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Karim S, Doll CM, Dingley B, Merchant SJ, de Moraes FY, Booth CM. The Choosing Wisely Oncology Canada Cancer List: An Update. J Cancer Policy 2023; 37:100431. [PMID: 37391095 DOI: 10.1016/j.jcpo.2023.100431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Choosing Wisely (CW) Canada is a national campaign to identify unnecessary or harmful services that are frequently used in Canada. The original CW Oncology Canada Cancer list was developed in 2014. A CW Oncology Canada working group was established to review new evidence and guidelines and to update the current CW Oncology Canada Cancer List. METHODS Between January and March 2022, we conducted a survey of members of the Canadian Association of Medical Oncology (CAMO), Canadian Association of Radiation Oncology (CARO) and the Canadian Society of Surgical Oncology (CSSO). We took the feedback from the survey, including potential new recommendations as well as those that were thought to be no longer relevant and up to date, and conducted a literature review with the assistance of the Canadian Agency for Drugs and Technology in Health (CADTH). The final updated list of recommendations was made by the CW Oncology Canada working group based on a consensus process. RESULTS We reviewed two potential recommendations to add and two potential recommendations to remove from the existing CW Oncology Canada Cancer List. The recommendation "Do not prescribe whole brain radiation over stereotactic radiosurgery for patient with limited brain metastases (≤4 lesions)" was supported by several evidence-based guidelines with the strength of recommendations ranging from strong to moderate and the quality of evidence ranging from level 1 to level 3. After reviewing the evidence, the working group felt that the other potential recommendation to add and the two potential recommendations to remove did not have sufficient strength and quality of evidence at this time to be added or removed from the list. CONCLUSION The updated Choosing Wisely Oncology Canada Cancer List consists of 11 items that oncologists should question in the treatment of patients with cancer. This list can be used to design specific interventions to reduce low value care.
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Affiliation(s)
- Safiya Karim
- Department of Oncology, University of Calgary, Calgary, AB, Canada.
| | - Corinne M Doll
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | | | - Shaila J Merchant
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Fabio Ynoe de Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, ON, Canada; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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Imlach F, Dunn A, Costello S, Gurney J, Sarfati D. Driving quality improvement through better data: The story of New Zealand's radiation oncology collection. J Med Imaging Radiat Oncol 2023; 67:119-127. [PMID: 36305425 DOI: 10.1111/1754-9485.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022]
Abstract
Aotearoa/New Zealand is one of the first nations in the world to develop a comprehensive, high-quality collection of radiation therapy data (the Radiation Oncology Collection, ROC) that is able to report on treatment delivery by health region, patient demographics and service provider. This has been guided by radiation therapy leaders, who have been instrumental in overseeing the establishment of clear and robust data definitions, a centralised database and outputs delivered via an online tool. In this paper, we detail the development of the ROC, provide examples of variation in practice identified from the ROC and how these changed over time, then consider the ramifications of the ROC in the wider context of cancer care quality improvement. In addition to a review of relevant literature, primary data were sourced from the ROC on radiation therapy provided nationally in New Zealand between 2017 and 2020. The total intervention rate, number of fractions and doses are reported for select cancers by way of examples of national variation in practice. Results from the ROC have highlighted areas of treatment variation and have prompted increased uptake of hypofractionation for curative prostate and breast cancer treatment and for palliation of bone metastases. Future development of the ROC will increase its use for quality improvement and ultimately link to a real time cancer services database.
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Affiliation(s)
- Fiona Imlach
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | - Alexander Dunn
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
| | | | - Jason Gurney
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand.,Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- Te Aho o Te Kahu/Cancer Control Agency, Wellington, New Zealand
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Park HJ, Kim K, Kim YB, Chang JS, Shin KH. Patterns and Longitudinal Changes in the Practice of Breast Cancer Radiotherapy in Korea: Korean Radiation Oncology Group 22-01. J Breast Cancer 2023. [DOI: 10.4048/jbc.2023.26.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Hanyang University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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Vaandering A, Jansen N, Weltens C, Moretti L, Stellamans K, Vanhoutte F, Scalliet P, Remouchamps V, Lievens Y. Radiotherapy-specific quality indicators at national level: How to make it happen. Radiother Oncol 2023; 178:109433. [PMID: 36464181 DOI: 10.1016/j.radonc.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE /OBJECTIVE To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments' evaluation of this initiative. MATERIAL AND METHODS The Donabedian approach was used, focussing on structural, process and outcome QIs. The criteria for QI selection were availability, required for low-threshold regular collection, and applicability to guidelines and good practice. The QIs were collected yearly and individualized reports were sent out to all RT departments. In 2021, a national survey was held to evaluate the ease of data collection and submission, and the perceived importance and validity of the collected QIs. RESULTS 18 structural QI and 37 process and outcome parameters (n = 25 patients/pathology/department) were collected. The participation rate amounted to 95 % overall. The analysis gave a national overview of RT activity, resources, clinical practice and reported acute toxicities. The individualized reports allowed departments to benchmark their performance. The 2021 survey indicated that the QIs were overall easy to collect, relevant and reliable. The collection of acute recorded toxicities was deemed a weak point due to inter-observer variabilities and lack of follow-up time. CONCLUSION QI collection on a national level is a valuable process in steering quality improvement initiatives. The feasibility and relevance was demonstrated with a high level of participation. The national initiative will continue to evolve as a quality monitoring and improvement tool.
