Clinical Audit in Radiation Oncology: Results from One Academic Centre in Delhi, India

  • Kaur, Jaspreet (Department of Radiotherapy, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Mohanti, Bidhu Kalyan (Department of Radiotherapy, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences) ;
  • Muzumder, Sandeep (Department of Radiotherapy, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences)
  • Published : 2013.05.30


The objective was to analyze the radiotherapy (RT) practice at the cancer centre of a tertiary academic medical institution in Delhi. This audit from an Indian public institution covered patient care processes related to cancer diagnosis, integration of RT with other anti-cancer modalities, waiting time, overall treatment time, and compliance with RT. Over a period of one year, all consecutively registered patients in radiotherapy were analyzed for the audit cycle. Analysis of 1,030 patients showed median age of 49.6 years, with presentation as stage I and II in 14.2%, stage III and IV in 71.2% and unknown stage in 14.6%. A total of 974 (95%) were advised for RT appointment; 669 (68.6%) for curative intent and 31.4% for palliation. Mean times for diagnostic workup and from registration at cancer centre to radiotherapy referral were 33 and 31 days respectively. Median waiting time to start of RT course was 41 days. Overall RT compliance was 75% and overall duration for a curative RT course ranged from 50 days to 61 days. Non-completion and interruption of RT course were observed in 12% and 13% respectively. Radiotherapy machine burden in a public cancer hospital in India increases the waiting time and 25% of advised patients do not comply with the prescribed treatment. Infrastructure, machine and manpower constraints lead to more patients being treated on cobalt (74%) and by two-dimensional (78%) techniques.


