Frontiers in oncology
Calendar-defined missed-workday gaps in radiotherapy: a site- and phase-stratified audit with linkage sensitivity analyses
By Lei R, Zheng Y, Chen Y and 3 others.
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.