Patterns of Care Study of Radiation Therapy for Esophageal Cancer in Japan: Influence of the Stratification of Institution on the Process

Abstract

PCSaudits were performed for 29 institutions. Based on the facility survey by Tsunemoto, 13 institutes were classified as A1 (university hospital/cancer centertreating >300 patients/year), 10 as B1 (otherinstitutes>120patients/year) and six as B2 (other institutes <120 patients/year). Medical charts for 455 patients with thoracic esophageal cancer between 1992 and 1994were reviewed based on the data format of PCS in the USA. Results: Concerning external beam equipment, linear accelerators of~1 0 MV were used for 73% of patients in A1, whereas in 81-2, 60CO machines were still used for 13%of 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. Forty-five percent of patients had received surgery in A1 and 34% in 81-2 (P= 0.0068).In the non-surgery group, a higher radiation dose of >60 Gy was delivered in A1 than in B1-2 (P = 0.0008). Chemotherapy was administered to 51 % of the patients in A1 and to 30% in B1-2 (P < 0.0001). Brachytherapy was utilized for 17% in A1 and only for 5% in B1-2 (P= 0.0001). Conclusion: Institutional stratification, including equipment andpersonnel, significantly affected the patterns of care for esophageal cancer. Therefore, to improve the quality of radiation therapy nationwide, improvement ofequipment andsupply of FTEpersonnel isextremely important. PCS was found to have great potential for the practical evaluation of how much will be required in Japan.Key words: Patterns ofCare Study -esophageal cancer -radiation therapy -quality assurance -structure offacility -radiation oncology equipment -radiation oncology personnel Received November 10,1997; accepted February 12, 1998 For reprints and all correspondence: Teruki Teshima, Department of Radiation Oncology, Osaka University Medical School, 2-2, Yamadaoka, Suita 565-0871, Japan. E-mail: teshima@sahs.med.osaka-u.ac.jp Abbreviations: PCS, Patterns of Care Study; QA, quality assurance; FTE, full-time equivalent; AJCC, American Joint Committee on Cancer; KPS, Karnofsky Performance Status; AI, university hospital/cancer center treating ;::300 patients/year; B1, other institutions treating ;::20patients/year; B2, other institutions treating < 120 patients/year INTRODUCTION Radiation therapy is expected to play an important role in cancer management in the next century because of a rapid increase in the number of elderly patients in Japan. These patients are generally not suitable candidates for aggressive surgery or chemotherapy. In the field of radiation oncology, many innovative techniques such as conformal therapy, intraoperative radiation therapy and heavy ion medical accelerator therapy have been developed by pioneers in Japan. However, basic treatment using photons, which is currently used to treat 99% of the candidates for radiation therapy, is not sophisticated enough. A structure survey of radiation oncology in 1990 by Tsunemoto (1) and a subsequent comparative study between the USA and Japan (2) showed that more than 60% of institutions in Japan we...

Patterns of Care Study of Radiation Therapy for Cervix Cancer in Japan: The Influence of the Stratification of Institution on the Process

“…In Al institutions, the ratio of the Stage III population was 15% lower than that in B 1-2 institutions, while the ratio of the Stage II population in A 1 institutions was 10% higher than that in B1-2 institutions . Our other pes of radiotherapy for esophageal cancer showed a higher rate of combination of surgery for the patients in Al institutions (6). Although we lack direct evidence in the current study, this suggests that in Al institutions even small populations of Stage III patients might undergo aggressive surgical treatment after intensive intra-arterial chemotherapy, and that in B1-2 institutions patients with an advanced stage are referred to radiation therapy.…”

“…8, p < 0.0001 ). The median value of the number of full-time-equivalent (FIE) radiation oncologists (40 h/week for the radiation oncology service) was 2.7 in Al institutions, 0.65 in BI and 0.2 in B2, as shown in Table 5 of our previous report (6).…”

“…Japanese institutions of radiation oncology were stratified into four categories on the basis of the facility master survey by Tsunemoto et al (Table 2) (1) as shown in a previous report (6). Based on this stratification, 13 institutions were classified as Al (university hospital/cancer center treating~300 patients/year), 10 as Bl (other institutions treating~120patients/year) and six as B2 (other institutions treating <120 patients/year) in the current series.…”

National Average for the Process of Radiation Therapy in Japan by Patterns of Care Study

“…In the current study, PCS was performed only for the institutions of members of the cancer research groups by the Ministry of Health and Welfare in Japan (8-27 and 8-29) and their affiliated hospitals. Its feasibility and usefulness were clarified in our previous reports (4,5). National averages can retrospectively and with a limited number of patients represent the actual state of medical care nationwide.…”

“…Differences among patients' backgrounds, work-up studies and treatment methods were examined through analysis in terms of institutional stratification (4,5). However, this study produced only simple ratios for radiother apeutic processes, without making adjustments for differences among institutions.…”