Peer Review Quality Assurance for Radiation Therapy
Peer review is an important quality assurance tool in healthcare. 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 (RCPs). The overall Ontario average of curative cases being peer reviewed is 88%, which exceeds the target of 75% for fiscal year 2016/2017.
Measure: Percentage of radical courses peer reviewed by a radiation oncologist
As of this Report:
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 colleagues .
- 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 therapists . For more information, see Cancer Care Ontario’s Radiation Oncology Peer Review Guidance Document.
- Widely endorsed among radiation oncologists, peer review has several dimensions . 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., nurses, physicians, physicists and therapists) review proposed treatment plans. This team review includes parameters such as prescribed dose, volumes to be covered, technique or patient set-up. It is sometimes referred to as “chart rounds” .
- 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 healthcare 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 approach 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 effective .
What do the results show?
Peer review in radiation therapy has improved significantly in Ontario.
- The overall Ontario average of curative cases being peer reviewed has risen significantly, up from 77% for fiscal year 2015/2016 to 88% for fiscal year 2016/2017. All regions exceeded the fiscal year 2016/2017 target of 75%.
- Mississauga Halton/Central West (99.6%), Central (96.8%) and North Simcoe Muskoka (95.2%) have the highest rates of peer review among the RCPs.
- Recent surveys of professional practice in Ontario show that the importance of peer review is strongly endorsed by all Regional Cancer Centres (RCCs). 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. Due to the use of targeted strategies last year, RCCs are exceeding the peer review target rate of 75%.
- Palliative peer review quality assurance for radiation treatment is a priority for the Radiation Treatment Program and starting in April 2017, a target of 30% for each individual centre by the end of the year was agreed to. By March 2017, 28% of palliative courses were peer reviewed in Ontario (data not shown).
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 in order to increase quality assurance and safety .
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 practice .
- 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 activities that benefit everyone .
- 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 CPQR recommends that all radiation treatment plans administered with adjuvant or curative intent undergo oncology peer review of volumes and dosimetry, ideally before the start of treatment . This is also the case for other plans that have a significant potential for adverse patient outcomes if tumour targets and/or normal structures are treated inappropriately.
- The Canadian Partnership Against Cancer and Cancer Care Ontario have supported the expansion of peer review activities in Ontario that 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. It will thus provide clarity around the following questions.
- What constitutes peer review? This may currently be contributing to the observed variation between RCCs.
- 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
- There are a number of articles that cover topics related to peer review in radiation, including the following:
- An overview of peer review:
- o Increasing peer review activities:
- An overview of peer review:
- To learn more about peer review in radiation therapy, visit ASTRO and its collection of white papers:
- Cancer Care Ontario provides more information on MCCs on its site:
- To learn more about Cancer Care Ontario’s Radiation Treatment Program, please visit:
- You can find the Radiation Oncology Peer Review Guidance Document here: