Japanese Journal of Clinical Oncology, Vol 28, Issue 6 388-395, Copyright © 1998 by Foundation for Promotion of Cancer Research
T Teshima, M Abe, H Ikeda, GE Hanks, JB Owen, S Yamada, K Sakai, T Mori, T Nishimura, M Mitomo, G Todo, D Hamanaka, M Koishi and Y Okazaki
BACKGROUND: To improve the quality of radiation oncology in Japan, Patterns
of Care Study (PCS), a widely known quality assurance (QA) program in the
USA, was introduced. The feasibility was tested by collecting nationwide
data by extramural audit for cervix cancer. METHODS: From July 1996 through
February 1997, PCS audits were performed for 29 institutions nationwide. On
the basis of the facility survey by Tsunemoto, 13 institutions were
classified as A1 (university hospital/cancer center), 10 as B1 (other
institutions treating >120 patients/year) and six as B2 (other
institutions treating <120 patients/year). Medical charts for the
patients treated for cervix cancer between 1992 and 1994 were reviewed
based on the data format of the US PCS. The total number of patients
surveyed was 432. RESULTS: Simulation was used for >90% of the patients
in both A1 and B1-2 institutions. However, in B1-2, planning for 5% of the
patients was performed with only a clinical set-up (p = 0.0287). A daily
fraction with a size of 200 cGy was given to >65% of patients in A1 and
to <47% in B1-2. On the other hand, >50% of those in B1-2 were
treated with daily fractions of 180 cGy and less compared with 25% in A1
institutions (p < 0.0001). Brachytherapy was utilized more frequently
for patients in Stages II (p = 0.0365), III (p = 0.0015) and IV (p =
0.0483) in A1 than in B1-2. As for external beam equipment, linear
accelerators with 10 MV or more were used for 83% of the patients in A1.
However, in B1-2 institutions, machines with lower energy were used for 38%
of the patients (p < 0.0001). The median number of full-time-equivalent
(FTE) radiation oncologists was 2.7 in A1, 0.65 in B1 and 0.2 in B2.
CONCLUSIONS: Institutional stratification, including equipment and
personnel, was found to affect significantly the patterns of care for
cervix cancer. Therefore, to improve the quality of radiation therapy
nationwide, improvements in equipment and in supply of FTE personnel are
extremely important. PCS was found to have great potential for a practical
evaluation of how much improvement will be required in Japan.
ORIGINAL ARTICLE
Patterns of care study of radiation therapy for cervix cancer in Japan: the influence of the stratification of institution on the process
Department of Radiation Oncology, Osaka University Medical School, Suita, Japan. teshima@sahs.med.osaka-u.ac.jp
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