Improving compliance with curative radiotherapy for cervical cancer in a high-volume centre in India: a bundled...

Timely completion of curative chemoradiotherapy within 56 days is a key determinant of oncological outcomes in cervical cancer; however, achieving this target remains challenging in high-volume public-sector settings in low- and middle-income countries (LMICs). At a tertiary public-sector cancer centre in South India, routine clinical observations identified poor compliance with recommended radiotherapy timelines, with delays and treatment defaults occurring at multiple points along the care pathway. In response, a quality improvement project was undertaken to improve treatment timeliness and completion.A retrospective baseline audit confirmed substantial delays and high default rates among patients receiving curative-intent external beam radiotherapy, followed by intracavitary brachytherapy. Root cause analysis identified system-, staff- and patient-related factors contributing to poor compliance. Based on these findings, a bundled workflow intervention (AID-CARE) was developed, incorporating early brachytherapy assessment, planned interdigitation, accelerated schedules for delayed cases, structured patient counselling, staff education and prospective patient tracking. The intervention was implemented using sequential Plan-Do-Study-Act cycles, followed by a prospective re-audit and sustainment phase. The primary outcomes were compliance with an overall treatment time of ≤56 days and treatment default rates assessed over time using run charts.At baseline, only 18.6% of patients completed treatment within 56 days, whereas 46.2% defaulted and 35.2% experienced prolonged treatment duration. Following implementation, compliance with the recommended treatment timeline improved to 70.1%, with a marked reduction in treatment defaults to 6.2%. These improvements were maintained during the sustainment phase. No increase in acute treatment-related toxicity was noted.This quality improvement initiative demonstrates that a structured, workflow-driven and resource-conscious approach can substantially and sustainably improve compliance with recommended radiotherapy timelines for cervical cancer in high-volume public-sector settings, with potential applicability to similar centres in LMICs.