title: A criterion-based audit of the technical quality of external beam radiotherapy for prostate cancer.
abstract: OBJECTIVE
  To evaluate the technical quality of external beam radiotherapy for prostate cancer in Canada.
  
  
  METHODS
  This was a multi-institution, retrospective study of a random sample of patients undergoing radiotherapy (RT) for prostate cancer in Canada. Patterns of care were determined by abstracting details of the patients' management from original records. The quality of patient's technical care was measured against a previously published, comprehensive suite of quality indicators.
  
  
  RESULTS
  32 of the 37 RT centres participated. The total study population of 810 patients included 25% low-risk, 44% intermediate-risk, and 28% high-risk cases. 649 received external beam RT (EBRT) only, for whom compliance with 12 indicators of the quality of pre-treatment assessment ranged from 56% (sexual function documented) to 96% (staging bone scan obtained in high-risk patients). Compliance with treatment-related indicators ranged from 78% (dose to prostate ≥74 Gy in intermediate risk patients not receiving hormone therapy) to 100% (3DCRT or IMRT plan). Compliance varied among centres; no centre demonstrated 100% compliance on all indicators and every centre was 100% compliant on at least some indicators. The number of assessment-related indicators (n=13) with which a given centre was 100% compliant ranged from 4 to 11 (median 7) and the number of the treatment-specific indicators (n=8) with which a given centre was 100% compliant ranged from 6 to 8 (median 8). ADT therapy was utilised in most high-risk cases (191, 92.3%).
  
  
  CONCLUSIONS
  While patterns of prostate cancer care in Canada vary somewhat, compliance on the majority of quality indicators is very high. However, all centres showed room for improvement on several indicators and few individual patients received care that met target benchmarks on all quality measures. This variation is particularly important for indicators such as delivered dose where impact on disease outcome is known to exist, and suggests that quality improvement programmes have the potential to further improve quality of care.
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada. michael.brundage@krcc.on.ca
authors.forename: Michael
authors.initials: M
authors.lastname: Brundage
authors.forename: Brita
authors.initials: B
authors.lastname: Danielson
authors.forename: Robert
authors.initials: R
authors.lastname: Pearcey
authors.forename: Brenda
authors.initials: B
authors.lastname: Bass
authors.forename: Tom
authors.initials: T
authors.lastname: Pickles
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bahary
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Peng
authors.forename: David
authors.initials: D
authors.lastname: Wallace
authors.forename: William
authors.initials: W
authors.lastname: Mackillop
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies
keywords: Prostate cancer; Quality indicators; Quality of care; Radiotherapy