SUO 2019: Better Outcomes at Higher Volume Centers: Evaluating Your Institution’s Data

Washington, DC (UroToday.com) The second session on renal cell carcinoma at the SUO focused on the management of advanced disease. Dr. Brugarolas was invited to present data regarding the value of a critical assessment of one’s own institution’s outcomes to drive patient outcomes. He is a professor at UT Southwestern (UTSW) Medical Center in both the Department of Hematology/Oncology and Developmental Biology, where he leads the Kidney Cancer Program and as such is uniquely posed to discuss quality outcomes in the multidisciplinary setting.

Dr. Brugarolas began his talk by recognizing that quality assessments are common at many other institutions and that at UTSW, they actually modeled their self-evaluation off the program already established at the Cleveland Clinic. Next, he outlined the steps to developing a meaningful assessment, providing the strategy that they employed at their institution as a guide. Dr. Brugarolas highlighted the importance of building a team and specifically, including a biostatistician with a depth of understanding regarding the disease in question. Next, one must select a benchmark for comparison to attempt to assess the impact of the program on patient outcomes. For their self-study, they selected data from SEER and analyzed time to death from diagnosis. To provide further rigor and avoid bias they invited independent analysis from the UTSW health system quality control office to validate their results.

Overall, compared to a national cohort, Dr. Brugarolas demonstrated improved survival in patients receiving care at their institution. The most appreciable difference was noted in Stage IV patients, 11.2% 5-year survival in SEER vs. 33% 5-year survival at UTSW. While this provided some evidence that institutional systems may shape outcomes, he acknowledged the limitations inherent to retrospective reviews.

Next, Dr. Brugarolas discussed system factors that potential impact care quality. He emphasized the assets provided by a multidisciplinary approach for the management of complex malignancies. Specifically, at UTSW he focused on the expertise available from colleagues in urology, medical oncology, radiation oncology, radiology and pathology. Even beyond those with interest specifically to the field, having close collaborations with other disciplines (vascular, orthopedics, neurosurgery) expands the care that can be delivered.

Dr. Brugarolas continued his talk by demonstrating how these collaborations drive advances in care, highlighting UTSW SAbR experience.  He provided multiple examples of innovations that have led to current phase I and phase II trials that are currently ongoing. Overall, Dr. Brugarolas reminded the audience that the hallmark of a strong program is dependent on a triad of patient care, research, and education. Overall, he demonstrated how an emphasis on these factors leads to the improved patient outcomes that he highlighted at the beginning of his talk.