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Affiliation(s)
- Aude Vaandering
- UCL Cliniques Universitaires St Luc, Department of radiation oncology, Brussels, Belgium; Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Nicolas Jansen
- University Hospital of Liège, Department of radiation oncology, Liège, Belgium
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Luigi Moretti
- Institut Jules Bordet, Department of radiation oncology, Brussels, Belgium
| | - Karin Stellamans
- AZ Groeninge, Department of radiation oncology, Kortrijk, Belgium
| | - Frederik Vanhoutte
- Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
| | - Pierre Scalliet
- Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Vincent Remouchamps
- CHU-UCL Namur - site Saint Elisabeth, Department of radiation oncology, Namur, Belgium
| | - Yolande Lievens
- Ghent University Hospital and Ghent University, Department of radiation oncology, Ghent, Belgium
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Batumalai V, James M. Unwarranted variation in radiation therapy fractionation. J Med Imaging Radiat Oncol 2022; 66:233-241. [PMID: 35243787 DOI: 10.1111/1754-9485.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023]
Abstract
The adoption of hypofractionation across multiple tumour sites has been slow despite robust evidence. There is considerable unwarranted variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician preference, lack of technology and differing financial incentives. Unwarranted variation in the use of hypofractionation has a tremendous effect on cost to both patients and the healthcare system. This places an unnecessary burden on patients and poorly utilises scarce healthcare resources. A collaborative effort from clinicians, patients, healthcare providers and policymakers is needed to reduce unwarranted variation in practice. This will improve quality of care both for patients and at broader healthcare system level.
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Affiliation(s)
- Vikneswary Batumalai
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,GenesisCare, Sydney, New South Wales, Australia
| | - Melissa James
- Christchurch Oncology Service, Canterbury Regional Cancer and Haematology Centre, Christchurch, New Zealand.,Department of Medicine, Christchurch Hospital, University of Otago Christchurch, Christchurch, New Zealand
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Kim S, Pitson G, Koh TL, Chao M, Byrne K, Hornby C, Foroudi F, Millar J, Ong WL. Increasing use of post-mastectomy hypofractionated radiation therapy for breast cancer in Victoria. J Med Imaging Radiat Oncol 2021; 66:428-435. [PMID: 34811941 DOI: 10.1111/1754-9485.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the use of post-mastectomy hypofractionationed radiation therapy (HFRT) for breast cancer in Victoria, Australia. METHODS This is a population-based cohort of women with breast cancer who received post-mastectomy RT to the chest wall with or without nodal irradiation between 2012 and 2017. HFRT was defined as <25 fractions of RT. Data were captured in the Victorian Radiotherapy Minimum Dataset (VRMDS). The changing pattern of HFRT use was evaluated using the Cochran-Armitage test. Patient-, treatment- and institutional-related factors associated with HFRT use were evaluated using multivariable logistic regression. RESULTS Two thousand and twenty-one women were included in this study, of which 238 (12%) received HFRT. This increased from 8% in 2012 to 18% in 2017 (P-trend < 0.001). Older women were more likely to have HFRT (26% in women above 70 years vs 6% in women under 50 years; P < 0.001). Women who did not have nodal irradiation were more likely to have HFRT than those who did (18% vs 9% respectively; P < 0.001). In multivariate analyses, the progressive increase in HFRT use over time remained statistically significant - women treated in 2017 were four times more likely to receive HFRT than those treated in 2012 (95% CI = 2.1-7.7; P < 0.001). Other factors independently associated with increased likelihood of HFRT use included increasing age at RT, and lack of nodal irradiation. CONCLUSION In this first Australian study evaluating the use of post-mastectomy HFRT, we observed increasing HFRT use in Victoria over time. We anticipate this rising trend will continue in the coming years.
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Affiliation(s)
- Sohyun Kim
- Department of Radiation Oncology, Barwon Health, Geelong, Victoria, Australia
| | - Graham Pitson
- Department of Radiation Oncology, Barwon Health, Geelong, Victoria, Australia
| | - Tze Lui Koh
- Department of Radiation Oncology, Chris O'Brien Life House, Camperdown, New South Wales, Australia
| | - Michael Chao
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia.,Genesis Cancer Care, Ringwood, Victoria, Australia
| | - Keelan Byrne
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Colin Hornby
- Victorian Department of Health, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
| | - Wee Loon Ong
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia.,Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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