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Table 1 Description of action plan (approved 18 April 2016)

From: Improving quality of care and clinical outcomes for rectal cancer through clinical audits in a multicentre cancer care organisation

Area for improvement

Target

Diagnostic phase

1 Increase availability of biopsy report

>  95% availability of reports

2 Standardise MRI report

>  85% of reports meet Mercury Study Group criteria* (ICS-IDI diagnostic imaging service)

3 Increase multidisciplinary working (treatment strategy)

>  85% of patients diagnosed at ICO have cases reviewed by tumour board

Treatment phase

1 Standardise criteria for indicating radiotherapy (IMRT)†

>  85% of patients with indication for radiotherapy are treated with IMRT

2 Improve adherence to planned RT treatment (OTT)

 

Develop protocol for managing treatment interruptions

Approve protocol by October 2016 and implement it

Disseminate and apply protocol

Reduce % of patients with prolonged OTT

Reduce % of patients finalising treatment on Monday

3 Standardise criteria for imaging controls during treatment

 

Develop protocol for imaging controls during treatment (IGRT)

Approve protocol by October 2016 and implement it

Disseminate and apply protocol

>  85% of patients with imaging control according to protocol

4 Standardise anatomical pathology report (surgical specimen): report ypCRM

>  85% of pathology reports note ypCRM

Follow-up phase

1 Report adverse effects according to severity, based on CTCAE (v4.0) classifications

>  85% of follow-up visits record presence or absence of adverse events and their CTCAE grade during the clinical course

  1. CTCAE Common Terminology Criteria for Adverse Events, ICS Institut Català de la Salut, ICO Institut Català d’Oncologia, IDI Institut de Diagnòstic per la Imatge, IGRT image-guided radiotherapy, IMRT intensity-modulated radiotherapy, MRI magnetic resonance imaging, OTT overall treatment time, ypCRM circumferential resection margin (following neoadjuvant treatment)
  2. aMercury Study Group criteria:
  3. 1) distance to anal verge and relationship between tumour and sphincter
  4. 2) infiltration beyond muscularis propia in mm
  5. 3) lymphatic state
  6. 4) extramural vascular spread
  7. 5) potential CRM invasion
  8. 6) presence of tumour implants
  9. bIndication for IMRT according to patient profile:
  10. 1) tumour in lower third of rectum in which dosage to genitals should be reduced to V30 < 35%
  11. 2) rectal tumour in patients with hysterectomy (or laparotomy) in whom the dosage to the intestine exceeds V15 < 150 cc or V15 < 120 cc
  12. 3) rT4 rectal tumour with infiltration to prostate, urinary bladder or uterus, in whom the planning target volume includes lymphatic areas of the external iliac system