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

M G Torras; E Canals; D Jurado-Bruggeman; S Marín-Borras; M Macià; J Jové; A M Boladeras; C Muñoz-Montplet; J Molero; C Picón; M Puigdemont; L Aliste; A Torrents; F Guedea; J M Borras

doi:10.1016/j.tranon.2018.03.015

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

Transl Oncol. 2018 Jun;11(3):794-799. doi: 10.1016/j.tranon.2018.03.015. Epub 2018 Apr 26.

Authors

M G Torras¹, E Canals², D Jurado-Bruggeman³, S Marín-Borras⁴, M Macià⁴, J Jové⁵, A M Boladeras⁴, C Muñoz-Montplet⁶, J Molero⁷, C Picón⁸, M Puigdemont⁹, L Aliste¹⁰, A Torrents¹⁰, F Guedea¹¹, J M Borras¹²

Affiliations

¹ Clinical Management Department, Institut Català d'Oncologia, Spain. Electronic address: gtorras@iconcologia.net.
² Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain.
³ Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Girona, Spain.
⁴ Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain.
⁵ Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain.
⁶ Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Spain.
⁷ Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Badalona, Spain.
⁸ Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain.
⁹ Hospital Tumor Registry, Institut Català d'Oncologia, Girona, Spain.
¹⁰ Catalonian Cancer Strategy, Department of Health, Barcelona.
¹¹ Radiation Oncology Department, Institut Català d'Oncologia, Spain.
¹² Catalonian Cancer Strategy, Department of Health, Barcelona; Radiation Oncology Department, Institut Català d'Oncologia, Spain; Clinical Sciences Department, IDIBELL, University of Barcelona.

Abstract

Background: The therapeutic approach to cancer is complex and multidisciplinary. Radiotherapy is among the essential treatments, whether used alone or in conjunction with other therapies. This study reports a clinical audit of the radiotherapy process to assess the process of care, evaluate adherence to agreed protocols and measure the variability to improve therapeutic quality for rectal cancer.

Methods: Multicentre retrospective cohort study in a representative sample of patients diagnosed with rectal cancer in the Institut Català d'Oncologia, a comprehensive cancer centre with three different settings. We developed a set of indicators to assess the key areas of the radiotherapy process. The clinical audit consisted of a review of a random sample of 40 clinical histories for each centre.

Results: The demographic profile, histology and staging of patients were similar between centres. The MRI reports did not include the distance from tumour to mesorectal fascia (rCRM) in 38.3% of the cases. 96.7% of patients received the planned dose, and 57.4% received it at the planned time. Surgery followed neoadjuvant treatment in 96.7% of the patients. Among this group, postoperative CRM was recorded in 65.5% of the cases and was negative in 93.4% of these. With regard to the 34.5% (n = 40) of cases where no CRM value was stated, there were differences between the centres. Mean follow-up was 3.4 (SD 0.6) years, and overall survival at four years was 81.7%.

Conclusions: The audit revealed a suboptimal degree of adherence to clinical practice guidelines. Significant variability between centres exists from a clinical perspective but especially with regard to organization and process.