Quality improvement program in radiation oncology: understanding patient hospitalizations, treatment breaks, and weight loss in patients receiving radiotherapy

INTRODUCTION: The reporting of adverse effects is an integral aspect of a hospital quality improvement (QI) program with the goal of improving care for current and future patients. We report the results of our experience tracking patient hospitalizations, treatment breaks, and weight loss in patients receiving radiotherapy as part of a departmental QI program. METHODS: In 2014, the Center for Cancer Care at Exeter hospital developed a departmental quality initiative to track adverse outcomes in a population of patients receiving radiation therapy. Criteria for inclusion in this initiative included: treatment break ≥3 days, hospitalization either while on treatment of within 2 weeks of treatment, death within 2 weeks of treatment, or weight loss of ≥10%. Patients included on this registry were reviewed at regularly scheduled departmental QI meetings, where solutions for improvement were discussed. RESULTS: Ninety-one patients were identified as having an event that meet the above-mentioned criteria. Forty-three patients were receiving concurrent chemotherapy (47.2%) Fifty-four (54.9%) patients had toxicity directly attributable to their treatment. Sixty-five patients (71.4%) were treated with curative intent. Nineteen patients (21.1%) died either during the course of radiotherapy, or within two weeks of completion of treatment. Advanced age was significantly associated with inferior overall and disease free survival in this analysis, HR 1.030 (1.006–1.054) p = 0.0125, and HR 1.034 (1.008–1.061) p = 0.010 respectively. CONCLUSION: We believe that this protocol to track events has been helpful in making practice changes in our department. Our results suggest that elderly patients who experience qualifying event are at increased risk of death, and providers should be cognizant of this finding. Future QI projects can seek to better understand how such changes have resulted in improvements in patient care.