Variation in the treatment of cervical cancer patients and the effect of consultant workload on survival: A population-based study

An Association of Cancer Physicians' strategy for improving services and outcomes for cancer patients

The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members.

Patterns of care study of brachytherapy in New South Wales: cervical cancer treatment quality depends on caseload

PURPOSE

We previously conducted modelling and a patterns of care study (POCS) that showed gynaecological brachytherapy (BT) was underutilized in New South Wales (NSW), the USA and Western Europe. The aim of the current study was to assess the quality of cervical BT in NSW, and to determine if caseload affects quality of treatment delivery.

MATERIAL AND METHODS

All nine NSW radiation oncology departments that treated patients with cervical BT in 2003 were visited. Patient, tumour and treatment related data were collected. Quality of BT was assessed using published quality benchmarks. Higher and lower caseload departments were compared.

RESULTS

The four higher cervical BT caseload departments treated 11-15 NSW residents in 2003, compared to 1-8 patients for the lower caseload departments. Cervix cancer patients treated at the higher caseload departments were more likely to be treated to a point A dose ≥ 80 Gy (58% vs. 14%, p = 0.001), and to have treatment completed within 8 weeks (66% vs. 35%, p = 0.02). Despite higher point A doses, there was no significant difference in proportions achieving lower than recommended rectal or bladder doses, implying better BT insertions in higher caseload departments.

CONCLUSIONS

Cervical BT in NSW was dispersed amongst a large number of departments and was frequently of sub-optimal quality. Higher quality BT was achieved in departments treating at least 10 patients per year. It is likely that improved outcomes will be achievable if at least 10 patients are treated per department per year.

Examining the potential relationship between multidisciplinary cancer care and patient survival: an international literature review

BACKGROUND AND OBJECTIVES

The aim of this review is to examine the relationship between multidisciplinary cancer care and patient survival.

METHODS

A literature review was undertaken between January 1950 and September 2009. Included studies described multidisciplinary cancer care and its relation to patient survival. Multidisciplinary care was defined as involvement of a team of clinical and allied specialists whose intent is individualized patient management. Studies were critically appraised for internal and external validity. All study designs were included.

RESULTS

Twenty-one studies met eligibility criteria for this review, including two systematic reviews, one abstract, and 18 original studies. Pooling of results was not possible due to heterogeneity of patient populations, disease sites, measured outcomes, and follow-up periods. Twelve studies (one prospective and six retrospective cohort studies, five before-after series) reported statistically significant association between multidisciplinary care and patient survival.

CONCLUSIONS

Due to methodological limitations, this review is unable to assert a causal relationship between multidisciplinary care and patient survival. In order to better evaluate this relationship, the oncology community must first accept a common definition of multidisciplinary care. Future efforts can then elucidate which aspects of multidisciplinary care impact survival, with consideration of confounding patient and tumour factors.