Diffusion of Community-based Radiation Oncology

In 2010, 1.5 million people are expected to be diagnosed with cancer. Two-thirds of these individuals will receive radiation as part of their cancer treatment, either curative or palliative in intent. Given this, ensuring each cancer patient receives high quality radiation oncology care is critically important to improve cancer outcomes, reduce morbidity, and optimize the survivorship period. Despite radiation oncology’s importance, to date, the majority of information on the quality of radiation oncology care in America comes from two sources: clinical trials in radiation oncology care and the Quality Research in Radiation Oncology (QRRO) study.

The latter is an annual, voluntary, non-audited study of the quality and practice patterns of a national, randomized sample of radiation oncologists from all practice settings. The study began in the 1970s as a Patterns of Care Study conducted by the American College of Radiology. While ahead of its time in terms of quality measurement and oncology professional participation, the bulk of the current quality measures address conventional external beam radiation, with little attention placed on newer, high-cost, high-technology radiation methodologies, such as image-guided radiation therapy, or I.G.R.T., and intensity-modulated radiation therapy, or I.M.R.T, stereotactic radiosurgery (SRS), gamma or cyber knife and partial breast irradiation. This limitation is important due to growing concerns regarding the use of these new technologies without proper comparative data regarding outcomes, morbidity and cost-effectiveness and a lack of adoption of proven standard therapies. These concerns have been heightened by recent reports in the New York Times suggesting a lack of regulatory oversight or proper training, leading to numerous errors resulting in disfiguring injuries and death. In response, regulators, radiation oncologists, advocates, patients and families have called for greater oversight.

Given the critical importance of radiation oncology, its growing complexity and the increasing need to assure high quality care for cancer patients, the Specific Aims of this pilot study are to:

1. Investigate capture and quality of radiation oncology data at three Cancer Research Network (CRN) sites (Group Health, Kaiser Colorado, Kaiser Northwest) between 2000-2008.

2. Study the diffusion of radiation oncology facilities, equipment and services from 2000 to 2010.

3. Build elements of radiation oncology data into the CRN Virtual Data Warehouse (VDW) for the three study sites, with methods and documentation for possible inclusion of radiation oncology data from all other CRN sites.

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