• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Peer Review Quality Assurance for Radiation Therapy

 
Measure Desired DirectionAs of this Report
Percentage of radical courses peer reviewed by a radiationoncologistBlack Arrow UpGreen Arrow Up
See Methodology and Approach to find out how the ratings are calculated.

Key findings

Peer review is an important quality assurance tool in health care. While peer review is being done among radiation oncologists across Ontario, variation in the rates of peer review has been reported by Regional Cancer Programs. The overall Ontario average of curative cases being peer reviewed is 77%, which exceeds the 2015/2016 target of 75%.

What is peer review?

  • Peer review is a valuable tool that is central to quality assurance programs in health care. Peer review is loosely defined as the evaluation of creative work or performance by other people in the same field to enhance the quality of work or the performance of colleagues1. In the context of quality radiation treatment practice, the Cancer Care Ontario Radiation Treatment Program has defined peer review as the evaluation of components of the attending radiation oncologist’s treatment plan by a second radiation oncologist, ideally with multidisciplinary input from physicists and radiation therapists2. For more information, see Cancer Care Ontario’s Radiation Oncology Peer Review Guidance Document.
  • Widely endorsed among radiation oncologists, peer review has several dimensions3. These include case conference review of treatment decision-making, peer-to-peer review of planning contours and team meetings where representatives from multiple disciplines (e.g. physicians, therapists, physicists and nurses) review proposed treatment plans. This team format reviews plans, including parameters such as prescribed dose, volumes to be covered, technique or patient set-up. It is sometimes referred to as “chart rounds”1.
  • Multidisciplinary cancer conferences (MCCs) are a second form of peer review common in many centres, although case presentation in MCCs is not included in the statistics that report radiation oncology peer-review rates. At MCCs, physicians from multiple disciplines and other members of the health care team discuss new patients or cases, reviewing decision points to help decide on the appropriate means of treatment (e.g. whether a patient should receive radiation treatment or if concurrent chemotherapy should be used). This contrasts with peer review in radiation treatment, which concentrates on ensuring that treatment plans associated with the delivery of radiation (which are created after the decision has been made to treat with radiotherapy) are both safe and effective2.
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What do the results show?

Peer review in radiation therapy is inconsistent across Ontario.

  • Many regions met or exceeded the 2014/2015 target of 60%. The 2015/16 target is 75% and the overall Ontario average of curative cases being peer reviewed is 77% for April 2015– March 2016.
  • Mississauga Halton/Central West (99.9%), North Simcoe Muskoka (96.9%) and Central (93.3%) have the highest rates of peer review among the regions.
  • Recent surveys of professional practice in Ontario show that the importance of peer review is strongly endorsed by all regional cancer centres. Implementing efficient peer-review practices has proven to be a challenge, however, particularly in older centres with well-established protocols and significant case volumes across all cancer types. These challenges are recognized by Cancer Care Ontario’s Radiation Treatment Program, but centres that have yet to meet the target are still expected to increase their peer-review rate. Some regional cancer centres reported rates below the 75% peer-review target, including Toronto Central North (62.0%), Champlain (62.8%), Erie St. Clair (68.4%), Central East (68.6%), Waterloo Wellington (70.4%), Hamilton Niagara Haldimand Brant (72.3%) and South West (73.9%). Where applicable, centres have identified strategies to improve the accuracy of peer-review rates locally.

Why is this important to Ontarians?

Quality assurance is vital to successful treatment outcomes.

  • The Canadian Partnership for Quality Radiotherapy (CPQR) issued a policy statement that recommends increased peer review within the radiation therapy treatment process and among members of the radiation oncology team to increase quality assurance and safety2.

Peer review encourages continuous professional improvement.

  • A recent meta-analysis of randomized controlled trials assessing the effects of peer review (audit and feedback) on objective professional practices or health outcomes found that audits and feedback can be effective in improving professional practice4.
  • Embracing a culture of peer review provides benefits beyond explicit peer-review decisions. Members of the health care team involved in peer review may feel empowered to increase their sphere of influence, making them more likely to suggest improvements in operations that benefit everyone2.
  • Several radiation oncology professional associations have expressed support for the implementation of peer review as a regular part of practice. In its “Quality Assurance Guidance for Canadian Radiation Treatment Programs,” the Canadian Partnership for Quality Radiotherapy (CPQR) recommends that all radiation treatment plans administered with adjuvant or curative intent, and other plans with significant potential for adverse patient outcomes if tumour targets and/or normal structures are treated inappropriately, undergo oncology peer review of volumes and dosimetry ideally before the start of treatment5.
  • The Canadian Partnership Against Cancer and Cancer Care Ontario have supported the expansion of peer-review activities in Ontario which will document the frequency of changes made due to peer-reviews and the associated disease sites. This new information will help determine the value of peer-review processes in improving the quality of care.
  • The Radiation Treatment Program is currently working towards setting disease site-specific guidance for peer review to improve the overall quality of care in Ontario. Guidance is required because the key components of a plan that require peer review differ across cancer sites, and will thus provide clarity around the following:
    • What constitutes peer review? (This may currently be contributing to the observed variation between Centres)
    • What are the minimum requirements for peer review best practice? This will increase the quality of peer review for each disease site.

Find out more

View Notes

  1. The Linux Information Project [Internet]. Linux Information Project; c2005. Peer review definition; [cited 2015 Mar 10]. Available from: http://www.linfo.org/peer_review.html.
  2. Marks LB, Adams RD, Pawlicki T, Blumberg AL, Hoopes D, Brundage MD, et al. Enhancing the role of case oriented peer review to improve quality and safety in radiation oncology. Pract Radiat Oncol. 2013; 3(3):149–156.
  3. Brundage M, Foxcroft S, McGowan T, et al. A survey of radiation treatment planning peer-review activities in a provincial radiation oncology programme: current practice and future directions. BMJ Open. 2013; 3:e003241.
  4. Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 2006; CD000259.
  5. Canadian Partnership for Quality Radiotherapy [Internet]. Canadian Partnership for Radiotherapy; c2013. Quality assurance guidance for Canadian radiation treatment programs; [cited 2014 Jan 16]. Available from: http://www.cpqr.ca/programs/quality-assurance/.