TY - JOUR
T1 - Patterns of care study in Japan
AU - Teshima, Teruki
AU - Mitsumori, Michihide
AU - Uno, Takashi
AU - Nakamura, Katsumasa
AU - Sumi, Minako
AU - Kenjo, Masahiro
AU - Shikama, Naoto
AU - Toita, Takafumi
AU - Ogawa, Kazuhiko
AU - Koizumi, Masahiko
AU - Onishi, Hiroshi
AU - Ashino, Yasuo
AU - Oguchi, Masahiko
AU - Yamauchi, Chikako
AU - Negoro, Yoshiharu
AU - Gunbai, Toshiyuki
AU - Sai, Heitetsu
AU - Nihei, Keiji
AU - Sasaki, Yoshihide
AU - Sasaki, Tomonari
AU - Shioyama, Yoshiyuki
AU - Urashima, Yusuke
AU - Saku, Madoka
AU - Yoshitake, Tadamasa
AU - Sasaki, Shigeru
AU - Nishikawa, Atsushi
AU - Mitsuhashi, Norio
AU - Maebayashi, Katsuya
AU - Seki, Kaori
AU - Murakami, Yuji
AU - Domoto, Koichi
AU - Kawakami, Hiroyuki
AU - Tanaka, Shiho
AU - Marino, Hiroshi
AU - Komiyama, Takashi
AU - Kodaira, Takeshi
AU - Shinoda, Atunori
AU - Ohno, Yuko
AU - Nakamura, Mitsuhiro
AU - Takegawa, Hideki
AU - Yoshioka, Munenori
AU - Numasaki, Hodaka
AU - Inoue, Toshihiko
AU - Ikeda, Hiroshi
N1 - Funding Information:
We thank all radiation oncologists who participated in this study. Their effort in providing information to us makes these surveys possible. The Japanese PCS working group currently includes the following members: Michihide Mitsumori, MD, Takashi Uno, MD, Katsumasa Nakamura, MD, Minako Sumi, MD, Masahiro Kenjo, MD, Naoto Shikama, MD, Takafumi Toita, MD, Kazuhiko Ogawa, MD, Masahiko Koizumi, MD, Hiroshi Onishi, MD, Yasuo Ashino, PhD, Masahiko Oguchi, MD, Chikako Yamauchi, MD, Yoshiharu Negoro, MD, Toshiyuki Gunbai, MD, Heitetsu Sai, MD, Keiji Nihei, MD, Yoshihide Sasaki, MD, Tomonari Sasaki, MD, Yoshiyuki Shioyama, MD, Yusuke Urashima, MD, Madoka Saku, MD, Tadamasa Yoshitake, MD, Shigeru Sasaki, MD, Atsushi Nishikawa, MD, Norio Mitsuhashi, MD, Katsuya Maebayashi, MD, Kaori Seki, MD, Yuji Murakami, MD, Koichi Domoto, MD, Hiroyuki Kawakami, MD, Shiho Tanaka, MD, Hiroshi Marino, MD, Takashi Komiyama, MD, Takeshi Kodaira, MD, Atunori Shinoda, MD, Yuko Ohno, PhD, Mitsuhiro Nakamura, MS, Hideki Takegawa, MS, Munenori Yoshioka, MS, Hodaka Numasaki, MS, Toshihiko Inoue, MD and Hiroshi Ikeda, MD. These studies were supported by Grant-in-Aid for Cancer Research (nos 8-27, 8-29, 10-17 and 14-6) from the Ministry of Health, Labor and Welfare of Japan.
Funding Information:
In 2002, new funding for PCS (no. 14–6) enabled us to conduct the third national survey, for which we used the same study design as for the second PCS. In addition, we collected image data obtained from, for example, treatment planning simulator films and portal films by using digital camera at audit. For browsing these images, we developed a novel image database linked with the original PCS databases. In this new trial, more detailed analysis of treatment planning was possible. The PCS data format became highly sophisticated as a result of the installation of new logical checking functions based on actual data of the second PCS to determine a reasonable range between minimum and maximum values and help functions to indicate criteria for the definition of each of the survey items. At the PCS data center, online supporting functions such as early checking of the accuracy of data entry and image capturing was developed for the auditors that produced a dramatic improvement in the accuracy of data entry compared to that of the second PCS. During this survey period, the Individual Information Protection Act (draft) was introduced, promoting us to prepare applications for approval for the PCS from the institutional review board of each of the participating institutes before the audit was conducted. External audits of the 76 institutes were performed from July 2002 to June 2004, and two-stage cluster sampling enabled us to collect detailed and accurate data for 3396 patients with carcinoma of any of the five sites and their 13 386 images (7.03 GB). The second Japan/USA PCS workshop was held in February 2003, at the National Cancer Center, Tokyo, supported by grants from the Japanese Foundation of Aging and Health, the Japanese Society for the Promotion of Science, the Japanese Foundation of Cancer Research, Siemens Medical Ltd, Toshiba Medical Ltd and CMS Japan Ltd. In this workshop, further comparisons based on the findings of the first workshop were made, especially with regard to the best current management, the outcome for the patients with any of the five diseases surveyed in PCS and radiation doses for patients with cancer of the cervix. Leading Japanese surgical oncologists, medical oncologists and members of the Korean PCS group also participated and discussed issues from a broader viewpoint (15).
