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Duggar WN, Roberts PR, Thomas TV, Dulaney C. Building Better Patient Care in Mississippi Radiation Oncology: Why Mississippi Needs a Collaborative Quality Initiative. South Med J 2023; 116:415-418. [PMID: 37137476 DOI: 10.14423/smj.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Cancer is an insidious and devastating disease that affects many people. Progress in mortality rate has not been realized universally across the United States, and challenges remain in how to best make up the ground that has been lost in these areas, one of which is Mississippi. Radiation therapy is a significant contributor to cancer control rates and certain challenges exist specifically regarding this treatment modality. METHODS The challenges of radiation oncology in Mississippi have been reviewed and discussed, with the proposal of a potential collaboration between clinical practitioners and payors to provide optimal and cost-effective radiation therapy to patients in Mississippi. RESULTS A similar model to that proposed has been reviewed and evaluated. This model is discussed based on its potential validity and usefulness in Mississippi. CONCLUSIONS Significant barriers exist in the state of Mississippi to patients receiving a consistent standard of care, regardless of their location and socioeconomic status. A collaborative quality initiative has been shown to be a boon to this endeavor elsewhere and stands to have a similar impact in Mississippi.
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Affiliation(s)
- William N Duggar
- From Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Paul R Roberts
- From Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Toms V Thomas
- From Radiation Oncology, University of Mississippi Medical Center, Jackson
| | - Caleb Dulaney
- Radiation Oncology, Anderson Regional Medical Center, Meridian, Mississippi
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Matrosic CK, Dess K, Boike T, Dominello M, Dryden D, Fraser C, Grubb M, Hayman J, Jarema D, Marsh R, Paximadis P, Torolski K, Wilson M, Jolly S, Matuszak M. Knowledge-Based Quality Assurance and Model Maintenance in Lung Cancer Radiation Therapy in a Statewide Quality Consortium of Academic and Community Practice Centers. Pract Radiat Oncol 2023; 13:e200-e208. [PMID: 36526245 DOI: 10.1016/j.prro.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Locally advanced lung cancer (LALC) treatment planning is often complex due to challenging tradeoffs related to large targets near organs at risk, making the judgment of plan quality difficult. The purpose of this work was to update and maintain a multi-institutional knowledge-based planning (KBP) model developed by a statewide consortium of academic and community practices for use as a plan quality assurance (QA) tool. METHODS AND MATERIALS Sixty LALC volumetric-modulated arc therapy plans from 2021 were collected from 24 institutions. Plan quality was scored, with high-quality clinical (HQC) plans selected to update a KBP model originally developed in 2017. The model was validated via automated KBP planning, with 20 cases excluded from the model. Differences in dose-volume histogram metrics in the clinical plans, 2017 KBP model plans, and 2022 KBP model plans were compared. Twenty recent clinical cases not meeting consortium quality metrics were replanned with the 2022 model to investigate potential plan quality improvements. RESULTS Forty-seven plans were included in the final KBP model. Compared with the clinical plans, the 2022 model validation plans improved 60%, 65%, and 65% of the lung V20Gy, mean heart dose, and spinal canal D0.03cc metrics, respectively. The 2022 model showed improvements from the 2017 model in hot spot management at the cost of greater lung doses. Of the 20 recent cases not meeting quality metrics, 40% of the KBP model-replanned cases resulted in acceptable plans, suggesting potential clinical plan improvements. CONCLUSIONS A multi-institutional KBP model was updated using plans from a statewide consortium. Multidisciplinary plan review resulted in HQC model training plans and model validation resulted in acceptable quality plans. The model proved to be effective at identifying potential plan quality improvements. Work is ongoing to develop web-based training plan review tools and vendor-agnostic platforms to provide the model as a QA tool statewide.
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Affiliation(s)
- Charles K Matrosic
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Kathryn Dess
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Michael Dominello
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | | | - Margaret Grubb
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James Hayman
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - David Jarema
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Kelly Torolski
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Shruti Jolly
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martha Matuszak
- Medical School, Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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Herr DJ, Hochstedler KA, Yin H, Dess RT, Matuszak M, Grubb M, Dominello M, Movsas B, Kestin LL, Bergsma D, Dragovic AF, Grills IS, Hayman JA, Paximadis P, Schipper M, Jolly S. Effect of education and standardization of cardiac dose constraints on heart dose in lung cancer patients receiving definitive radiation therapy across a statewide consortium. Pract Radiat Oncol 2022; 12:e376-e381. [PMID: 35121192 DOI: 10.1016/j.prro.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE/OBJECTIVES Cardiac radiation exposure is associated with an increased rate of adverse cardiac events in patients receiving radiation therapy for locally advanced non-small cell lung carcinoma (NSCLC). Previous analysis of practice patterns within XXXX revealed 1 in 4 patients received a mean heart dose >20 Gy and significant heterogeneity existed among treatment centers in using cardiac dose constraints. The purpose of this study is to analyze the effect of education and initiation of standardized cardiac dose constraints on heart dose across a statewide consortium. MATERIALS/METHODS From 2012 to 2020, 1681 patients from 27 academic and community centers who received radiation therapy for locally advanced NSCLC were included in this analysis. Dosimetric endpoints including mean heart dose (MHD), mean lung dose, and mean esophagus dose were calculated using data from dose-volume histograms. These dose metrics were grouped by year of treatment initiation for all patients. Education regarding data for cardiac dose constraints first occurred in small lung cancer working group meetings and then consortium-wide starting in 2016. In 2018, a quality metric requiring mean heart dose <20 Gy while maintaining dose coverage (D95) to the target was implemented. Dose metrics were compared before (2012-2016) versus after (2017-2020) initiation of interventions targeting cardiac constraints. Statistical analysis was performed using the Wilcoxon Rank Sum test. RESULTS Following education and implementation of the heart dose performance metric, mean MHD declined from an average of 12.2 Gy pre-intervention to 10.4 Gy post-intervention (p < 0.0001), and the percentage of patients receiving MHD >20 Gy reduced from 21.1% to 10.3% (p < 0.0001). Mean lung dose and mean esophagus dose did not increase, and target coverage remained unchanged. CONCLUSIONS Education and implementation of a standardized cardiac dose quality measure across a statewide consortium was associated with a reduction of mean heart dose in patients receiving radiation therapy for locally advanced NSCLC. These dose reductions were achieved without sacrificing target coverage, increasing mean lung dose, or increasing mean esophagus dose. Analysis of the clinical ramifications of the reduction in cardiac doses is ongoing.
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Affiliation(s)
- Daniel J Herr
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Huiying Yin
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Margaret Grubb
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Michael Dominello
- Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, MI
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
| | - Larry L Kestin
- MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, MI
| | - Derek Bergsma
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; St. Mary's Hospital, Lacks Cancer Center, Grand Rapids, MI
| | - Aleksandar F Dragovic
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Brighton Center for Specialty Care, Brighton, MI
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health, Royal Oak, MI
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Peter Paximadis
- Department of Radiation Oncology, Spectrum Health Lakeland, St. Joseph, MI
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
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