Quality of Care and Long-term Outcomes of Active Surveillance: Gaining Insights from Population-level Perspectives
Notice bibliographique
Résumé
Active surveillance (AS) for low-risk prostate cancer (PC) is evolving as an internationally recognized standard of care and is recognized by major urological associations as a preferred treatment option. AS is increasingly used worldwide, yet research on variations of quality of care during AS is lacking, and compliance with AS guidelines is largely unknown at the population level. The aims of this research were to develop quality indicators (QIs) for AS, evaluate the quality of care for patients on AS using those QIs, and estimate long-term oncological outcomes after initial AS. A first study aimed to develop national consensus-based system-level QIs for evaluation of AS care among patients with low-risk PC. A second study aimed to critically apply QIs to examine/understand quality of care during AS at the population level. A third study aimed to evaluate long-term oncological outcomes at the population level in patients who received initial AS. This thesis establishes a foundation on which to measure and monitor the quality of care for AS patients at the population level. We developed 20 comprehensive structure-process-outcome-based QIs for measuring quality of AS care. Further, by applying these AS QIs to a large Canadian population database, we identified current gaps in the quality of AS care. The findings suggest that process of care QIs measured at PC diagnosis and during eligibility assessment for AS were improving in recent years; however, considerable variation appeared with many process indicators during the AS follow-up phase. Finally, our third study is one of the first to measure long-term oncological outcomes of AS using population-level data compared with initial treatment. Among men diagnosed with low-risk PC and managed with AS, the results suggest excellent 10- and 15-year metastasis-free survival, overall survival, and PC-specific mortality, similar to published observational studies from academic centres. However, at a population level, AS was associated with slightly worse long-term metastasis-free survival, overall survival and PC-specific mortality compared with initial treatment. These results should help clinicians and policy makers understand the impact of AS on long-term outcomes after widespread adoption.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,004 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».