Robert Olson1, Matthew Chan2, Neelam Minhas2, Gurkirat Kandola2, Manpreet Tiwana3, Shilo Lefresne4, Ross Halperin5, Devin Schellenberg6, Elaine Wai7, Nissar Ahmed8, Scott Tyldesley4. 1. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada; BC Cancer-Centre for the North, Canada. Electronic address: Rolson2@bccancer.bc.ca. 2. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada. 3. PEI Cancer Treatment Centre, Charlottetown, Canada. 4. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada; BC Cancer-Vancouver Centre, Canada. 5. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada; BC Cancer-Kelowna Centre, Canada. 6. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada; BC Cancer-Surrey Centre, Canada. 7. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada; BC Cancer-Victoria Centre, Canada. 8. Department of Surgery, Division of Radiation Oncology, University of British Columbia, Vancouver, Canada; BC Cancer-Abbotsford Centre, Canada.
Abstract
PURPOSE: There is ample evidence that single-fraction radiation therapy (SFRT) is as efficacious as more costly and morbid multifraction regimens. We previously demonstrated that an audit-based intervention increased the use of SFRT in all regional cancer centers the following year. However, other investigators have demonstrated that interventions were only associated with a transient 1-year change in prescribing practices. We sought to determine whether our intervention resulted in a more lasting impact. METHODS AND MATERIALS: In 2012, we performed an audit of the prescribing practices of individual physicians, which was then presented to leaders and oncologists as an intervention to increase SFRT. We compared the use of SFRT between 2007 to 2011 (preintervention) and 2013 to 2016 (postintervention) in all 31,192 patients treated in our provincial program. RESULTS: The use of SFRT increased from 49.2% to 58.9% postintervention (P < .001). Rates from 2007 to 2011 were 51%, 51%, 48%, 49%, and 48%, respectively, whereas the postintervention rates from 2013 to 2016 were 60%, 62%, 59%, and 56%, respectively. Postintervention, half of the centers prescribed SFRT in a relatively narrow range (55%-58%). However, across all centers, there was still a broad range, with the lowest and highest users at 35% and 81%, respectively, although the lowest-using center still showed a significant increase (26% to 35%; P < .001). CONCLUSIONS: Our audit and education-based intervention resulted in a lasting and meaningful 10% change in practice. Our provincial rate is similar to that of a previously recommended benchmark rate of 60%, but we continue to see significant variation by center, suggesting further room for improvement in provincial standardization. With emerging evidence in support of ablative radiation therapy for select populations of patients with bone metastases, future benchmark rates of SFRT should be readdressed. However, our data suggest that programmatic comparison and dissemination of SFRT prescribing practices can achieve a population-based SFRT utilization rate near 60%.
PURPOSE: There is ample evidence that single-fraction radiation therapy (SFRT) is as efficacious as more costly and morbid multifraction regimens. We previously demonstrated that an audit-based intervention increased the use of SFRT in all regional cancer centers the following year. However, other investigators have demonstrated that interventions were only associated with a transient 1-year change in prescribing practices. We sought to determine whether our intervention resulted in a more lasting impact. METHODS AND MATERIALS: In 2012, we performed an audit of the prescribing practices of individual physicians, which was then presented to leaders and oncologists as an intervention to increase SFRT. We compared the use of SFRT between 2007 to 2011 (preintervention) and 2013 to 2016 (postintervention) in all 31,192 patients treated in our provincial program. RESULTS: The use of SFRT increased from 49.2% to 58.9% postintervention (P < .001). Rates from 2007 to 2011 were 51%, 51%, 48%, 49%, and 48%, respectively, whereas the postintervention rates from 2013 to 2016 were 60%, 62%, 59%, and 56%, respectively. Postintervention, half of the centers prescribed SFRT in a relatively narrow range (55%-58%). However, across all centers, there was still a broad range, with the lowest and highest users at 35% and 81%, respectively, although the lowest-using center still showed a significant increase (26% to 35%; P < .001). CONCLUSIONS: Our audit and education-based intervention resulted in a lasting and meaningful 10% change in practice. Our provincial rate is similar to that of a previously recommended benchmark rate of 60%, but we continue to see significant variation by center, suggesting further room for improvement in provincial standardization. With emerging evidence in support of ablative radiation therapy for select populations of patients with bone metastases, future benchmark rates of SFRT should be readdressed. However, our data suggest that programmatic comparison and dissemination of SFRT prescribing practices can achieve a population-based SFRT utilization rate near 60%.
Authors: Costanza M Donati; Elena Nardi; Erika Galietta; Maria L Alfieri; Giambattista Siepe; Alice Zamagni; Milly Buwenge; Gabriella Macchia; Francesco Deodato; Savino Cilla; Lidia Strigari; Silvia Cammelli; Francesco Cellini; Alessio G Morganti Journal: Clin Med Insights Oncol Date: 2021-07-22