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Patterns of care study of radiation therapy for esophageal cancer in Japan: influence of the stratification of institution on the process. 1998

T Teshima, and M Abe, and H Ikeda, and G E Hanks, and J B Owen, and M Hiraoka, and Y Hirokawa, and M Oguchi, and M Nishio, and T Yamashita, and H Niibe, and K Masuda, and S Watanabe, and T Inoue
Department of Radiation Oncology, Osaka University Medical School, Suita, Japan. teshima@sahs.med.osaka-u.ac.jp

BACKGROUND To improve the quality of radiation therapy in Japan, Patterns of Care Study (PCS), a widely known QA program in the USA, was introduced in Japan. The feasibility was tested by collecting nationwide data by extramural audit for esophageal cancer. METHODS From July 1996 through February 1997, PCS audits were performed for 29 institutions. Based on the facility survey by Tsunemoto, 13 institutes were classified as A1 (university hospital/cancer center treating > 300 patients/year), 10 as B1 (other institutes > 120 patients/year) and six as B2 (other institutes < 120 patients/year). Medical charts for 455 patients with thoracic esophageal cancer between 1992 and 1994 were reviewed based on the data format of PCS in the USA. RESULTS Concerning external beam equipment, linear accelerators of > or = 10 MV were used for 73% of patients in A1, whereas in B1-2, 60Co machines were still used for 13% of patients (P < 0.0001). The median number of full-time equivalent (FTE) radiation oncologists was 2.7 in A1, 0.65 in B1 and 0.2 in B2. Forty-five percent of patients had received surgery in A1 and 34% in B1-2 (P = 0.0068). In the non-surgery group, a higher radiation dose of > 60 Gy was delivered in A1 than in B1-2 (P = 0.0008). Chemotherapy was administered to 51% of the patients in A1 and to 30% in B1-2 (P < 0.0001). Brachytherapy was utilized for 17% in A1 and only for 5% in B1-2 (P = 0.0001). CONCLUSIONS Institutional stratification, including equipment and personnel, significantly affected the patterns of care for esophageal cancer. Therefore, to improve the quality of radiation therapy nationwide, improvement of equipment and supply of FTE personnel is extremely important. PCS was found to have great potential for the practical evaluation of how much will be required in Japan.

UI MeSH Term Description Entries
D007564 Japan A country in eastern Asia, island chain between the North Pacific Ocean and the Sea of Japan, east of the Korean Peninsula. The capital is Tokyo. Bonin Islands
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010818 Practice Patterns, Physicians' Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided. Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D011785 Quality Assurance, Health Care Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Assessment, Health Care,Health Care Quality Assessment,Health Care Quality Assurance,Healthcare Quality Assessment,Healthcare Quality Assurance,Quality Assessment, Healthcare,Quality Assurance, Healthcare,Assessment, Healthcare Quality,Assessments, Healthcare Quality,Assurance, Healthcare Quality,Assurances, Healthcare Quality,Healthcare Quality Assessments,Healthcare Quality Assurances,Quality Assessments, Healthcare,Quality Assurances, Healthcare
D011879 Radiotherapy Dosage The total amount of radiation absorbed by tissues as a result of radiotherapy. Dosage, Radiotherapy,Dosages, Radiotherapy,Radiotherapy Dosages
D001918 Brachytherapy A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. Curietherapy,Implant Radiotherapy,Plaque Therapy, Radioisotope,Radioisotope Brachytherapy,Radiotherapy, Interstitial,Radiotherapy, Intracavity,Radiotherapy, Surface,Brachytherapy, Radioisotope,Interstitial Radiotherapy,Intracavity Radiotherapy,Radioisotope Plaque Therapy,Radiotherapy, Implant,Surface Radiotherapy,Therapy, Radioisotope Plaque
D002294 Carcinoma, Squamous Cell A carcinoma derived from stratified SQUAMOUS EPITHELIAL CELLS. It may also occur in sites where glandular or columnar epithelium is normally present. (From Stedman, 25th ed) Carcinoma, Epidermoid,Carcinoma, Planocellular,Carcinoma, Squamous,Squamous Cell Carcinoma,Carcinomas, Epidermoid,Carcinomas, Planocellular,Carcinomas, Squamous,Carcinomas, Squamous Cell,Epidermoid Carcinoma,Epidermoid Carcinomas,Planocellular Carcinoma,Planocellular Carcinomas,Squamous Carcinoma,Squamous Carcinomas,Squamous Cell Carcinomas
D003037 Cobalt Radioisotopes Unstable isotopes of cobalt that decay or disintegrate emitting radiation. Co atoms with atomic weights of 54-64, except 59, are radioactive cobalt isotopes. Radioisotopes, Cobalt
D004938 Esophageal Neoplasms Tumors or cancer of the ESOPHAGUS. Cancer of Esophagus,Esophageal Cancer,Cancer of the Esophagus,Esophagus Cancer,Esophagus Neoplasm,Neoplasms, Esophageal,Cancer, Esophageal,Cancer, Esophagus,Cancers, Esophageal,Cancers, Esophagus,Esophageal Cancers,Esophageal Neoplasm,Esophagus Cancers,Esophagus Neoplasms,Neoplasm, Esophageal,Neoplasm, Esophagus,Neoplasms, Esophagus

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