1. Patterns of Care Study of Radiation Therapy for Cervix Cancer in Japan: The Influence of the Stratification of Institution on the Process
- Author
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Tomoyuki Mori, Teruki Teshima, Kunio Sakai, Tetsuo Nishimura, Daizaburo Hamanaka, Shogo Yamada, Hiroshi Ikeda, Masanori Mitomo, Jean B. Owen, Yoichi Okazaki, Mototsugu Koishi, Giro Todo, Gerald E. Hanks, and Mitsuyuki Abe
- Subjects
Adult ,Cancer Research ,medicine.medical_specialty ,Quality Assurance, Health Care ,medicine.medical_treatment ,Brachytherapy ,Uterine Cervical Neoplasms ,Audit ,Age Distribution ,Japan ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,Practice Patterns, Physicians' ,Patterns of care study ,Cervix ,Aged ,Aged, 80 and over ,Cervical cancer ,Medical Audit ,business.industry ,Radiotherapy Dosage ,Cancer Care Facilities ,General Medicine ,Middle Aged ,medicine.disease ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,Emergency medicine ,Female ,business ,Quality assurance - Abstract
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.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 treating120 patients/year) and six as B2 (other institutions treating120 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.Simulation was used for90% 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 to65% of patients in A1 and to47% 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 (p0.0001). 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 (p0.0001). The median number of full-time-equivalent (FTE) radiation oncologists was 2.7 in A1, 0.65 in B1 and 0.2 in B2.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.
- Published
- 1998
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