- Email: [email protected]
Development of the Veteran Health Administration – Radiation Oncology Quality and Safety Initiative (VHA-ROQSI)
S492
International Journal of Radiation Oncology Biology Physics
effects, and to implement preventive measures and adaptive health education. Author Disclosure: T.Y. Eng: None. A. Patel: None. V. Clyburn: None.
objectives can serve as a model for the radiation oncology community at large. Materials/Methods: The VHA-ROQSI is a new initiative by the VHA’s National Radiation Oncology Program office with a goal of electronically collecting and aggregating data to assess quality and safety of radiation treatment delivery and determine disease site-specific outcomes. This would be accomplished by; (1) Gathering and maintaining ROS profile data: The data include information on radiation therapy planning, delivery equipment, services provided, patient volume, and quality assurance activities. The data elements are captured are harmonized with similar efforts from RPC and ACR for credentialing and accreditation respectively. (2) Gathering data on accreditation and credentialing status of each ROS: These data elements are collected and updated periodically via web based forms. (3) Creating a system-wide log of periodic remote monitoring of output calibration data and provide each ROS a feedback on a continuing basis. (4) Implementing a remote peer review system: A Web-based peer review system will enable proactive and rapid peer review of all complex clinical cases. (5) Implementing a radiation oncology incident reporting system (ROIR): Each ROSs will be able to report adverse events and near miss information on patients for review by radiation oncology domain experts. (6) Collecting disease site-specific outcome data: De-identified outcome data on patient treated at each ROS will be collected in a central registry. The data will also include DICOM-RT based dosimetry parameters. Results: We have designed an electronic infrastructure that minimizes key strokes and multiple entries of redundant data by end users to accomplish each one of the aforementioned objectives. The prototypes of various modules for electronic data collection have been developed and are in beta testing. Once completed, the integrated system will facilitate peer review of complex treatment plans, collection of data elements for treatment quality and outcome assessment, and tracking of adverse events and near misses on patient treatments. Conclusions: The VHA-ROQSI overcomes the challenge faced by radiation oncology services providers of submitting redundant data to disparate sources to fulfill the practice requirements. The electronic infrastructure designed to satisfy the requirements of VHA-ROQSI will circumvent the need for separate registries for outcome, quality, and safety tracking under development by various stakeholders at the present time Author Disclosure: R. Kapoor: K. Stock; TSG Innovations Inc. J. Palta: None. M.P. Hagan: None.
2757 Improving Quality of Life and Increasing Cost Effectiveness for Cervical Cancer Patients C.M. Fisher, P.E. DeWitt, T.E. Schefter, and J.A. Carlson; University of Colorado Denver, Denver, CO Purpose/Objective(s): The objective of this study is to perform a patterns of care analysis for the treatment of FIGO Stage I-II cervical cancer over a 26 year time period. We anticipate seeing decreased use of surgery in patients with larger tumor size, higher stage, and positive nodes, thus decreasing serious side effects and lowering the cost of care in these patients who will require radiation therapy regardless of surgical intervention. Materials/Methods: A total of 20,290 women with clinical stage IA through IIB cervical cancer with known tumor characteristics were identified in the Surveillance, Epidemiology and End Results (SEER) program from 1983 to 2009. Of these, 12,993 women had known treatment status (radiation alone, surgery alone, or surgery plus radiation) and were included in the final analysis. Results: Of the 12,993 women identified, 30% received both surgery plus radiation, 46% received surgery alone, and 24% received radiation alone. Over the time period evaluated, a decline in percentage of patients receiving surgery alone was noted, with an accompanying increase in percentage of patients receiving radiation alone, and a moderate decline in percentage of patients receiving surgery plus radiation. No change was seen in the odds ratio of a node positive patient or of a patient with parametrial involvement receiving surgery plus radiation over the time period; however, a significant decrease in the odds ratio of a patient with tumor size >4 cm receiving surgery plus radiation therapy was seen (OR 0.96; 95% CI, 0.95, 0.97; p < 0.0001). On multivariate analysis, factors significantly associated with choice of therapy included year of diagnosis, age, race, SCC histology, and tumor size. Smaller tumor size (1-4 cm) was associated with decreased odds ratio of radiation alone versus surgery plus radiation, while tumors measuring 5+ cm had an increased odds ratio of radiation alone. Node positivity was associated with decreased odds ratio of receiving radiation alone (0.33, p < .0001). Conclusions: Equivalent survival results with surgery versus radiation have been demonstrated for early stage cervical cancer, with associated increased toxicity when both therapies are used for tumors with high risk features. In this large review, a decline in surgery alone was seen with a moderate decline in surgery plus radiation therapy, and an increase in radiation alone. Based on published data, this should decrease the risk of serious side effects associated with surgery plus radiation, and also decrease costs via de-escalating treatment and causing fewer serious side effects to manage. Patients with tumor >5 cm are more likely to appropriately receive definitive radiation. Further improvement in patient quality of life and cost effectiveness can be realized by consistent use of PET/CT to prospectively identify patients with positive nodes for definitive radiation therapy. Author Disclosure: C.M. Fisher: None. P.E. DeWitt: None. T.E. Schefter: None. J.A. Carlson: None.
