Does Peer-Review of Radiation Treatment Plans Impact Clinical Care? A Systematic Review of the Literature

Abstract

Peer-review of radiation plans is recommended as an approach to improving patient safety and quality of care. However, peer-review rounds are resource-intensive, and their impact on clinical care is not well-quantified. The objective of this study was to undertake a systematic review of the literature to assess the impact of peer-review on clinical care. A systemic review of the literature was conducted according to PRISMA guidelines, including MEDLINE, EMBASE, and abstracts from relevant radiation oncology meetings. For inclusion, studies were required to report the impact of physician peer-review on at least one element of treatment planning (e.g. target volume/organ-at-risk delineation, dose prescription, or dosimetry). Surveys in which radiation oncologists were asked to estimate the impact of peer-review on treatment planning were also included to ascertain physician perspective on the clinical impact of peer review. Studies reporting central review of contours in clinical trials were excluded. All proportions reported represent weighted averages across studies. The initial search yielded 882 potentially eligible studies. Full-text review was performed independently by two researchers, with discrepancies settled by a third. In total, 16 studies met inclusion criteria and were included in the final analysis. Twelve studies, involving 12,239 patients, reported patient outcomes whereas, four surveys reported oncologists’ estimates of clinical impact. Studies were recent, with the majority (75%) published since 2010. Twelve studies reported on multiple tumor sites, while single-site studies included head and neck (n=1), lung (n=2), and breast (n=1). In most studies, peer-review occurred before the start of radiotherapy or within the first few fractions. Overall, peer-review resulted in modifications to 10.7% of patient plans. Five studies differentiated between minor versus major changes and reported averages of 7.5% minor changes and 2.5% major changes. From the survey studies, oncologists estimates that modifications occurred in 6% of treatment plans. Based on a systematic review of the literature, peer-review results in changes in clinical care in approximately 1 out every 9 cases overall, with major changes in approximately 1 out of every 40 cases. Further research is required to determine the essential elements of peer-review, and to assess the impact of peer review on clinical outcomes.