Calendar-defined missed-workday gaps in radiotherapy: a site- and phase-stratified audit with linkage sensitivity analyses.
- 1Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
Abstract
Background
Missed treatment workdays can prolong overall treatment time and may reduce tumor control, yet routine audits often conflate weekends, statutory holidays, and departmentally accepted rest schedules with untreated institutional workdays.Methods
We quantified calendar-defined missed-workday gaps-inter-fraction intervals containing ≥1 untreated institutional workday after excluding routine rest days-among patients with first treatment between June 2021 and December 2025 who were linkable between the MOSAIQ radiotherapy information system and the institutional oncology database (1,319 patients; 1,342 episodes). A locked stratified sample of 100 algorithm-positive gaps underwent documentation-based chart review as unplanned relevant (UR) or planned/appropriate (PA). We analyzed linkage sensitivity, opportunity-adjusted site rates with patient-clustered confidence intervals (CIs), opportunity-offset Poisson generalized estimating equations (GEE) including calendar year, and episode-clustered phase GEE.Results
Under the documentation-based chart-review rule, 92 of 100 algorithm-positive gaps were labeled UR (17 department/equipment; 75 patient-factor) and 8 PA. Gaps occurred in 638/1,342 episodes (47.5%; patient-level 48.0%). Linked versus unlinked prevalence was 48.2% versus 51.7% (absolute difference -3.4 percentage points, 95% CI -11.2 to 4.4; P = 0.435). Among subgroups with ≥50 episodes, head and neck had the highest prevalence (75.3%) and breast the lowest (41.3%); opportunity-adjusted rates were 5.63 (cluster-bootstrap 95% CI 4.76-6.52) versus 2.63 (2.36-2.92) per 100 opportunities. Opportunity-offset Poisson GEE with calendar year gave a head-and-neck versus breast incidence rate ratio (IRR) of 2.99 (95% CI 2.18-4.11). An exploratory phase GEE (29,763 intervals; 1,323 clusters) showed a late versus early odds ratio (OR) of 1.31 (95% CI 1.12-1.54; P = 0.0009; absolute rates 2.8% vs 3.6%); after site, year, and intent adjustment, the OR was 1.32 (95% CI 1.12-1.57).Conclusions
This operational audit of institutional workdays without recorded treatment-rather than clinically confirmed unplanned interruptions-shows frequent gaps after excluding routine rest. Most reviewed positives received patient-factor labels under a documentation rule. Calendar-aware auditing may support departmental monitoring; priority-based compensation remains a proposed application.
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BibTeX
@article{lei2026calendardefined,
title = {{Calendar-defined missed-workday gaps in radiotherapy: a site- and phase-stratified audit with linkage sensitivity analyses.}},
author = {Runhong Lei and Yongping Zheng and Yi Chen and Haitao Sun and Ang Qu and Ping Jiang},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1932765},
url = {https://europepmc.org/article/MED/42908819},
note = {CC BY},
}
RIS
TY - JOUR
TI - Calendar-defined missed-workday gaps in radiotherapy: a site- and phase-stratified audit with linkage sensitivity analyses.
AU - Runhong Lei
AU - Yongping Zheng
AU - Yi Chen
AU - Haitao Sun
AU - Ang Qu
AU - Ping Jiang
PY - 2026
DA - 2026/10/07
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1932765
UR - https://europepmc.org/article/MED/42908819
AB - Background Missed treatment workdays can prolong overall treatment time and may reduce tumor control, yet routine audits often conflate weekends, statutory holidays, and departmentally accepted rest schedules with untreated institutional workdays.Methods We quantified calendar-defined missed-workday gaps-inter-fraction intervals containing ≥1 untreated institutional workday after excluding routine rest days-among patients with first treatment between June 2021 and December 2025 who were linkable between the MOSAIQ radiotherapy information system and the institutional oncology database (1,319 patients; 1,342 episodes). A locked stratified sample of 100 algorithm-positive gaps underwent documentation-based chart review as unplanned relevant (UR) or planned/appropriate (PA). We analyzed linkage sensitivity, opportunity-adjusted site rates with patient-clustered confidence intervals (CIs), opportunity-offset Poisson generalized estimating equations (GEE) including calendar year, and episode-clustered phase GEE.Results Under the documentation-based chart-review rule, 92 of 100 algorithm-positive gaps were labeled UR (17 department/equipment; 75 patient-factor) and 8 PA. Gaps occurred in 638/1,342 episodes (47.5%; patient-level 48.0%). Linked versus unlinked prevalence was 48.2% versus 51.7% (absolute difference -3.4 percentage points, 95% CI -11.2 to 4.4; P = 0.435). Among subgroups with ≥50 episodes, head and neck had the highest prevalence (75.3%) and breast the lowest (41.3%); opportunity-adjusted rates were 5.63 (cluster-bootstrap 95% CI 4.76-6.52) versus 2.63 (2.36-2.92) per 100 opportunities. Opportunity-offset Poisson GEE with calendar year gave a head-and-neck versus breast incidence rate ratio (IRR) of 2.99 (95% CI 2.18-4.11). An exploratory phase GEE (29,763 intervals; 1,323 clusters) showed a late versus early odds ratio (OR) of 1.31 (95% CI 1.12-1.54; P = 0.0009; absolute rates 2.8% vs 3.6%); after site, year, and intent adjustment, the OR was 1.32 (95% CI 1.12-1.57).Conclusions This operational audit of institutional workdays without recorded treatment-rather than clinically confirmed unplanned interruptions-shows frequent gaps after excluding routine rest. Most reviewed positives received patient-factor labels under a documentation rule. Calendar-aware auditing may support departmental monitoring; priority-based compensation remains a proposed application.
SN - 2234-943X
ER -