• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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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 radiation oncologist Black Arrow Up Green 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 healthcare. While peer review is being done among radiation oncologists across Ontario, there is variation in the rates of peer review reported by Regional Cancer Programs. The overall Ontario average of curative cases being peer reviewed is 73%, which is close to the 2015/2016 target of 75%.  

What is peer review?

  • Peer review is a valuable tool that is central to quality assurance programs in healthcare. 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 radiotherapy 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 centers, 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 healthcare team discuss new patients or cases, reviewing decision points to help decide on the appropriate means of treatment (e.g. whether or not a patient should receive radiation treatment or if concurrent chemotherapy should be used). This is in contrast to 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 have 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 73% for January–December 2015.
  • Mississauga Halton/Central West (99.8%), Central (97.7%) and North Simcoe Muskoka (97.2%) 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 volume 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 65% target for peer review, including Toronto Central North (59.3%) and Champlain (56.5%). Where applicable, centres have identified strategies to address data quality and improve the accuracy of peer review rates locally.

Why is this important to Ontarians?

Quality assurance is vital to successful treatment outcomes.

  • The American Society for Radiation Oncology (ASTRO) issued a white paper 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 controlled improvement.

  • A recent meta-analysis of randomized control 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 healthcare 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 where there is a significant potential for adverse patient outcome if tumour targets and/or normal structures are treated inappropriately, undergo oncology peer review of volumes and dosimetry ideally before the start of treatment5
  • Cancer Care Ontario and The Canadian Partnership Against Cancer have supported the expansion of peer review activities in Ontario that will allow collection of additional information. 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.

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/.