title: Variation in adherence to external beam radiotherapy quality measures among elderly men with localized prostate cancer.
abstract: OBJECTIVE
  To characterize the variation in adherence to quality measures of external beam radiotherapy (EBRT) for localized prostate cancer and its relation to patient and provider characteristics in a population-based, representative sample of U.S. men.
  
  
  METHODS
  We evaluated EBRT quality measures proposed by a RAND expert panel of physicians among men aged >or=65 years diagnosed between 2000 and 2002 with localized prostate cancer and treated with primary EBRT using data from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare program. We assessed the adherence to five EBRT quality measures that were amenable to analysis using SEER-Medicare data: (1) use of conformal RT planning; (2) use of high-energy (>10-MV) photons; (3) use of custom immobilization; (4) completion of two follow-up visits with a radiation oncologist in the year after therapy; and (5) radiation oncologist board certification.
  
  
  RESULTS
  Of the 11,674 patients, 85% had received conformal RT planning, 75% had received high-energy photons, and 97% had received custom immobilization. One-third of patients had completed two follow-up visits with a radiation oncologist, although 91% had at least one visit with a urologist or radiation oncologist. Most patients (85%) had been treated by a board-certified radiation oncologist.
  
  
  CONCLUSIONS
  The overall high adherence to EBRT quality measures masked substantial variation in geography, socioeconomic status in the area of residence, and teaching affiliation of the RT facility. Future research should examine the reasons for the variations in these measures and whether the variation is associated with important clinical outcomes.
authors: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. bekelmaj@mskcc.org
authors: Justin E
authors: JE
authors: Bekelman
authors: Michael J
authors: MJ
authors: Zelefsky
authors: Thomas L
authors: TL
authors: Jang
authors: Ethan M
authors: EM
authors: Basch
authors: Deborah
authors: D
authors: Schrag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019983:Guideline Adherence / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D017785:Photons / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal / Q000592:standards*; D011882:Radiotherapy, High-Energy / Q000592:standards*; D018426:SEER Program / Q000592:standards; D012959:Socioeconomic Factors; D014481:United States
references: J Clin Epidemiol. 2000 Dec;53(12):1258-67
references: 11146273
references: J Natl Cancer Inst. 2001 Apr 4;93(7):500
references: 11287443
references: N Engl J Med. 2001 Sep 6;345(10):725-30
references: 11547741
references: Int J Qual Health Care. 2001 Dec;13(6):475-80
references: 11769750
references: J Natl Cancer Inst. 2002 Jun 5;94(11):835-44
references: 12048271
references: Med Care. 2002 Aug;40(8 Suppl):IV-82-95
references: 12187173
references: Cancer. 2003 Mar 15;97(6):1428-35
references: 12627506
references: J Clin Oncol. 2003 May 15;21(10):1928-36
references: 12743145
references: Med Care. 2003 Sep;41(9):1003-5
references: 12972839
references: Int J Radiat Oncol Biol Phys. 2004 Jul 15;59(4):1053-61
references: 15234039
references: J Clin Oncol. 2004 Aug 1;22(15):2985-91
references: 15284249
references: Med Care. 1993 Aug;31(8):732-48
references: 8336512
references: Am J Epidemiol. 1998 Sep 1;148(5):475-86
references: 9737560
references: Ethn Dis. 1999 Winter;9(1):111-25
references: 10355480
references: J Urol. 2004 Nov;172(5 Pt 2):S13-6; discussion S17
references: 15535436
references: Ethn Dis. 2005 Spring;15(2 Suppl 2):S31-3
references: 15822835
references: J Urol. 2005 Aug;174(2):425-31
references: 16006858
references: Cancer. 2005 Sep 1;104(5):985-92
references: 16047332
references: Strahlenther Onkol. 2005 Sep;181(9):557-66
references: 16170482
references: J Clin Oncol. 2005 Nov 1;23(31):7881-8
references: 16204005
references: J Natl Cancer Inst. 2006 Jan 4;98(1):26-38
references: 16391369
references: J Clin Oncol. 2006 Feb 1;24(4):626-34
references: 16401682
references: Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):322-3
references: 16690426
references: J Clin Oncol. 2007 Jan 20;25(3):277-84
references: 17159190
references: Med Care. 2007 May;45(5):401-9
references: 17446826
references: Ann Intern Med. 2000 May 2;132(9):705-10
references: 10787363
references: Am J Med. 2000 Jun 1;108(8):642-9
references: 10856412
references: Med Care. 2003 Sep;41(9):1006-12
references: 12972840
references: N Engl J Med. 2003 Oct 2;349(14):1350-9
references: 14523144
references: J Gen Intern Med. 2004 Feb;19(2):146-55
references: 15009794