Background and Context: Radiotherapy plays an important curative role in patients with locally advanced cervical cancer (LACC). Optimal treatment depends on strong, multidisciplinary support and availability of specialized skills. There are currently no standards to define best practice and the treatment landscape is rapidly changing with increasing emphasis on new imaging modalities, brachytherapy approaches and the concept of personalized medicine.
Aim: The purpose of this study was to develop a suite of radiotherapy quality of care indicators (QIs) for the curative management of LACC to guide assessment of programmatic performance and motivate practice harmonization.
Strategy/Tactics: A comprehensive literature search was conducted to identify candidate QIs. A modified Delphi method was used. Phase 1 involved surveying all Canadian GYN radiation oncologists to rate the importance of each QI from 0-9 (9, essential) on a Likert scale and achievability at their centre on a binary scale (yes/no). The ability to meet previously validated, pre-specified criteria was evaluated. Phase 2 consisted of a face-to-face meeting with a smaller expert panel facilitated by an outside moderator to discuss, vote and compile a suite of QIs yielding a consensus guideline.
Outcomes/What was learned:
The literature review identified 83 candidate QIs. Survey response rate was 71%. Forty-four QIs met criteria for endorsement after Phase 1. Phase 2 yielded a final list of 40 QIs that were sub-categorized to encompass all aspects of patient management: Pre-treatment assessment, External beam radiotherapy, Brachytherapy, Follow-up and Expertise/Workload. The most prominent theme from the GYN radiation oncology community was the importance of having QIs to measure the current state, evolution and future uptake of MR-guided brachytherapy.
This is the first prospective study establishing radiotherapy quality of care indicators in LACC based on expert consensus. These QIs should be used to guide programmatic direction and resource allocation to assure consistent treatment and optimal patient care.