2758 Development of the Veteran Health Administration e Radiation Oncology Quality and Safety Initiative (VHA-ROQSI) R. Kapoor, J. Palta, and M.P. Hagan; Veteran Health Administration, National Radiation Oncology Program (652/10P4H), Richmond, VA Purpose/Objective(s): The overall goal of VHA-ROQSI is to ensure that veterans receive radiation therapy safely and effectively and to monitor quality and treatment outcomes at each Radiation Oncology Service (ROS) within VHA. The electronic infrastructure developed to achieve these
2759 Cancer in Botswana: A Prospective Cohort Study of Cancer Type, Treatment, and Outcomes G. Suneja,1 S. Dryden-Peterson,2,3 M. Boyer,4 Z. Musimar,5 M. NsingoBvochora,6 D. Ramogola-Masire,7 H. Medhin,8 J. Bekelman,1 S. Lockman,2,3 and T. Rebbeck9; 1University of Pennsylvania, Perelman School of Medicine, Radiation Oncology, Philadelphia, PA, 2Brigham and Women’s Hospital, Division of Infectious Diseases, Boston, MA, 3 Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana, 4 Marshall University, Joan C. Edwards School of Medicine, Huntington, WV, 5Princess Marina Hospital, Gaborone, Botswana, 6Gaborone Private Hospital, Department of Radiation Oncology, Gaborone, Botswana, 7 Botswana-UPenn Partnership, Gaborone, Botswana, 8Botswana Ministry of Health, Gaborone, Botswana, 9University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA Purpose/Objective(s): In sub-Saharan Africa, the cancer burden is substantial and rates are projected to rise. Limited information regarding cancer type, presentation, stage, and outcome is available. We sought to characterize cancers treated at the largest public oncology facility in Botswana, where the Ministry of Health has recognized cancer as a national health priority. Materials/Methods: Consenting adult patients receiving treatment for a new cancer diagnosis at the National Referral Hospital in Gaborone, Botswana (Princess Marina) have been enrolled in a prospective
International Journal of Radiation Oncology Biology Physics
effects, and to implement preventive measures and adaptive health education. Author Disclosure: T.Y. Eng: None. A. Patel: None. V. Clyburn: None.
objectives can serve as a model for the radiation oncology community at large. Materials/Methods: The VHA-ROQSI is a new initiative by the VHA’s National Radiation Oncology Program office with a goal of electronically collecting and aggregating data to assess quality and safety of radiation treatment delivery and determine disease site-specific outcomes. This would be accomplished by; (1) Gathering and maintaining ROS profile data: The data include information on radiation therapy planning, delivery equipment, services provided, patient volume, and quality assurance activities. The data elements are captured are harmonized with similar efforts from RPC and ACR for credentialing and accreditation respectively. (2) Gathering data on accreditation and credentialing status of each ROS: These data elements are collected and updated periodically via web based forms. (3) Creating a system-wide log of periodic remote monitoring of output calibration data and provide each ROS a feedback on a continuing basis. (4) Implementing a remote peer review system: A Web-based peer review system will enable proactive and rapid peer review of all complex clinical cases. (5) Implementing a radiation oncology incident reporting system (ROIR): Each ROSs will be able to report adverse events and near miss information on patients for review by radiation oncology domain experts. (6) Collecting disease site-specific outcome data: De-identified outcome data on patient treated at each ROS will be collected in a central registry. The data will also include DICOM-RT based dosimetry parameters. Results: We have designed an electronic infrastructure that minimizes key strokes and multiple entries of redundant data by end users to accomplish each one of the aforementioned objectives. The prototypes of various modules for electronic data collection have been developed and are in beta testing. Once completed, the integrated system will facilitate peer review of complex treatment plans, collection of data elements for treatment quality and outcome assessment, and tracking of adverse events and near misses on patient treatments. Conclusions: The VHA-ROQSI overcomes the challenge faced by radiation oncology services providers of submitting redundant data to disparate sources to fulfill the practice requirements. The electronic infrastructure designed to satisfy the requirements of VHA-ROQSI will circumvent the need for separate registries for outcome, quality, and safety tracking under development by various stakeholders at the present time Author Disclosure: R. Kapoor: K. Stock; TSG Innovations Inc. J. Palta: None. M.P. Hagan: None.
