Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project

Abstract

Purpose: To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. Materials and methods: Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. Results: The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0-100%) or multidisciplinary tumour board (50-95%); 2) pretreatment MRI (61.5-100%) and thoracoabdominal CT (15.0-100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6-58.6 days) and between the first visit and start of treatment (15.1-38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5-90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. Conclusions: This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.

IROCA-TES: Improving Quality in Radiation Oncology through Clinical Audits — Training and Education for Standardization

“…Given the proven benefits of external audits, together with the need to harmonise clinical practice in Europe, our group previously carried out a multicentre clinical audit in four different European countries (Spain, Poland, Portugal, and Italy). The results of that study, known as IROCA ( Improving Quality in Radiation Oncology through Clinical Audits ) [ 15 , 16 ], revealed important differences in clinical practice in radiotherapy planning and delivery for rectal and prostate cancer.…”

The impact of oncological package implementation on the treatment of rectal cancer in years 2013–2019 in Poland – multicenter study

“…Our research indicated that coordinated standards of care have had a positive impact on rectal cancer treatment. Several studies evaluating the standards of rectal cancer care were performed in other countries [5,[13][14][15][16][17][18][19][20][21][22][23][24]. Many of which have underlined the diversity of the national and international outcomes [4,5,11,21,25] and the crucial role of high-quality auditing [20,22].…”

Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres

“…Although we have sought to put the findings of the present audit in the context of other studies, it is difficult to compare results due to methodological differences, particularly due heterogeneity in the parameters evaluated. Comparison is further hindered by the scant data available and because the parameters must, of necessity, vary according to tumour type, as evidenced in the previous IROCA studies for prostate and rectal cancer 9 , 44 . In this regard, we still lack a set of internationally recognized, standardized indicators to permit international comparisons among radiotherapy centres 3 , despite efforts made by several different groups 3 – 5 , 11 , 45 .…”