Consensus Quality Measures and Dose Constraints for Prostate Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel.

There are no agreed upon measures to comprehensively determine the quality of radiation oncology (RO) care delivered for prostate cancer. Consequently, it is difficult to assess the implementation of scientific advances and adherence to best practices in routine clinical practice. To address this need, the US Department of Veterans Affairs (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance (VA ROQS) Program to develop clinical quality measures to assess the quality of RO care delivered to Veterans with cancer. This article reports the prostate cancer consensus measures.

The VA ROQS Program contracted with the American Society for Radiation Oncology to commission a Blue Ribbon Panel of prostate cancer experts to develop a set of evidence-based measures and performance expectations. From February to June 2021, the panel developed quality, aspirational, and surveillance measures for (1) initial consultation and workup, (2) simulation, treatment planning, and delivery, and (3) follow-up. Dose-volume histogram (DVH) constraints to be used as quality measures for definitive and post-prostatectomy radiation therapy were selected. The panel also identified the optimal Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE V5.0), toxicity terms to assess in follow-up.

Eighteen prostate-specific measures were developed (13 quality, 2 aspirational, and 3 surveillance). DVH metrics tailored to conventional, moderately hypofractionated, and ultrahypofractionated regimens were identified. Decision trees to determine performance for each measure were developed. Eighteen CTCAE V5.0 terms were selected in the sexual, urinary, and gastrointestinal domains as highest priority for assessment during follow-up.

This set of measures and DVH constraints serves as a tool for assessing the comprehensive quality of RO care for prostate cancer. These measures will be used for ongoing quality surveillance and improvement among veterans receiving care across VA and community sites. These measures can also be applied to clinical settings outside of those serving veterans.

Practical radiation oncology. 2022 Dec 09 [Epub ahead of print]

Abhishek A Solanki, Lindsay L Puckett, Ksenija Kujundzic, Evangelia Katsoulakis, John Park, Rishabh Kapoor, Michael Hagan, Maria Kelly, Jatinder Palta, Leslie K Ballas, John DeMarco, Karen E Hoffman, Colleen A F Lawton, Jeff Michalski, Louis Potters, Michael Zelefsky, Randi Kudner, Samantha Dawes, Emily Wilson, Howard Sandler

Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois; Department of Radiation Oncology, Edward Hines Jr, VA Hospital, Hines, Illinois. Electronic address: ., Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin., American Society for Radiation Oncology, Arlington, Virginia., Department of Radiation Oncology, James A. Haley Veterans Affairs Healthcare System, Tampa, Florida., Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri; Department of Radiation Oncology, University of Missouri, Kansas City, Missouri., Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia., Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia; National Radiation Oncology Program, Veteran's Healthcare Administration, Richmond, Virginia., National Radiation Oncology Program, Veteran's Healthcare Administration, Richmond, Virginia., Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California., Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas., Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin., Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri., Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York; Department of Radiation Medicine, Zucker School of Medicine, Hempstead, New York., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.