ANNUAL REPORT OF ONCOLOGY

Annual Report of Oncology

Annual Report of Oncology Care program Course Project

Introduction

In 1999, the Sunshine Hospital (ESMO) created a Palliative Care Working Group to improve the delivery of supportive and palliative care (S + PC) by oncologists, oncology departments and cancer centers. They have addressed this task through initiatives in policy, education, research and incentives.

Overview of the oncology program standards

As an incentive program for oncology departments and centers, Sunshine Hospital developed a program of Designated Centers (DCs) for programs meeting predetermined targets of service development and delivery of a high level of S + PC. Since 2004, 75 centers have applied for designation and 48 have been accredited including 34 comprehensive cancer centers (CCCs) in general hospitals and seven freestanding CCCs. Perceived benefits accrued from the accreditation included the following: improved status and role identification of the center, positive impact on daily work, positive impact on business activity and positive impact on funding for projects (Badinter, 2001).

Overview of pertinent accreditation and governmental requirements

The accreditation of DCs has been a central to the Sunshine Hospital initiative to improve the palliative care provided by oncologists and oncology centers. It is likely that many other oncology departments and cancer centers already meet the criteria and Sunshine Hospital strongly encourages them to apply for accreditation.

Overview of CTR responsibilities

Over the past 30 years, there have been major developments in the standards of practice in palliative and supportive care for patients with advanced cancer. Importantly, it is now widely acknowledged that a palliative and supportive care approach to care should utilized whenever needs are identified, irrespective of the stage of the disease, and not only at the end of life. By implication, many patients receiving active disease-modifying treatment will need palliative and supportive care as part of a comprehensive care plan. For patients with advanced and refractory cancer, when the risks outweigh the benefits of anticancer treatments, palliative care becomes the most important paradigm of good cancer care.

Discussion and Analysis

This report described our initial experience with a QA program in a multi-institutional prospective study. Our program is very simple and inexpensive. Ishikura et al. investigated the quality of RT in a Japanese clinical trial and found that 60% of patients received less satisfactory RT in 2001. They extended their research to 2005 and demonstrated that protocol violation decreased dramatically to less than 5%. The early RTOG study also showed that the frequency of major and minor deviation was as high as between 60 and 70%. They reported that the appropriateness rate rose over time, because the participating radiation oncologists became familiar with the protocol. The Trans-Tasman Radiation Oncology Group (TROG) also demonstrated an improvement in QA over time.

Our observation that 92% of patients received RT per protocol specification was very promising for the initial QA experience. In addition to the decrease of protocol violation over time, Halperin et al. reported that institutional experiences affected the incidence of major deviations. RTOG also found that the QA performance was significantly better at principal centers ...