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. 2025 Aug:44:103886.
doi: 10.1016/j.clon.2025.103886. Epub 2025 May 30.

Quality Indicators and Benchmarks for Radiotherapy in Lung Cancer: A Modified Delphi Approach

K-L Chiew  1 , C Donnelly  2 , S V Harden  3 , G G Hanna  4 , N Hardcastle  5 , S Jolly  6 , M Lehman  7 , M M Matuszak  6 , F McDonald  8 , Y Y Soon  9 , Y M Tsang  10 , F Ynoe Moraes  11 , S K Vinod  12
Affiliations
Free article

Quality Indicators and Benchmarks for Radiotherapy in Lung Cancer: A Modified Delphi Approach

K-L Chiew et al. Clin Oncol (R Coll Radiol). 2025 Aug.
Free article

Abstract

Aims: While there are many published quality indicators (QIs) for assessing clinical care in lung cancer, few specifically measure the quality of radiotherapy (RT). To address this gap, we used a structured modified Delphi technique to develop a core set of QIs and benchmarks to evaluate RT processes for lung cancer treatment.

Materials and methods: Candidate QIs identified from the systematic review were evaluated through survey consensus and deliberation by a multidisciplinary reference committee for inclusion in the initial survey and then after each round. A modified Delphi technique was employed across two rounds to reach consensus for QI development. The international expert survey panel consisting of radiation oncologists treating lung cancer rated QI importance, feasibility, and benchmarks, with consensus predefined as at least 70% of respondents reaching a threshold rating on a Likert scale.

Results: There were 70 respondents over two surveys, with 30 of the 47 QIs reaching the threshold for importance in the first Delphi round and 29 after the final Delphi round. Agreement ranged from 71% to 97% with 12 QIs reaching a consensus of 90% or more. Final consensus was reached as all 29 QIs were identified as feasible, and 27 of the suggested benchmarks were deemed acceptable.

Conclusion: This core set of QIs provides a well-defined framework for evaluating RT processes in lung cancer treatment. They have the potential to establish a foundation for standardised quality measurement and benchmarking for guiding quality improvement efforts and improving patient outcomes.

Keywords: Lung cancer; quality indicators; quality of care; radiotherapy.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gerard G Hanna reports a relationship with AstraZeneca Pharmaceuticals LP that includes consulting or advisory. Gerard G Hanna reports a relationship with Merck Sharp & Dohme UK Ltd that includes travel reimbursement. Nicholas Hardcastle reports a relationship with SeeTreat Medical that includes consulting or advisory. Nicholas Hardcastle reports a relationship with Varian Medical Systems Inc that includes funding grants. Gerard G Hanna reports a relationship with ADDRAD study that includes board membership. Gerard G Hanna reports a relationship with SPORT study that includes board membership. Shalini K Vinod reports a relationship with AstraZeneca Pharmaceuticals LP that includes speaking and lecture fees. Shalini K Vinod reports a relationship with Merck Sharp & Dohme (Australia) Pty Limited that includes speaking and lecture fees. Kim-Lin Chiew reports a relationship with AstraZeneca Pharmaceuticals LP that includes speaking and lecture fees and travel reimbursement. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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