Preoperative radiotherapy for rectal cancer: a comparative study of quality control adherence at two cancer hospitals in Spain and Poland

Abstract

BackgroundWe performed a clinical audit of preoperative rectal cancer treatment at two European radiotherapy centres (Poland and Spain). The aim was to independently verify adherence to a selection of indicators of treatment quality and to identify any notable inter-institutional differences.MethodsA total of 162 patients, in Catalan Institute of Oncology (ICO) 68 and in Greater Poland Cancer Centre (GPCC) 94, diagnosed with locally advanced rectal cancer and treated with preoperative radiotherapy or radio-chemotherapy were included in retrospective study. A total of 7 quality control measures were evaluated: waiting time, multidisciplinary treatment approach, portal verification, in vivo dosimetry, informed consent, guidelines for diagnostics and therapy, and patient monitoring during treatment.ResultsSeveral differences were observed. Waiting time from pathomorphological diagnosis to initial consultation was 31 (ICO) vs. 8 (GPCC) days. Waiting time from the first visit to the beginning of the treatment was twice as long at the ICO. At the ICO, 82% of patient experienced treatment interruptions. The protocol for portal verification was the same at both institutions. In vivo dosimetry is not used for this treatment localization at the ICO. The ICO utilizes locally-developed guidelines for diagnostics and therapy, while the GPCC is currently developing its own guidelines.ConclusionsAn independent external clinical audit is an excellent approach to identifying and resolving deficiencies in quality control procedures. We identified several procedures amenable to improvement. Both institutions have since implemented changes to improve quality standards. We believe that all radiotherapy centres should perform a comprehensive clinical audit to identify and rectify deficiencies.

Improving quality of care and clinical outcomes for rectal cancer through clinical audits in a multicentre cancer care organisation

“…The study began with the creation of a working group made up of radiation oncologists and medical physicists from all three centres, and led by the clinical reference centre in rectal cancer. Key aspects of the diagnostic, therapeutic and follow-up phases were identified based on the literature [11,12], as were the study indicators, including the appropriateness of the diagnostic tests performed, quality of the diagnostic reports, multidisciplinary approach, appropriateness and adherence to the prescribed treatment, imaging controls during the RT sessions, post-surgical circumferential resection margin (ypCRM), and adverse effects. A purpose-designed form was used to collect the required data during the first audit, and for the second audit it was adapted to include the new indicators derived from the action plan.…”

Clinical Audit of the Radiotherapy Process in Rectal Cancer: Clinical Practice Guidelines and Quality Certification Do Not Avert Variability in Clinical Practice

“…To design the study, we formed a working group of radiation oncologists, medical physicists, and technologists from the three participating centers, led by the senior clinician in rectal cancer. We identified the key areas for assessment, including the diagnostic, treatment, and follow-up phase, based on the reviewed literature [8] , [9] and a previous study that ICO performed in collaboration with the Wielkospolskie Centrum Onkologii group [10] .…”

“…Some authors have proposed general indicators to assess the quality of the radiotherapeutic process [8] , [9] or specific ones related to rectal cancer [10] , and recently, the International Consortium for Health Outcomes Measurement [11] has also put forward a set of indicators focused on the impact of treatment and quality of life in patients with colorectal cancer. However, for the most part, there are no available indicators with international validity that could serve as a reference for comparing radiation oncology services.…”

Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project

“…In recent years, the role of clinical audits in improving quality has been increasing recognized. However, to date only a limited number have been conducted in the field of radiation oncology [4][5][6][7][8], and even fewer have specifically focused on rectal cancer [9][10][11][12].…”

“…In this context, six European comprehensive cancer centres joined together in an international project known as IROCA (Improving Quality in Radiation Oncology through Clinical Audits; https://iroca.eu) to carry out clinical audits of the radiotherapy process [10]. This project was, in part, inspired by previous experience at two of these hospitals, which performed a clinical audit to identify best practices and thereby improve and optimize radiotherapy delivery at those institutions [9].…”