Patterns of Care Study of Radiation Therapy for Esophageal Cancer in Japan: Influence of the Stratification of Institution on the Process

Background: To improve the qualityof radiation therapyin Japan, Patterns of CareStudy(PCS), a widely known QA program in the USA, was introduced in Japan. The feasibility was tested by collecting nationwide data by extramural audit for esophageal cancer. Methods: From July 1996through February 1997,PCSaudits wereperformed for 29 institutions. Based on the facility survey by Tsunemoto, 13 institutes were classified as A1 (university hospital/cancer centertreating >300patients/year), 10 as B1 (otherinstitutes>120patients/year) and six as B2 (other institutes 60 Gy was delivered in A1 than in B1-2 (P = 0.0008). Chemotherapy was administered to 51 % of the patients in A1 and to 30% in B1-2 (P < 0.0001). Brachytherapy was utilized for 17% in A1 and only for 5% in B1-2 (P= 0.0001). Conclusion: Institutional stratification, including equipment andpersonnel, significantly affected the patterns of care for esophageal cancer. Therefore, to improve the quality of radiation therapy nationwide, improvement ofequipment andsupply of FTEpersonnel isextremely important. PCS was found to have greatpotential for the practical evaluation of how much will be required in Japan.