Funding Information:
In 1996, we introduced PCS in Japan with partial support from a Grant-in-Aid for Cancer Research Groups from the Ministry of Health, Labor and Welfare in Japan (nos 8–27 and 8–29). We selected esophagus and cervix cancers as target disease sites, because annual numbers of these patients exceeded 4000 for either cancer type according to a structure survey by the Japan Society of Therapeutic Radiology and Oncology (JASTRO). We used the same database as that of American PCS, courtesy of ACR, which was installed on a personal computer. Since an important characteristic of PCS is data collection by external audit, we selected 37 radiotherapy facilities nationwide for our PCS survey and the audit was performed from July 1996 to February 1998 by the author and detailed information was collected for 561 patients with esophageal cancer (7,8) and 490 patients with cervix cancer (9). However, we could not use the original two-stage cluster sampling employed for the American PCS because of budget limitations for the first trial.
PY - 2005/9
Y1 - 2005/9
N2 - Background: The Patterns of Care Study (PCS), started in the 1970's, is a well-known study used for clinical quality assurance (QA) in radiation oncology in the United States. PCS has been introduced in Japan since 1996. Methods: Three national PCS surveys have been performed by means of external audit to evaluate patterns of care for the patients with carcinoma of any of esophagus and cervix treated with radiation between 1992 and 1994, for those with carcinoma of any of esophagus, cervix, breast, lung and prostate between 1995 and 1997, and for those with any of the five disease sites between 1999 and 2001. In the first PCS, feasibility of the study was confirmed. In the second PCS, two-stage cluster sampling of institutions and patients was performed and national averages for the survey items were calculated as QA measures. In the third PCS, additional imaging data were collected. The Japan/USA PCS workshops were held at San Francisco in 2001 and at Tokyo in 2003. Results: Significant variations in process and structure were observed according to institutional stratification. In academic institutions, external beam energy ≥6 MV for deep-seated tumors of esophagus, lung, prostate and cervix, and brachytherapy for those of cervix and esophagus were used more frequently. There was an average of less than one full-time equivalent radiation oncologist in most non-academic institutions. These variations influenced the outcomes. There were also significant differences between USA and Japan in various aspects, e.g. a difference in radiation dose of 20% for uterine cervix cancer patients. It is higher in the USA. The number of new cancer patients requiring radiation is increasing steeply (120 000 in 2000 and 170 000 in 2005). Based on PCS data, structural guidelines were published and distributed throughout Japan. Conclusion: PCS is useful for establishing the clinical QA for radiation oncology as well as other specialties through detailed monitoring and evaluation of their structures, processes and outcomes.
AB - Background: The Patterns of Care Study (PCS), started in the 1970's, is a well-known study used for clinical quality assurance (QA) in radiation oncology in the United States. PCS has been introduced in Japan since 1996. Methods: Three national PCS surveys have been performed by means of external audit to evaluate patterns of care for the patients with carcinoma of any of esophagus and cervix treated with radiation between 1992 and 1994, for those with carcinoma of any of esophagus, cervix, breast, lung and prostate between 1995 and 1997, and for those with any of the five disease sites between 1999 and 2001. In the first PCS, feasibility of the study was confirmed. In the second PCS, two-stage cluster sampling of institutions and patients was performed and national averages for the survey items were calculated as QA measures. In the third PCS, additional imaging data were collected. The Japan/USA PCS workshops were held at San Francisco in 2001 and at Tokyo in 2003. Results: Significant variations in process and structure were observed according to institutional stratification. In academic institutions, external beam energy ≥6 MV for deep-seated tumors of esophagus, lung, prostate and cervix, and brachytherapy for those of cervix and esophagus were used more frequently. There was an average of less than one full-time equivalent radiation oncologist in most non-academic institutions. These variations influenced the outcomes. There were also significant differences between USA and Japan in various aspects, e.g. a difference in radiation dose of 20% for uterine cervix cancer patients. It is higher in the USA. The number of new cancer patients requiring radiation is increasing steeply (120 000 in 2000 and 170 000 in 2005). Based on PCS data, structural guidelines were published and distributed throughout Japan. Conclusion: PCS is useful for establishing the clinical QA for radiation oncology as well as other specialties through detailed monitoring and evaluation of their structures, processes and outcomes.
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U2 - 10.1093/jjco/hyi142
DO - 10.1093/jjco/hyi142
M3 - Review article
C2 - 16120622
AN - SCOPUS:27644564898
VL - 35
SP - 497
EP - 506
JO - Japanese Journal of Clinical Oncology
JF - Japanese Journal of Clinical Oncology
SN - 0368-2811
IS - 9
ER -
