Programmatic comparison and dissemination of an audit of single fraction radiotherapy prescribing practices for bone metastases is associated with a meaningful and lasting change in practice on a population level

Publication date: Available online 11 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Robert Olson, Matthew Chan, Neelam Minhas, Gurkirat Kandola, Manpreet Tiwana, Shilo Lefresne, Ross Halperin, Devin Schellenberg, Elaine Wai, Nissar Ahmed, Scott Tyldesley
PurposeThere is ample evidence that single fraction radiation therapy (SFRT) is equally efficacious as more costly and morbid multi-fraction regimens. We previously demonstrated that an audit-based intervention increased the use of SFRT in all regional cancer centers the year following. However, other investigators have demonstrated interventions were only associated with a transient one-year change in prescribing practices. We sought to determine if our intervention resulted in a more lasting impact.MethodsIn 2012 we performed an audit of prescribing practices of individual physicians, which were then presented to leaders and oncologists as an intervention to increase SFRT. We then compared the use of SFRT from 2007-2011 (pre-intervention) and 2013-2016 (post-intervention) in all 31,192 patients treated in our provincial program.ResultsThe use of SFRT increased from 49.2% to 58.9% post intervention (p<0.001), with rates in 2007-2011 of 51, 51, 48, 49, and 48%, while post intervention in 2013-2016 they were 60, 62, 59, and 56%. Post intervention, half of the centers prescribed SFRT in a relatively narrow range (55-58%). However, across all centers, there was still a broad range, with the lowest and highest users at 35% and 81% respectively, though the lowest utilizing center still showed a significant increase (26% to 35%; p <0.001).ConclusionOur audit and educational based intervention resulted in a lasting and meaningful 10% change in practice. Our provincial rate is similar to a previously recommended benchmark rate of 60%, though we continue to see significant variation by center, suggesting further room for improvement in provincial standardization. With emerging evidence in support of ablative radiotherapy for select populations of patients with bone metastases, future benchmark rates of SFRT should be readdressed, though our data suggest programmatic comparison and dissemination of SFRT prescribing practices can achieve a population-based SFRT utilization rate near 60%.

Teaser

After an audit-based educational intervention in our population-based provincial radiotherapy program, we demonstrate a lasting and meaningful 10% increase in the prescription of SFRT for bone metastases. Other jurisdictions should consider using similar programmatic audit-based educational approaches in an effort to increase the use of this cost-effective treatment which has been historically used well below evidence-based benchmarks internationally. Our data suggests that the benchmark of 60% use of SFRT for bone metastases is feasible.


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