action, emphasizing the need for increased awareness and adherence to guidelines for prostate cancer diagnosis and treatment. The findings also highlight the potential benefits of disseminating information about available treatment options and quality control indicators to improve healthcare outcomes in the region.

It is important to note that the study has limitations, including its small sample size and missing data on some patients. Furthermore, the involvement of multiple specialists in patient care due to treatment received at different institutions highlights the complexity of prostate cancer management.

In conclusion, the study provides valuable insights into the QoC for prostate cancer patients in Kashmir and underscores the importance of addressing gaps in healthcare delivery. Further research and initiatives aimed at enhancing the understanding and management of prostate cancer in the region are essential to improve patient outcomes and overall healthcare quality.

This research was conducted with the approval of the Institutional Ethics Committee of Hakim Sanaullah Specialist Hospital and Cancer Center (HSSHCC).