title: Patterns of radiation therapy practice for patients treated for intact cervical cancer in 2005 to 2007: a quality research in radiation oncology study.
abstract: OBJECTIVE
  To assess practice patterns and compliance with clinical performance measures for radiation therapy (RT) for patients with intact carcinoma of the cervix.
  
  
  METHODS
  Trained research associates reviewed the records of 261 randomly selected patients who received RT for cervix carcinoma between 2005 and 2007 from 45 facilities randomly selected after stratification by practice type. National estimates of patient and treatment characteristics were calculated from survey data using SUDAAN statistical software.
  
  
  RESULTS
  From the survey data, we estimated that only 8% of US facilities treated on average more than 3 eligible patients per year. No small or medium nonacademic facilities in the survey treated more than 3 eligible patients per year. Approximately 65.5% of patients began treatment in a facility that treated 3 or fewer eligible patients per year. Although 87.5% of patients had brachytherapy as part of their treatment, the proportion treated with external beam RT only was about double that estimated from the 1996 to 1999 survey. The use of high-dose-rate brachytherapy sharply increased, particularly in small nonacademic facilities. Overall, patients treated in nonacademic facilities were more likely to have incomplete or protracted treatment; 43% of patients treated in small nonacademic facilities did not have treatment completed within 10 weeks. Also, patients treated in facilities that treated 3 or fewer eligible patients per year were significantly less likely to receive concurrent chemotherapy than were patients treated in other facilities.
  
  
  CONCLUSIONS
  Survey results indicate a disturbingly high rate of noncompliance with established criteria for high-quality care of patients with cervical cancer. Noncompliance rates are particularly high in nonacademic facilities, especially those that treat relatively few patients with intact cervical cancer.
authors.affiliation: Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: peifel@mdanderson.org.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, Pennsylvania.
authors.forename: Alex
authors.initials: A
authors.lastname: Ho
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, Pennsylvania.
authors.forename: Najma
authors.initials: N
authors.lastname: Khalid
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
authors.affiliation: American College of Radiology Clinical Research Center, Philadelphia, Pennsylvania.
authors.forename: Jean
authors.initials: J
authors.lastname: Owen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000706:statistics & numerical data*; D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006276:Health Facility Size / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D018787:Radiation Oncology / Q000592:standards* / Q000706:statistics & numerical data; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents