Radiology must avoid turning ‘blind eye’ to patient-centered prostate cancer outcomes

Researchers are gaining more and more ground in the fight against prostate cancer, but one expert is reminding the field not to forget about what matters most: the patient.

That was the overarching message put forth by Julianna M. Czum, MD, with Dartmouth-Hitchcock Medical Center, in a new Journal of the American College of Radiology opinion piece. Czum wrote that developments such as multiparametric MRI and the prostate imaging reporting and data system have improved how clinicians approach and diagnose the disease. And while these accomplishments are critical, the field isn’t paying as much mind to patients’ perspectives.

“As researchers fight the good fight against the physical ravages of cancer with advances in image-based diagnosis, focused on getting as close as possible to ‘hard targets’ such as 100% accuracy and 0% adverse events, it’s all too easy to overlook studying ‘soft targets’ of the impact of those advances,” she wrote.

Czum is referring to patient-centered outcomes, which of course include improved accuracy and impact on mortality, but other consequences as well, such as emotional outcomes, time costs and test duration.

Assessing the impact of these factors can be done, and should be a priority, Czum argued. Patient satisfaction surveys and approved psychosocial tools can determine how much time a prostate cancer patient was forced to take off work, if dealing with their insurance company has been difficult, or if imaging exams have affected their quality of life.

Gathering this information requires more personal and subjective data, she wrote, which seems “simpler,” but may not be considered as worthy to researchers when compared to the “elusive holy grail” of sensitivity, specificity and other “hard targets.”

Czum encouraged radiology and oncology researchers to begin putting themselves in patients’ shoes, and consider their day-to-day struggles. 

“Although PI-RADS is useful for ongoing data collection for classic diagnostic test outcomes [and] monitoring in patients undergoing mpMRI, researchers should be careful to not let the fanfare that accompanies similar technology-centered advances have them turn a blind eye to the ‘simple’ things patients care about,” Czum wrote in the piece. “Being alive and extending life is important, but the daily living of that life, with all its intricacies and struggles, matters too.”