2757 Improving Quality of Life and Increasing Cost Effectiveness for Cervical Cancer Patients C.M. Fisher, P.E. DeWitt, T.E. Schefter, and J.A. Carlson; University of Colorado Denver, Denver, CO Purpose/Objective(s): The objective of this study is to perform a patterns of care analysis for the treatment of FIGO Stage I-II cervical cancer over a 26 year time period. We anticipate seeing decreased use of surgery in patients with larger tumor size, higher stage, and positive nodes, thus decreasing serious side effects and lowering the cost of care in these patients who will require radiation therapy regardless of surgical intervention. Materials/Methods: A total of 20,290 women with clinical stage IA through IIB cervical cancer with known tumor characteristics were identified in the Surveillance, Epidemiology and End Results (SEER) program from 1983 to 2009. Of these, 12,993 women had known treatment status (radiation alone, surgery alone, or surgery plus radiation) and were included in the final analysis. Results: Of the 12,993 women identified, 30% received both surgery plus radiation, 46% received surgery alone, and 24% received radiation alone. Over the time period evaluated, a decline in percentage of patients receiving surgery alone was noted, with an accompanying increase in percentage of patients receiving radiation alone, and a moderate decline in percentage of patients receiving surgery plus radiation. No change was seen in the odds ratio of a node positive patient or of a patient with parametrial involvement receiving surgery plus radiation over the time period; however, a significant decrease in the odds ratio of a patient with tumor size >4 cm receiving surgery plus radiation therapy was seen (OR 0.96; 95% CI, 0.95, 0.97; p < 0.0001). On multivariate analysis, factors significantly associated with choice of therapy included year of diagnosis, age, race, SCC histology, and tumor size. Smaller tumor size (1-4 cm) was associated with decreased odds ratio of radiation alone versus surgery plus radiation, while tumors measuring 5+ cm had an increased odds ratio of radiation alone. Node positivity was associated with decreased odds ratio of receiving radiation alone (0.33, p < .0001). Conclusions: Equivalent survival results with surgery versus radiation have been demonstrated for early stage cervical cancer, with associated increased toxicity when both therapies are used for tumors with high risk features. In this large review, a decline in surgery alone was seen with a moderate decline in surgery plus radiation therapy, and an increase in radiation alone. Based on published data, this should decrease the risk of serious side effects associated with surgery plus radiation, and also decrease costs via de-escalating treatment and causing fewer serious side effects to manage. Patients with tumor >5 cm are more likely to appropriately receive definitive radiation. Further improvement in patient quality of life and cost effectiveness can be realized by consistent use of PET/CT to prospectively identify patients with positive nodes for definitive radiation therapy. Author Disclosure: C.M. Fisher: None. P.E. DeWitt: None. T.E. Schefter: None. J.A. Carlson: None.
2758 Development of the Veteran Health Administration e Radiation Oncology Quality and Safety Initiative (VHA-ROQSI) R. Kapoor, J. Palta, and M.P. Hagan; Veteran Health Administration, National Radiation Oncology Program (652/10P4H), Richmond, VA Purpose/Objective(s): The overall goal of VHA-ROQSI is to ensure that veterans receive radiation therapy safely and effectively and to monitor quality and treatment outcomes at each Radiation Oncology Service (ROS) within VHA. The electronic infrastructure developed to achieve these
2759 Cancer in Botswana: A Prospective Cohort Study of Cancer Type, Treatment, and Outcomes G. Suneja,1 S. Dryden-Peterson,2,3 M. Boyer,4 Z. Musimar,5 M. NsingoBvochora,6 D. Ramogola-Masire,7 H. Medhin,8 J. Bekelman,1 S. Lockman,2,3 and T. Rebbeck9; 1University of Pennsylvania, Perelman School of Medicine, Radiation Oncology, Philadelphia, PA, 2Brigham and Women’s Hospital, Division of Infectious Diseases, Boston, MA, 3 Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana, 4 Marshall University, Joan C. Edwards School of Medicine, Huntington, WV, 5Princess Marina Hospital, Gaborone, Botswana, 6Gaborone Private Hospital, Department of Radiation Oncology, Gaborone, Botswana, 7 Botswana-UPenn Partnership, Gaborone, Botswana, 8Botswana Ministry of Health, Gaborone, Botswana, 9University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA Purpose/Objective(s): In sub-Saharan Africa, the cancer burden is substantial and rates are projected to rise. Limited information regarding cancer type, presentation, stage, and outcome is available. We sought to characterize cancers treated at the largest public oncology facility in Botswana, where the Ministry of Health has recognized cancer as a national health priority. Materials/Methods: Consenting adult patients receiving treatment for a new cancer diagnosis at the National Referral Hospital in Gaborone, Botswana (Princess Marina) have been enrolled in a prospective