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Evaluation of Quality Indicators for Radiation Therapy of Cervical Cancer: Experience From a Tertiary Cancer Center
Shweta Baral1, Sudhir Raj Silwal1, Nancy Bhattarai1
1Bhaktapur Cancer Hospital, Kathmandu, Nepal.
Purpose:
Cervical cancer is the second commonest cancer among women in Nepal. The objective of the study was to evaluate the quality indicators (QIs) in radiotherapy management of cervical carcinoma and establishment of organizational priorities feasible in our setting.
Methods:
The retrospective study included 83 patients with locally advanced cervical carcinoma who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected based on convenience sampling. All 19 QIs in cervical cancer management according to The European Society of Gynecological Oncology (ESGO)/European Society for Radiotherapy and Oncology (ESTRO) were chosen for assessment. These QIs were calculated for all patients and compared with the ESGO/ESTRO standard target. Frequencies and percentages were calculated. Binomial 95% of the rates for QI adherence was also calculated for each QI.
Results:
Of the 19 QIs, very high adherence rates were observed in QIs associated with brachytherapy like Treatment with brachytherapy boost (97.59%), Imaging for Image guided Adaptive Brachytherapy (100%), and Brachytherapy after the patient has received a total EBRT dose ≥36 Gy (100%). Compliance was good for patients receiving primary chemo-radiotherapy (86.74%) and center treating adequate cases (100%). Very low adherence rates were observed for pretreatment work-up (0%), use of intensity modulated radiotherapy (2.4%), on-board image guided radiotherapy (0%), clinical trial participation (0%), and follow-up program and sexual rehabilitation (0%). Multidisciplinary team meeting discussion of cases (48.19%), use of interstitial brachytherapy when required (12.34%), and EBRT dose of 45 Gy/25 fractions (27.71%) also had a low adherence rate.
Conclusion:
The study highlighted rates of compliance to cervical radiotherapy QIs in our hospital. Low adherence to various QIs was identified. On the basis of these findings, mitigating strategies could be planned at our center.