  1. American Joint Committee on Cancer (2002). AJCC Cancer Staging Manual. 6th ed. Philadelphia, PA: Lippincott-Raven Publishers.
  2. Ang KK, Chen A, Curran WJ Jr, et al (2012). Head and neck carcinoma in the United States: first comprehensive report of the longitudinal oncology registry of head and neck carcinoma (LORHAN). Cancer, 118, 5783-92.
  3. Barton MB, Frommer M, Shafiq J (2006). Role of radiotherapy in cancer control in low-income and middle-income countries. Lancet Oncol, 7, 584-95.
  4. Benk V, Przybysz R, McGowan T, Paszat L (2006). Waiting times for radiation therapy in Ontario. Can J Surg, 49, 16-21.
  5. Bhatt CR, K Sharan K, Ninan J, et al (2009). Cancer treatment by radiotherapy in Western Nepal:a hospital-based study. Asian Pac J Cancer Prev, 10, 205-8.
  6. Budiharto T, Musat E, Poortmans P, et al (2008). EORTC Radiation Oncology Group. Profile of European radiotherapy departments contributing to the EORTC Radiation Oncology Group (ROG) in the 21st century. Radiother Oncol, 88, 403-10.
  7. Delaney G, Jacob S, Featherstone C, Barton M (2005). The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer, 104, 1129-37.
  8. Dische S (1984). Quality assurance in radiation therapy: European experience-present and future clinical efforts. Int J Radiat Oncol Biol Phys, 10, 55-7.
  9. Dinshaw KA (1996). Radiation oncology: the Indian scenario. Int J Radiat Oncol Biol Phys, 36, 941-3.
  10. Eifel PJ, Moughan J, Erickson B, et al (2004). Patterns of radiotherapy practice for patients with carcinoma of the uterine cervix: a patterns of care study. Int J Radiat Oncol Biol Phys, 60, 1144-53.
  11. European Society of Radiology (ESR) (2011). European commission guidelines on clinical audit. Statement by the European society of radiology. Insights Imaging, 2, 97-8.
  12. Fesinmeyer MD, Mehta V, Tock L, et al (2009). Completion of radiotherapy for local and regional head and neck cancer in medicare. Arch Otolaryngol Head Neck Surg, 135, 860-7.
  13. Global Cancer Facts and Figures (2011). American Cancer Society. Accessed: 21 November 2012.
  14. Hansen RP, Vedsted P, Sokolowski I, Sondergaard J, Olesen F (2011). Time intervals from first symptom to treatment of cancer: a cohort study of 2, 212 newly diagnosed cancer patients. BMC Health Serv Res, 11, 284.
  15. International Atomic Energy Agency (2007).Comprehensive audits of radiotherapy practices: a tool for quality improvement: Quality Assurance Team for Radiation Oncology(QUATRO). IAEA.Vienna :ISBN 92-0-103707-4.
  16. Joint Council for Clinical Oncology (1993). Reducing delays in cancer treatment: some targets. London: Royal College of Physicians.
  17. Jensen AR, Nellemann HM, Overgaard J (2007). Tumor progression in waiting time for radiotherapy in head and neck cancer. Radiother Oncol, 84, 5-10.
  18. Kron T, Azhari H, Voon E, et al (2012). Medical physics aspects of cancer care in the Asia Pacific region: 2011 survey results. Biomed Imaging Interv J, 8, 10.
  19. Moller TR, Brorsson B, Ceberg J, et al (2003). SBU Survey Group. A prospective survey of radiotherapy practice 2001 in Sweden. Acta Oncol, 42, 387-410.
  20. Murthy NS, Chaudhry K, Rath GK(2008). Burden of cancer and projections for 2016, Indian Scenario: gaps in the availability of radiotherapy treatment facilities. Asian Pac J Cancer Prev, 9, 671-7.
  21. National Institute for Clinical Excellence (2002). Principles for Best Practice in Clinical Audit. Oxford: Radcliffe Medical Press Ltd.
  22. Numasaki H, Nishio M, Ikeda H, et al (2012). Japanese society for therapeutic radiology and oncology database committee. Japanese structure survey of radiation oncology in 2009 with special reference to designated cancer care hospitals. Int J Clin Oncol, [Epub ahead of print].
  23. Olesen F, Hansen RP, Vedsted P (2009). Delay in diagnosis: the experience in Denmark. Br J Cancer, 101, 5-8.
  24. Pal SK, Mittal B (2004). Improving cancer care in India: prospects and challenges. Asian Pac J Cancer Prev, 5, 226-8.
  25. Patel UA, Thakkar KH, Holloway N (2008). Patient compliance to radiation for advanced head and neck cancer at a tertiary care county hospital. Laryngoscope, 118, 428-32.
  26. Porter A, Aref A, Chodounsky Z, et al (1999). A global strategy for radiotherapy: a WHO consultation. Clin Oncol (R Coll Radiol), 11, 368-70.
  27. Rao DN, Shroff PD, Chattopadhyay G, Dinshaw KA (1998). Survival analysis of 5595 head and neck cancers--results of conventional treatment in a high-risk population. Br J Cancer, 77, 1514-8.
  28. Rayson D, Saint-Jacques N, Younis T, Meadows J, Dewar R (2007). Comparison of elapsed times from breast cancer detection to first adjuvant therapy in Nova Scotia in 1999/2000 and 2003/04. CMAJ, 176, 327-32.
  29. Rutqvist LE (2006). Waiting times for cancer patients--a “slippery slope” in oncology. Acta Oncol, 45, 121-3.
  30. Salminen EK, Kiel K, Ibbott GS, et al (2011). International Conference on Advances in Radiation Oncology (ICARO): outcomes of an IAEA meeting. Radiat Oncol, 6, 11.
  31. Serkies K, Jassem J (2004). Concurrent weekly cisplatin and radiotherapy in routine management of cervical cancer: a report on patient compliance and acute toxicity. Int J Radiat Oncol Biol Phys, 60, 814-21.
  32. Sethi RA, Stamell EF, Price L, DeLacure M, Sanfilippo N (2010). Head and neck radiotherapy compliance in an underserved patient population. Laryngoscope, 120, 1336-41.
  33. Shikama N, Nishikawa A, Mitsumori M, et al (2003). Patterns of care study: comparison of process of post-mastectomy radiotherapy (PMRT) in Japan and the USA. Jpn J Clin Oncol, 33, 518-21.
  34. Soimakallio S, Alanen A, Jarvinen H, et al (2011). Clinical audit: development of the criteria of good practices. Radiat Protect Dosimetry, 147, 30-3.
  35. Stevens G, Firth I (1996). Clinical audit in radiation oncology: results from one centre. Australas Radiol, 40, 47-54.
  36. The American Society for Radiation Oncology (2004) Fast Facts About Radiation Therapy. ASTRO Fact Sheet for immediate review.
  37. Thomsen MS, Norrevang O (2009). A model for managing patient booking in a radiotherapy department with differentiated waiting times. Acta Oncol, 48, 251-8.
  38. Trott K (1990). Cell repopulation and overall treatment time. Int J Radiat Oncol Biol Phys, 19, 1071-5.
  39. Valentini V, Bourhis J, Hollywood D (2012). ESTRO 2012 strategy meeting: vision for radiation oncology. Radiother Oncol, 103, 99-102.
  40. Van de Werf E, Verstraete J, Lievens Y (2012). The cost of radiotherapy in a decade of technology evolution. Radiother Oncol, 102, 148-53.
  41. Williams MV, Summers ET, Drinkwater K, Barrett A (2007) . Radiotherapy dose fractionation, access and waiting times in the countries of theUK in 2005. Clin Oncol (R Coll Radiol), 19, 273-86.

Cited by

  1. Locoregional recurrences after post-operative volumetric modulated arc radiotherapy (VMAT) in oral cavity cancers in a resource constrained setting: experience and lessons learned vol.88, pp.1048, 2015,