title: Directly Improving the Quality of Radiation Treatment Through Peer Review: A Cross-sectional Analysis of Cancer Centers Across a Provincial Cancer Program.
abstract: To describe the outcomes of peer review across all 14 cancer centers in Ontario.
  
  
  
  We identified all peer-reviewed, curative treatment plans delivered in Ontario within a 3-month study period from 2013 to 2014 using a provincial cancer treatment database and collected additional data on the peer-review outcomes.
  
  
  
  Considerable variation was found in the proportion of peer-reviewed plans across the centers (average 70.2%, range 40.8%-99.2%). During the study period, 5561 curative plans underwent peer review. Of those, 184 plans (3.3%) had changes recommended. Of the 184 plans, the changes were major (defined as requiring repeat planning or having a major effect on planning or clinical outcomes, or both) in 40.2% and minor in 47.8%. For the remaining 12.0%, data were missing. The proportions of recommended changes varied among disease sites (0.0%-7.0%). The disease sites with the most recommended changes to treatment plans after peer review and with the greatest potential for benefit were the esophagus (7.0%), uterus (6.7%), upper limb (6.3%), cervix and lower limb (both 6.0%), head and neck and bilateral lung (both 5.9%), right supraclavicular lymph nodes (5.7%), rectum (5.3%), and spine (5.0%). Although the heart is an organ at risk in left-sided breast treatment plans, the proportions of recommended changes did not significantly differ between the left breast treatment plans (3.0%, 95% confidence interval 2.0%-4.5%) and right breast treatment plans (2.4%, 95% confidence interval 1.5%-3.8%). The recommended changes were more frequently made when peer review occurred before radiation therapy (3.8%) than during treatment (1.4%-2.8%; P=.0048). The proportion of plans with recommended changes was not significantly associated with patient volume (P=.23), peer-review performance (P=.36), or center academic status (P=.75).
  
  
  
  Peer review of treatment plans directly affects the quality of care by identifying important clinical and planning changes. Provincial strategies are underway to optimize its conduct in radiation oncology.
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Rouette
authors.affiliation: Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Donnell
authors.affiliation: Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Reddeman
authors.affiliation: Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hart
authors.affiliation: Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Foxcroft
authors.affiliation: Canadian Partnership Against Cancer, Toronto, Ontario, Canada.
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.affiliation: Radiation Treatment Program, Cancer Care Ontario, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
authors.affiliation: Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada. Electronic address: michael.brundage@krcc.on.ca.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brundage
mesh_terms: D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D061847:Hospitals, High-Volume / Q000592:standards / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D009864:Ontario; D058958:Organs at Risk; D010380:Peer Review / Q000592:standards*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D018787:Radiation Oncology / Q000592:standards / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000592:standards; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome