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Sharp J, Mulcare H, Schofield P. Trajectories of distress in women with gynaecological cancer treated with curative-intent radiotherapy. Psychol Health 2024; 39:1466-1484. [PMID: 36628613 DOI: 10.1080/08870446.2022.2162555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/11/2022] [Accepted: 12/18/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aims of this study were to investigate trajectories of anxiety and depression symptoms among gynaecological cancer (GC) patients having curative-intent radiotherapy (RT) treatment and identify which patient characteristics predict anxiety and depression trajectories. METHODS AND MEASURES Latent profile analysis (LPA) was used to identify unique trajectories of anxiety and depression symptoms, spanning prior to the start of RT until 12-month post-RT, among 151 GC patients in the PeNTAGOn randomized control trial. Demographic and clinical characteristics were assessed at baseline, and anxiety and depression symptoms were assessed five times over 12 months. A bias-adjusted 3-step maximum likelihood approach was used to identify demographic and clinical predictors of trajectory profiles. RESULTS Four latent profiles each were identified for anxiety and depression trajectories. Most patients had minimal to mild levels of anxiety or depression that remained steady or declined over 12 months following treatment. A minority of patients were in profiles that exhibited clinically significant distress; either 'High fluctuating' anxiety or 'Mild-moderate fluctuating' depression. Anxiety and depression profiles were predicted by clinical and demographic factors, such as age, living arrangements, RT type, cancer stage, physical symptom distress and use of support services. CONCLUSIONS Psychological care of patients in the higher distress trajectories is paramount and, importantly, they could be identified prior to treatment based on the factors identified. Review for at least a month post-RT is warranted.
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Affiliation(s)
- Jessica Sharp
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Hunter Mulcare
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Psychology Department, Western Health, St Albans, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
- Behavioural Sciences Unit, Health Service Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
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2
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Fakes K, Boyes A, Hall A, Carey M, Leigh L, Brown S, Sanson-Fisher R. Trajectories and Predictors of Raised State Anxiety Among Outpatients Who Have Undergone Medical Imaging Procedures. J Am Coll Radiol 2024; 21:285-294. [PMID: 37453598 DOI: 10.1016/j.jacr.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The aim of this study was to examine the prevalence of raised state anxiety before and after medical imaging procedures, the prevalence of state anxiety trajectories, and factors associated with postprocedural raised state anxiety. METHODS A prospective survey was administered to outpatients undergoing elective medical imaging procedures (CT, radiography, MRI, ultrasound, angiography, or fluoroscopy) recruited from one center. Participants completed a self-report survey preprocedure (time 1) and postprocedure (time 2). State anxiety was measured using the six-item State-Trait Anxiety Inventory. The point prevalence of raised state anxiety (State-Trait Anxiety Inventory score ≥33.16) at time 1 and time 2 was calculated, as was the prevalence of four state anxiety trajectories over time: persistent low anxiety, decreasing anxiety, increasing anxiety, and persistent raised anxiety. Factors predictive of raised state anxiety at time 2 were examined using logistic regression analysis. RESULTS Three hundred fifteen participants completed both surveys. The prevalence of raised state anxiety at time 1 (50%) and time 2 (51%) was similar. Most patients reported persistent raised anxiety (36%) and persistent low anxiety (34%) over time. Fewer patients reported increasing anxiety (15%) and decreasing anxiety (14%). Raised state anxiety (odds ratio, 4.84; 95% confidence interval, 2.48-9.48) and lower reported health status (odds ratio, 2.48; 95% confidence interval, 1.11-5.51) at time 1 were significantly associated with greater odds of raised anxiety at time 2. CONCLUSIONS Raised state anxiety related to medical imaging procedures is common among outpatients. Half of patients either developed or continued to experience raised anxiety after their procedures. Outpatients may benefit from evidence-based methods of alleviating anxiety before their procedures.
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Affiliation(s)
- Kristy Fakes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Allison Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Mariko Carey
- Hunter Medical Research Institute, New Lambton Heights, Australia; Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sandy Brown
- Hunter New England Imaging, John Hunter Hospital/Royal Newcastle Centre, New Lambton Heights, Australia
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3
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Dayan G, Bahig H, Fortin B, Filion É, Nguyen-Tan PF, O'Sullivan B, Charpentier D, Soulières D, Gologan O, Nelson K, Létourneau L, Schmittbuhl M, Ayad T, Bissada E, Guertin L, Tabet P, Christopoulos A. Predictors of prolonged treatment time intervals in oral cavity cancer. Oral Oncol 2023; 147:106622. [PMID: 37948896 DOI: 10.1016/j.oraloncology.2023.106622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Delays in treatment time intervals have been associated with overall survival in oral cavity squamous cell carcinoma (OCSCC). The aim of this study was to identify bottlenecks leading to prolonged treatment intervals. MATERIAL AND METHODS A retrospective analysis was conducted using a cohort of OCSCC patients who underwent surgery and adjuvant radiation therapy. The endpoints of interest were prolonged treatment intervals. Multivariable logistic regression was used to adjust for patient and tumour characteristics. RESULTS Median diagnosis-to-treatment interval (DTI) and surgery to initiation of postoperative radiation therapy interval (S-PORT) were 39 days (IQR 30-54) and 64 days (IQR 54-66), respectively. Prolonged DTI was associated with older age, worse Charlson Comorbidity index scores and worse T stages. Patients with prolonged DTI had longer times to preoperative imaging reports (25 vs 9 days; P < 0.01). Time to preoperative pathology did not differ. Prolonged S-PORT was associated with longer times to pathology report (28 vs 18 days; P < 0.01), to maxillofacial consult (38 vs 15 days; P < 0.01) and to maxillofacial approval of radiation (50 vs 28 days; P < 0.01). In patients requiring medical oncology consults, those with prolonged S-PORT had longer waiting times until consultation (58 vs 38 days; P = 0.02). Multivariate analysis showed independent predictors of prolonged DTI: time to preoperative imaging; and prolonged S-PORT: time to pathology report, time to maxillofacial consult, and time to medical oncology consult. CONCLUSIONS Strategies targeting these organizational bottlenecks may be effective for shortening treatment time intervals, hence representing potential opportunities for improving oncological outcomes in OCSCC patients.
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Affiliation(s)
- Gabriel Dayan
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Fortin
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Hopital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Édith Filion
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Phuc-Felix Nguyen-Tan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Charpentier
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Denis Soulières
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Olga Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Kristoff Nelson
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Létourneau
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Matthieu Schmittbuhl
- Department of Stomatology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Tareck Ayad
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Eric Bissada
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Louis Guertin
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Paul Tabet
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada.
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Kotha NV, Guram K, Morgan K, Deshler L, Brown D, Rash D, Dyer B, McHale M, Yashar C, Scanderbeg D, Einck J, Mayadev J. A randomized patient education trial investigating treatment-related distress and satisfaction with the use of an at-home gynecologic brachytherapy educational video. Int J Gynecol Cancer 2023:ijgc-2023-004331. [PMID: 37247940 DOI: 10.1136/ijgc-2023-004331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Physician explanation of gynecologic brachytherapy can be overwhelming or induce patient anxiety, and may be time-constrained given clinical limitations. We report the first randomized trial of an educational video intervention in gynecologic brachytherapy on patient-reported outcomes. METHODS Between February 2020 and January 2022, 80 gynecologic cancer patients prescribed brachytherapy were randomly assigned to either standard informed consent (Arm A) or a supplemental 16 min brachytherapy educational video (https://vimeo.com/403385455/d0716e3cc8) via the internet (Arm B). Primary outcome was treatment-related distress (National Comprehensive Cancer Network (NCCN) distress scale scored 0 (no distress) to 10 (maximum distress)). Secondary outcome was patient satisfaction (summated Likert-scale scored 11-55). Surveys were administered at baseline, after first treatment, and prior to brachytherapy completion. RESULTS All patients completed the prescribed brachytherapy. In Arm B, 19/40 (48%) patients and 10/40 (25%) patients' family/friends viewed the video. For patients that completed all surveys (Arm A n=29, Arm B n=28), there was no difference between arms in the sociodemographic, clinical, or treatment variables. Distress scores were low at baseline (Arm A median 4, Arm B median 4, p=0.65) and there was no detectable change in distress between arms on surveys 1 and 2 (β 0.36, p=0.67) or surveys 1 and 3 (β -1.02, p=0.29) in multivariable analysis. Satisfaction scores were high at baseline (Arm A median 54, Arm B median 54.5, p=0.64) and there was no detectable change in satisfaction between arms on surveys 1 and 2 (β 0.22, p=0.93) or surveys 1 and 3 (β 0.63, p=0.85) in multivariable analysis. CONCLUSIONS Among patients randomized to an educational video tool for gynecologic brachytherapy, approximately 50% of the cohort and 25% of the cohort's family/friends used the video. Overall, patients had low distress scores and high satisfaction scores with no significant differences between the standard and video intervention arms. Further work is needed to understand factors contributing to gynecologic brachytherapy anxiety. TRIAL REGISTRATION NUMBER NCT04363957.
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Affiliation(s)
- Nikhil V Kotha
- Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Kripa Guram
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Kylie Morgan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Leah Deshler
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Derek Brown
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Dominique Rash
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Brandon Dyer
- Radiation Oncology, Legacy Health System, Portland, Oregon, USA
| | - Michael McHale
- Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Daniel Scanderbeg
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - John Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
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5
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Casà C, Dinapoli L, Marconi E, Chiesa S, Cornacchione P, Beghella Bartoli F, Bracci S, Salvati A, Scalise S, Colloca GF, Chieffo DPR, Gambacorta MA, Valentini V, Tagliaferri L. Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives. Front Public Health 2023; 11:1056307. [PMID: 36755901 PMCID: PMC9901799 DOI: 10.3389/fpubh.2023.1056307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.
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Affiliation(s)
- Calogero Casà
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Marconi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,*Correspondence: Elisa Marconi ✉
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Cornacchione
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Scalise
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Vicinanza F, Ippolito E, Sisto A, Santo B, Fiore M, Trodella LE, Silipigni S, Quintiliani L, Ramella S. The psychological impact of the covid-19 pandemic on radiotherapy cancer patients. Transl Oncol 2022; 22:101457. [PMID: 35607456 PMCID: PMC9117227 DOI: 10.1016/j.tranon.2022.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/25/2022] Open
Abstract
In March 2020, the World Health Organization (WHO) characterized the outbreak of the coronavirus disease 2019 (COVID-19) as a pandemic. The aim of this study was to evaluate the psychological impact of the COVID-19 pandemic on cancer patients undergoing radiotherapy. Were enrolled 210 patients in treatment and in follow-up who had access to the Radiation Oncology Department of the Campus Bio-Medico University Hospital Foundation between April and May 2020. The sample was subjected to structured interview and validated questionnaires. 37% of patients showed significant levels of distress; depressive symptoms were reported by 22.4% of patients and 99% of sample had clinically significant anxiety symptoms. All patients anxiety worsened during the COVID-19 pandemic (p=< 0.001). Patients on active treatment had higher levels of distress (3.5 vs 2.6; p = 0.04) and anxiety (3.5 vs 2.6; p = 0.04). Lung cancer patients appeared to be more afraid of COVID-19 than other patients (24.2 vs 22.2). This study highlights the presence of clinically significant anxiety in 99% of sample. This conclusion reflects the condition of emotional distress present during the pandemic which makes it necessary to treat patients in a multidisciplinary perspective that includes psychological support in the care plan.
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Affiliation(s)
- Flavia Vicinanza
- Clinical Psychological Service, Campus Bio-Medico University Hospital Foundation, Italy
| | - Edy Ippolito
- Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Italy
| | - Antonella Sisto
- Clinical Psychological Service, Campus Bio-Medico University Hospital Foundation, Italy.
| | - Bianca Santo
- Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Italy
| | - Michele Fiore
- Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Italy
| | - Luca Eolo Trodella
- Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Italy
| | - Sonia Silipigni
- Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Italy
| | - Livia Quintiliani
- Clinical Psychological Service, Campus Bio-Medico University Hospital Foundation, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University Hospital Foundation, Italy
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7
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Kirkove D, Barthelemy N, Coucke P, Mievis C, Ben Mustapha S, Jodogne S, Dardenne N, Donneau AF, Pétré B. [Feasibility study: The medical imaging as a tool for therapeutic education in radiotherapy]. Cancer Radiother 2022; 26:1034-1044. [PMID: 35843782 DOI: 10.1016/j.canrad.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Assess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy. MATERIALS AND METHODS Experimental feasibility trial of "RCT" type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software "Stone of Orthanc". RESULTS Forty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 - 2.2)) vs (+ 1.4 (1.4 - 1.8)), as well as a decrease in scores related to anxiety (- 3.0 (-4.5 - (-2.0)) vs - 1.0 (-5.0 - 0.0)) and emotional distress ((- 5.0 (- 7.5 - (- 3.5)) vs (- 2.0 (- 5.0 - (- 1.0)) A significant reduction (p=0.043) is observed for the depression score ((- 2.0 (-3.0 - (-1.5)) vs (0.0 (0.0 - 0.0)). CONCLUSION This study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.
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Affiliation(s)
- D Kirkove
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique.
| | - N Barthelemy
- Service Equipe mobile de soins palliatifs, Oncologie Radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - P Coucke
- Département de Physique Médicale, Service médical de radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - C Mievis
- Service Equipe mobile de soins palliatifs, Oncologie Radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - S Ben Mustapha
- Service Equipe mobile de soins palliatifs, Oncologie Radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - S Jodogne
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain School of Engineering, 1348 Louvain-la-Neuve, Belgique
| | - N Dardenne
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique; Centre Hospitalo-Universitaire Biostatistique et méthodes de recherche (B-STAT), Faculté de Médecine, Université de Liège, B23/Avenue Hippocrate, n°13, 4000 Liège, Belgique
| | - A-F Donneau
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique; Centre Hospitalo-Universitaire Biostatistique et méthodes de recherche (B-STAT), Faculté de Médecine, Université de Liège, B23/Avenue Hippocrate, n°13, 4000 Liège, Belgique
| | - B Pétré
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique
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8
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Xu C, Yang KB, Feng RJ, Chen L, Du XJ, Mao YP, Li WF, Liu Q, Sun Y, Ma J. Radiotherapy interruption due to holidays adversely affects the survival of patients with nasopharyngeal carcinoma: a joint analysis based on large-scale retrospective data and clinical trials. Radiat Oncol 2022; 17:36. [PMID: 35183221 PMCID: PMC8858542 DOI: 10.1186/s13014-022-02006-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
Background The impact of radiotherapy interruption due to the Spring Festival holidays in China on the survival of patients with nasopharyngeal carcinoma (NPC) is unclear. Methods Nontrial patients with locoregionally advanced NPC receiving radiotherapy plus induction chemotherapy (IC) and/or concurrent chemotherapy (CC) were included (N = 5035) and divided into two groups based on the Spring Festival-induced radiotherapy interruption. Kaplan–Meier curves for overall survival (OS) and failure-free survival (FFS) were compared between rival groups. Impact of the timing of radiotherapy interruption (during or outside the Spring Festival) on survival was investigated in a propensity score-matched dataset. We adopted ordination correspondence analysis to determine the cut-off of radiotherapy prolongation for prognostic prediction, and accordingly performed subgroup analysis based on delayed days and chemotherapy details. Individual patient data of three phase III NPC trials (NCT00677118, NCT01245959, NCT01872962) were used for validation (N = 1465). Results Radiotherapy interruption was most frequently observed between December to January of the following year. Significantly lower OS and FFS were associated with the Spring Festival-induced interruption of radiotherapy (P = 0.009 and 0.033, respectively), but not that interruption of IC. In two matched comparison groups, the timing of radiotherapy interruption during the Spring Festival was more likely to lead to a decrease in FFS than outside the Spring Festival (P = 0.046), which was not observed in the validation using clinical trial data or in the subgroup analysis based on the 5-day delayed time. The absence of CC and the accumulated dose of cisplatin < 200 mg were related to the negative influences of the Spring Festival-induced radiotherapy interruption on FFS (P = 0.002) and OS (P = 0.010), respectively. Conclusions The poor survival of patients with NPC is associated with the Spring Festival-induced interruption of radiotherapy. We recommend that these patients receive adequate doses of cisplatin concurrently with radiotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02006-5.
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9
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Pembroke M, Bradley J, Mueller M, Mollica M, Nemeth LS. Feasibility of Breast Radiation Therapy Video Education Combined With Standard Radiation Therapy Education for Patients With Breast Cancer. Oncol Nurs Forum 2021; 48:279-290. [PMID: 33856002 DOI: 10.1188/21.onf.279-290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the feasibility of incorporating a brief animated educational video shown during the radiation therapy (RT) consultation appointment for patients with breast cancer and to collect preliminary quality-of-life data. SAMPLE & SETTING 20 participants with breast cancer were recruited from an outpatient radiation oncology facility in the southeastern United States. METHODS & VARIABLES This single-arm, pre- and post-test feasibility study aimed to assess feasibility and preliminary outcomes of patient-reported anxiety, distress, and RT concerns. RESULTS The video intervention demonstrated feasibility, as evidenced by meeting or exceeding benchmarks set for recruitment, retention, and feasibility measured scores. The difference in means of total patient-reported scores comparing pre- to postintervention decreased. IMPLICATIONS FOR NURSING The intervention proved feasible. In addition, the decrease in total mean scores suggests the video may have a positive effect on reducing patient distress, anxiety, and RT concerns.
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10
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Lopes de Castro C, Fundowicz M, Roselló A, Jové J, Deantonio L, Aguiar A, Pisani C, Villà S, Boladeras A, Konstanty E, Kruszyna-Mochalska M, Milecki P, Jurado-Bruggeman D, Lencart J, Modolell I, Muñoz-Montplet C, Aliste L, Torras MG, Puigdemont M, Carvalho L, Krengli M, Guedea F, Malicki J. Results of the IROCA international clinical audit in prostate cancer radiotherapy at six comprehensive cancer centres. Sci Rep 2021; 11:12323. [PMID: 34112863 PMCID: PMC8192927 DOI: 10.1038/s41598-021-91723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
To assess adherence to standard clinical practice for the diagnosis and treatment of patients undergoing prostate cancer (PCa) radiotherapy in four European countries using clinical audits as part of the international IROCA project. Multi-institutional, retrospective cohort study of 240 randomly-selected patients treated for PCa (n = 40/centre) in the year 2015 at six European hospitals. Clinical indicators applicable to general and PCa-specific radiotherapy processes were evaluated. All data were obtained directly from medical records. The audits were performed in the year 2017. Adherence to clinical protocols and practices was satisfactory, but with substantial inter-centre variability in numerous variables, as follows: staging MRI (range 27.5-87.5% of cases); presentation to multidisciplinary tumour board (2.5-100%); time elapsed between initial visit to the radiation oncology department and treatment initiation (42-102.5 days); number of treatment interruptions ≥ 1 day (7.5-97.5%). The most common deviation from standard clinical practice was inconsistent data registration, mainly failure to report data related to diagnosis, treatment, and/or adverse events. This clinical audit detected substantial inter-centre variability in adherence to standard clinical practice, most notably inconsistent record keeping. These findings confirm the value of performing clinical audits to detect deviations from standard clinical practices and procedures.
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Affiliation(s)
- Carla Lopes de Castro
- Instituto Português de Oncologia, Porto, Portugal.
- Department of Radiation Oncology, Instituto Português de Oncologia Francisco Gentil-Porto, Porto, Portugal.
| | | | | | - Josep Jové
- Institut Català d'Oncologia, Badalona, Spain
| | - Letizia Deantonio
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | - Artur Aguiar
- Instituto Português de Oncologia, Porto, Portugal
| | - Carla Pisani
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | | | - Anna Boladeras
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | - Marta Kruszyna-Mochalska
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Milecki
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
| | | | | | | | | | - Luisa Aliste
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | | | | | - Marco Krengli
- Università degli Studi del Piemonte Orientale (UNIUPO), Novara, Italy
| | - Ferran Guedea
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | - Julian Malicki
- Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
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11
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Castro-Figueroa EM, Torres-Blasco N, Rosal MC, Jiménez JC, Castro-Rodríguez WP, González-Lorenzo M, Vélez-Cortés H, Toro-Bahamonde A, Costas-Muñiz R, Armaiz-Peña GN, Jim H. Brief Report: Hispanic Patients' Trajectory of Cancer Symptom Burden, Depression, Anxiety, and Quality of Life. NURSING REPORTS 2021; 11:475-483. [PMID: 34968222 PMCID: PMC8608069 DOI: 10.3390/nursrep11020044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Anxiety and depression symptoms are known to increase cancer symptom burden, yet little is known about the longitudinal integrations of these among Hispanic/Latinx patients. The goal of this study was to explore the trajectory and longitudinal interactions among anxiety and depression, cancer symptom burden, and health-related quality of life in Hispanic/Latinx cancer patients undergoing chemotherapy. Methods: Baseline behavioral assessments were performed before starting chemotherapy. Follow-up behavioral assessments were performed at 3, 6, and 9 months after starting chemotherapy. Descriptive statistics, chi-square tests, Fisher’s exact tests, and Mann–Whitney tests explored associations among outcome variables. Adjusted multilevel mixed-effects linear regression models were also used to evaluate the association between HADS scores, follow-up visits, FACT—G scale, MDASI scale, and sociodemographic variables. Results: Increased cancer symptom burden was significantly related to changes in anxiety symptoms’ scores (adjusted β^ = 0.11 [95% CI: 0.02, 0.19]. Increased quality of life was significantly associated with decreased depression and anxiety symptoms (adjusted β^ = −0.33; 95% CI: −0.47, −0.18, and 0.38 adjusted β^= −0.38; 95% CI: −0.55, −0.20, respectively). Conclusions: Findings highlight the need to conduct periodic mental health screenings among cancer patients initiating cancer treatment.
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Affiliation(s)
- Eida M. Castro-Figueroa
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
- Correspondence:
| | - Normarie Torres-Blasco
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | - Milagros C. Rosal
- Population and Quantitative Health Sciences, School of Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA;
| | - Julio C. Jiménez
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | | | - Marilis González-Lorenzo
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | - Héctor Vélez-Cortés
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | | | - Rosario Costas-Muñiz
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, Puerto Rico, CA 00984, USA;
| | - Guillermo N. Armaiz-Peña
- Ponce Health Sciences University-Ponce Research Institute, Ponce 00716, Puerto Rico; (N.T.-B.); (J.C.J.); (M.G.-L.); (H.V.-C.); (G.N.A.-P.)
| | - Heather Jim
- Moffitt Cancer Center, Tampa, FL 33612, USA;
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12
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How do radiation therapists detect and manage patients experiencing anxiety in the radiation oncology setting? A vignette study. Support Care Cancer 2021; 29:5973-5981. [PMID: 33770258 DOI: 10.1007/s00520-021-06133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Anxiety is commonly observed in oncology patients but infrequently screened, assessed or addressed. According to psychosocial guidelines, all healthcare professionals, including radiation therapists, are responsible for the psychosocial care of patients. Radiation therapists (RTs) interact with patients daily throughout treatment; however, little research exists to evaluate RTs' ability to identify and manage patients' psychosocial needs. This study aimed to determine if RTs can detect and manage patient anxiety. METHOD A cross-sectional, mixed-methods survey containing two clinically relevant vignettes was developed. Two fictitious patients were presented to elicit responses reflective of RTs' experiences and judgements in the recognition and management of anxiety. Surveys were distributed via email in Australia, New Zealand and Canada. Ethical approval was obtained from the University of Sydney (2016/227) and informed consent was obtained from participants. RESULTS Eligible and complete surveys were received from 582 respondents (240 (41.2%) from Australia; 78 (13.4%) New Zealand; 264 (45.4%) Canada). Almost all respondents endorsed a relevant descriptor of anxiety (vignette 1, 577 (99.1%); vignette 2, 579 (99.5%)). For both vignettes, the most frequently endorsed management strategy was to acknowledge the patients' feelings and encourage them to express their concerns (vignette 1, 548 (94.2%); vignette 2, 455 (78.2%)). CONCLUSION RTs in Australia, New Zealand and Canada are able to detect anxiety and endorse a strategy to manage patients experiencing anxiety depicted in written vignettes. Exploring RTs' abilities to detect and manage patient anxiety whilst in the high-pressure clinical environment is an important next step.
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13
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O'steen L, Lockney NA, Morris CG, Johnson-Mallard V, Pereira D, Amdur RJ. A Prospective Randomized Trial of the Influence of Music on Anxiety in Patients Starting Radiation Therapy for Cancer. Int J Radiat Oncol Biol Phys 2021; 109:670-674. [PMID: 33121861 DOI: 10.1016/j.ijrobp.2020.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE One of the most downloaded articles in 2017 from the International Journal of Radiation Oncology, Biology, and Physics was a study suggesting that music therapy during radiation therapy (RT) simulation substantially reduces anxiety. To further evaluate the potential of music's clinical efficacy in the context of radiation therapy, we conducted a randomized trial evaluating the influence of genre-based music chosen by the study participant on anxiety during the first RT treatment session with a method that is applicable to routine clinical practice. METHODS AND MATERIALS We conducted a prospective randomized trial of music versus no music during the first RT treatment for cancer. We limited the study to women because prior studies document a higher rate of anxiety in female patients with cancer. Anxiety was evaluated before and after the first RT treatment using the State-Trait Anxiety Inventory (STAI) and Symptom Distress Thermometer (SDT). Patients randomized to music had their preferred genre of music played from a web-based application while in the treatment vault. RESULTS In the study, 102 females were enrolled (51 with and 51 without music). Baseline high anxiety score before RT was recorded in 48% of patients using the STAI and 58% using the SDT. The percent decrease in mean STAI score was 16% with music versus 10% without music (P = .2197). The mean SDT percent changes were a 13% decrease with music versus a 2% increase without music (P = .3298). CONCLUSIONS This study documents that high anxiety is common in women receiving RT for cancer and that music, as used in this study, does not reduce anxiety to a meaningful degree.
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Affiliation(s)
- Lillie O'steen
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Natalie A Lockney
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | | | - Deidre Pereira
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida.
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Li Z, Lin Y, Cheng B, Zhang Q, Cai Y. Prognostic Model for Predicting Overall and Cancer-Specific Survival Among Patients With Cervical Squamous Cell Carcinoma: A SEER Based Study. Front Oncol 2021; 11:651975. [PMID: 34336651 PMCID: PMC8317021 DOI: 10.3389/fonc.2021.651975] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical squamous cell carcinoma (CSCC) is the most common histological subtype of cervical cancer. The purpose of this study was to assess prognostic factors and establish personalized risk assessment nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in CSCC patients. METHODS CSCC patients diagnosed between 1988 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox proportional hazard regression models were applied to select meaningful independent predictors and construct predictive nomogram models for OS and CSS. The concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve were used to determine the predictive accuracy and discriminability of the nomogram. RESULTS A total cohort (n=17962) was randomly divided into a training cohort (n=11974) and a validation cohort (n=5988). Age, race, histologic grade, clinical stage, tumor size, chemotherapy and historic stage were assessed as common independent predictors of OS and CSS. The C-index value of the nomograms for predicting OS and CSS was 0.771 (95% confidence interval 0.762-0.780) and 0.786 (95% confidence interval 0.777-0.795), respectively. Calibration curves of the nomograms indicated satisfactory consistency between nomogram prediction and actual survival for both 3-year and 5-year OS and CSS. CONCLUSION We constructed nomograms that could predict 3- and 5-year OS and CSS of CSCC patients. These nomograms showed good performance in prognostic prediction and can be used as an effective tool to evaluate the prognosis of CSCC patients, thus contributing to clinical decision making and individualized treatment planning.
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Affiliation(s)
- Zhuolin Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, China
| | - Yao Lin
- Department of Plastic Surgery and Burn Center, The Second Affiliated Hospital of Shantou University Medical College, Guangdong, China
| | - Bizhen Cheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, China
| | - Qiaoxin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, China
| | - Yingmu Cai
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Guangdong, China
- *Correspondence: Yingmu Cai,
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15
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Costa DS, Mercieca‐bebber R, Rutherford C, Gabb L, King MT. The Impact of Cancer on Psychological and Social Outcomes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12165] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Sj Costa
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | - Rebecca Mercieca‐bebber
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | - Claudia Rutherford
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
| | | | - Madeleine T King
- Quality of Life Office, Psycho‐oncology Co‐operative Research Group, School of Psychology, University of Sydney,
- Sydney Medical School, University of Sydney,
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16
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Fundowicz M, Aguiar A, de Castro CL, Torras MG, Deantonio L, Konstanty E, Kruszyna-Mochalska M, Macia M, Canals E, Caro M, Pisani C, Zwierzchowska D, Molero J, Eraso A, Lencart J, Muñoz-Montplet C, Carvalho L, Krengli M, Malicki J, Guedea F. Multicentre clinical radiotherapy audit in rectal cancer: results of the IROCA project. Radiat Oncol 2020; 15:208. [PMID: 32854730 PMCID: PMC7453535 DOI: 10.1186/s13014-020-01648-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/19/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To perform a clinical audit to assess adherence to standard clinical practice for the diagnosis, treatment, and follow-up of patients undergoing radiotherapy for rectal cancer treatment in four European countries. MATERIALS AND METHODS Multi-institutional, retrospective cohort study of 221 patients treated for rectal cancer in 2015 at six European cancer centres. Clinical indicators applicable to general radiotherapy processes were evaluated. All data were obtained from electronic medical records. RESULTS The audits were performed in the year 2017. We found substantial inter-centre variability in adherence to standard clinical practices: 1) presentation of cases at departmental clinical sessions (range, 0-100%) or multidisciplinary tumour board (50-95%); 2) pretreatment MRI (61.5-100%) and thoracoabdominal CT (15.0-100%). Large inter-centre differences were observed in the mean interval between biopsy and first visit to the radiotherapy department (range, 21.6-58.6 days) and between the first visit and start of treatment (15.1-38.8 days). Treatment interruptions ≥ 1 day occurred in 43.9% (2.5-90%) of cases overall. Treatment compensation was performed in 2.1% of cases. Treatment was completed in the prescribed time in 55.7% of cases. CONCLUSIONS This multi-institutional clinical audit revealed that most centres adhered to standard clinical practices for most of the radiotherapy processes-related variables assessed. However, the audit revealed marked inter-centre variability for certain quality indicators, particularly inconsistent record keeping. Multiple targets for improvement and/or harmonisation were identified, confirming the value of routine clinical audits to detect potential deviations from standard clinical practice.
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Affiliation(s)
| | - Artur Aguiar
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Carla Lopes de Castro
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Maria Glòria Torras
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Letizia Deantonio
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | | | - Marta Kruszyna-Mochalska
- Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland
- Deparment of Electroradiology, University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Miquel Macia
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Eugeni Canals
- Institut Català d’Oncologia, Avinguda de França, S/N 17007, Girona, Spain
| | - Monica Caro
- Institut Català d’Oncologia, Ctra. Canyet s/n 08916, Badalona, Spain
| | - Carla Pisani
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | | | - Jaume Molero
- Institut Català d’Oncologia, Ctra. Canyet s/n 08916, Badalona, Spain
| | - Arantxa Eraso
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joana Lencart
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Carles Muñoz-Montplet
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Luisa Carvalho
- Instituto Português de Oncologia; do Porto FG, EPE (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Marco Krengli
- “Amedeo Avogadro” - Rettorato, Università degli Studi del Piemonte Orientale (UNIUPO), via Duomo, 6 - 13100 Vercelli, Novara, Italy
| | - Julian Malicki
- Greater Poland Cancer Centre, Garbary 15 St, 61-866 Poznan, Poland
- Deparment of Electroradiology, University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland
| | - Ferran Guedea
- Institut Català d’Oncologia, L’Hospitalet, Avinguda Granvia de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
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17
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Piraux E, Caty G, Renard L, Vancraeynest D, Tombal B, Geets X, Reychler G. Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Prostate Cancer Prostatic Dis 2020; 24:156-165. [PMID: 32719354 DOI: 10.1038/s41391-020-0259-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise training has shown beneficial effects in the management of radiotherapy-related side effects in prostate cancer (PCa) patients undergoing radiation therapy (RT). However, the optimal modality of the exercise programs have not been yet determined. The aim of this randomized controlled trial was to investigate the effects of high-intensity interval training (HIIT) and resistance training (RES) compared to usual care (UC) on cancer-treatment-related fatigue (CTRF) (primary outcome), quality of life, depression, daytime sleepiness, insomnia, sleep quality, functional exercise capacity and executive function in PCa patients during RT. METHODS PCa patients undergoing RT with or without ADT were randomized in HIIT, RES or UC. Both exercise programs included three sessions per week during 5-8 weeks. HIIT consisted of 8-15 × 60 s intervals (≥85% maximal heart rate). RES was performed with 1-3 sets of 8-12 repetitions for each large muscle groups. The primary outcome was changed in CTRF measured with the Functional Assessment of Chronic Illness Therapy-Fatigue. RESULTS Seventy-two subjects (69.1 ± 8.2 years) completed the study. No exercise-related adverse events occurred. HIIT (p = 0.012) and RES (p = 0.039) training attenuated increases in CTRF compared to UC. Functional exercise capacity, evaluated by the 6-min walk test, increased after HIIT (p = 0 = 0.43) and RES (p = 0.041) compared to UC (+0.1%). No other secondary variables were different between groups. CONCLUSIONS Both intervention groups displayed beneficial effects on CTRF and functional exercise capacity in PCa patients undergoing RT. In addition, HIIT and RES are both safe with an excellent attendance rate to the exercise sessions.
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Affiliation(s)
- Elise Piraux
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium. .,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium. .,Clinical Neuroscience, Institute of Neurosciences, Université catholique de Louvain, Brussels, Belgium.
| | - Gilles Caty
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Laurette Renard
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Bertrand Tombal
- Service d'urologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Pembroke M, Bradley J, Nemeth LS. Breast Cancer Survivors' Unmet Needs After Completion of Radiation Therapy Treatment. Oncol Nurs Forum 2020; 47:436-445. [PMID: 32555557 DOI: 10.1188/20.onf.436-445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify the unmet needs of breast cancer survivors after radiation therapy. PARTICIPANTS & SETTING Patients who received radiation therapy for unilateral breast cancer with six months or longer of follow-up and exhibited no disease progression were eligible for selection to a study conducted at an outpatient radiation therapy academic practice in the southeastern United States. METHODOLOGIC APPROACH A qualitative descriptive study was undertaken using semistructured interviews, framed by the five domains of the Survivor Unmet Needs Survey and analyzed using an iterative inductive and deductive process. FINDINGS Of the 24 invited patients, 17 agreed to the interview (including one male patient). Themes emerged from the emotional, relationships, and information needs domains. IMPLICATIONS FOR NURSING Healthcare providers should perform a comprehensive needs assessment for patients with breast cancer receiving radiation therapy. Self-management assessment instruments may address patients' confidence in managing all phases of radiation therapy side effects.
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Piraux E, Caty G, Aboubakar Nana F, Reychler G. Effects of exercise therapy in cancer patients undergoing radiotherapy treatment: a narrative review. SAGE Open Med 2020; 8:2050312120922657. [PMID: 32595968 PMCID: PMC7301662 DOI: 10.1177/2050312120922657] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/06/2020] [Indexed: 12/25/2022] Open
Abstract
Despite its beneficial effects, radiotherapy still results in a range of side effects that negatively impact quality of life of patients. Exercise has been shown to counteract the side effects induced by cancer treatment. This narrative review aims to provide an up-to-date review of the effects of an exercise intervention in cancer patients during radiotherapy. A literature search was performed on PubMed to identify original articles that evaluated the effects of an exercise programme to alleviate treatment-related side effects in cancer patients undergoing radiotherapy with or without other cancer treatments. Benefits related to exercise training have been shown in breast, prostate, rectal, lung, head and neck cancer patients undergoing radiotherapy. Therefore, exercise should be considered as a concurrent treatment alongside radiotherapy to alleviate treatment-related side effects and facilitate effective recovery. Due to the onset and progress of treatment-related side effects throughout radiotherapy, a regular clinical evaluation seems strongly advisable in order to continuously adapt the exercise programme depending on symptoms and side effects. An exercise professional is needed to personalize exercise training based on the medical condition and tailor it throughout the intervention according to progress and the patient’s medical status. Future studies are needed to confirm the potential benefits of exercises observed on treatment-related side effects. Furthermore, because of the narrative design of this study, a systematic review is required to evaluate the strength of the evidence reported.
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Affiliation(s)
- Elise Piraux
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Gilles Caty
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Frank Aboubakar Nana
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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20
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Pembroke M, Nemeth LS. Instruments to Evaluate Self-Management of Radiation Dermatitis in Patients With Breast Cancer. Oncol Nurs Forum 2020; 47:101-111. [PMID: 31845919 DOI: 10.1188/20.onf.101-111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION Radiation dermatitis (RD) is an expected side effect of radiation to the breast and chest wall. Healthcare providers routinely grade the severity of RD without assessing its impact on quality of life for patients with breast cancer. Instruments are needed to identify a patient's ability and confidence to self-manage RD. LITERATURE SEARCH A search was conducted of published literature from 2001 to 2018 that included patients who had received radiation therapy for breast cancer. A validated instrument was used to assess RD. DATA EVALUATION Eleven instruments were identified and evaluated for assessing self-management. SYNTHESIS One instrument was identified that measured a patient's ability to self-manage symptoms. The Patient-Reported Outcomes Measurement Information System Self-Efficacy for Managing Chronic Conditions-Manage Symptoms should be considered for clinical integration. IMPLICATIONS FOR PRACTICE Using a validated instrument to assess patients' needs and ability to self-manage RD will promote personalized care plans tailored to each patient. Findings can be used to implement a patient-reported outcome measure into clinical practice, develop educational programs for RD management, and create personalized care plans.
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21
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Dyer BA, Li CS, Daly ME, Monjazeb AM, Mayadev JS. Prospective, Randomized Control Trial Investigating the Impact of a Physician-Communicated Radiation Therapy Plan Review on Breast Cancer Patient-Reported Satisfaction. Pract Radiat Oncol 2019; 9:e487-e496. [PMID: 31226443 DOI: 10.1016/j.prro.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/22/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Patients with breast cancer face complex medical decision-making. We investigated the impact of a physician-communicated, patient-specific radiation therapy (RT) plan review on patient-reported outcomes (PROs) for patients with breast cancer receiving adjuvant RT in a prospective randomized trial. METHODS AND MATERIALS Patients with stage I-III breast cancer treated with adjuvant RT were prospectively randomized to a standard nondetailed review (Arm A) versus an in-depth, individualized RT plan review during week 1 of RT (Arm B). Plan review included visualization of the treatment plan, RT doses, beam arrangements, normal tissue doses, and dose/volume constraints. Patient-reported satisfaction was assessed using a subset of the Functional Assessment of Chronic Illness Therapy - Treatment Satisfaction - Patient Satisfaction questionnaire related to physician communication (PC), technical competency (TC), confidence and trust (C&T), and overall satisfaction (OS). The difference in mean scores at baseline, week 1, and the end of RT were assessed. RESULTS From March 2014 to March 2016, 64 patients with breast cancer (37 in Arm A; 27 in Arm B) were randomized and completed all 3 surveys. Mean baseline scores for PC, TC, C&T, and OS mean were 2.73 (standard deviation [SD], 0.71), 2.66 (SD, 0.86), 2.56 (SD, 0.98), and 2.27 (SD, 0.88), respectively, with high baseline scores in both arms. There was no difference in baseline-reported communication indicators between the arms. There were no significant differences among the 3 time points for PC, TC, C&T, or OS (P = .63, .53, 0.52, and 0.71, respectively). CONCLUSIONS We report the first randomized trial evaluating the impact of in-depth RT plan review on PROs during breast radiation. Both baseline and postintervention scores were high for all domains. Detailed patient assessment, understanding of communication types, and information processing may be necessary to determine subtle PRO differences. Further investigations of PROs could potentially direct and optimize physician and patient communication during RT.
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Affiliation(s)
- Brandon A Dyer
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Jyoti S Mayadev
- Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
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22
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Fareed MM, Galloway TJ. Time abides long enough for those who make use of it. CANCERS OF THE HEAD & NECK 2019; 3:11. [PMID: 31093364 PMCID: PMC6460542 DOI: 10.1186/s41199-018-0038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/09/2018] [Indexed: 01/29/2023]
Abstract
Increased treatment package time is an independent poor prognostic factor for outcomes in head and neck squamous cell carcinoma (HNSCC). Similarly the timeliness of treatment initiation is a risk factor for disease recurrence. Despite these well-known issues, the timeliness of treatment initiation is actually worsening in the United States and the expeditious completion of radiation treatments continues to be difficult secondary to a number of patients and treatment related issues. This analysis evaluates the current data on treatment intervals in the management of head and neck cancer. Rapid staging/diagnosis of head and neck cancer, appropriate referrals to providers qualified to treat said cancer, and expeditious treatment completion remains the most cost-effective, widely applicable method to improve outcomes in head and neck cancer.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
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23
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Waddle MR, Niazi S, Aljabri D, White L, Kaleem T, Naessens J, Spaulding A, Habboush J, Rummans T, Miller R. Cost of Acute and Follow-Up Care in Patients With Pre-Existing Psychiatric Diagnoses Undergoing Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 104:748-755. [PMID: 30904707 DOI: 10.1016/j.ijrobp.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/04/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The impact of psychiatric comorbidities on the cost of cancer care in radiation oncology practices is not well studied. We assessed the acute and 24-month follow-up costs for patients with and without pre-existing psychiatric comorbidities undergoing radiation therapy. METHODS AND MATERIALS Patients with cancer undergoing radiation therapy at our institution from 2009 to 2014 were denoted as having pre-existing psychiatric conditions (Psych group) if they had associated billing codes for any of the 422 International Classification of Diseases, 9th revision psychiatric conditions during the 12 months before their cancer diagnosis. The Elixhauser comorbidity index was calculated, excluding psychiatric categories. Medicare reimbursement was assigned to professional services, and Medicare departmental cost-to-charge ratios were applied to service line hospital charges and adjusted for inflation to create 2017 standardized costs. Acute (0-6 month) and follow-up (6-24 month) costs were subcategorized into clinic, emergency department, hospital inpatient, and outpatient costs. RESULTS Among 1275 patients, 126 (9.9%) had at least 1 pre-existing psychiatric diagnosis. On univariate analysis, both acute and long-term costs were higher in the Psych group. The largest significant differences in costs were follow-up hospital inpatient costs ($5861 higher; 95% confidence interval [CI], $687-$11,035; P = .002), follow-up hospital outpatient costs ($2086 higher; 95% CI, -$142 to $4,314; P = .040), and follow-up emergency department costs ($396 higher; 95% CI, $149-$643; P < .001). Age, race, sex, and treatment modalities were comparable, but the Psych group patients had more median comorbidities (2 vs 1) and had more respiratory cancer diagnoses than the nonpsychiatric group (31% vs 17%). On multivariate analysis adjusted for age, sex, cancer diagnosis, and comorbidities, global follow-up costs remained 150% higher in the Psych group (P < .001). Acute costs were similar after adjustment (P = .63). CONCLUSIONS Psychiatric comorbidities independently predict elevated healthcare costs in patients treated for cancer. Radiation oncology payment models should consider adjustments to account for psychiatric comorbidities because addressing these may mitigate cost differential.
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Affiliation(s)
- Mark R Waddle
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Shehzad Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida
| | - Duaa Aljabri
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrhman Bin Faisal University, Dammam, Saudi Arabia
| | - Launia White
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Tasneem Kaleem
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - James Naessens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida; Division of Health Care Policy & Research, Mayo Clinic, Jacksonville, Florida
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
| | - Jacob Habboush
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Teresa Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida
| | - Robert Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
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Biopsychosocial Correlates of Adjustment to Cancer during Chemotherapy: The Key Role of Health-Related Quality of Life. ScientificWorldJournal 2019; 2019:9750940. [PMID: 30983914 PMCID: PMC6431483 DOI: 10.1155/2019/9750940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/21/2019] [Indexed: 12/18/2022] Open
Abstract
Background Patients adjust to cancer in a continuous process that follows the course of the disease. Previous research has considered several illness-related variables and demographics, quality of life, personality, and social factors as predictors of adjustment to cancer, which can be maladaptive (e.g., helplessness-hopelessness and anxious preoccupation) or adaptive (e.g., fighting spirit). Aims Assuming a biopsychosocial view, we test an empirical model in which disease stage, patient's age, and gender are viewed as the distal antecedents of positive and negative adjustment to cancer for chemotherapy patients. Health-related quality of life (HRQoL) has a key role, interposing between the distal antecedents and adaptational outcomes. Social support and positive thinking are also included in the model as related to adjustment. Methods One-hundred-sixty-two consecutive cancer patients receiving adjuvant or standard chemotherapy participated in the study. Patients completed the Mini-Mental Adjustment to Cancer, the Brief-COPE, the Social Provision Scale, and the SF-12 Health Survey. Partial least squares structural equation modeling (PLS-SEM) was applied for model building and hypotheses testing. Results We found a negative association between advanced stage and physical functioning, a strong positive link between physical functioning and mental health, and significant relations between mental health and helpless-hopelessness, anxious preoccupation, and cognitive avoidance. Social support and positive thinking were related to fighting spirit and fatalism. Cancer stage and female gender were indirectly associated with adaptational outcomes through HRQoL. The patient's age had no significant relationships in the model. Discussion HRQoL (both physical and mental) is a key factor for preventing maladjustment in chemotherapy patients. Social support and positive thinking coping style fosters fighting spirit and fatalism on health outcomes. Two potential lines of action seem promising: preventing maladaptive and promoting adaptive adjustments working on patient's mental health individually and involving significant others in supportive care, respectively.
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25
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Arving C, Assmus J, Thormodsen I, Berntsen S, Nordin K. Early rehabilitation of cancer patients—An individual randomized stepped‐care stress‐management intervention. Psychooncology 2018; 28:301-308. [DOI: 10.1002/pon.4940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/31/2018] [Accepted: 11/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Cecilia Arving
- Department of Oncology and Medical PhysicsHaukeland University Hospital Bergen Norway
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
| | - Jörg Assmus
- Centre for Clinical ResearchHaukeland University Hospital Bergen Norway
| | - Inger Thormodsen
- Department of Oncology and Medical PhysicsHaukeland University Hospital Bergen Norway
| | - Sveinung Berntsen
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport SciencesUniversity of Agder Kristiansand Norway
| | - Karin Nordin
- Department of Public Health and Caring SciencesUppsala University Uppsala Sweden
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport SciencesUniversity of Agder Kristiansand Norway
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26
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Anderson J, Slade AN, McDonagh PR, Burton W, Fields EC. The long-lasting relationship of distress on radiation oncology-specific clinical outcomes. Adv Radiat Oncol 2018; 4:354-361. [PMID: 31011681 PMCID: PMC6460100 DOI: 10.1016/j.adro.2018.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/10/2018] [Accepted: 11/02/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The diagnosis and treatment of cancer can have significant mental health ramifications. The National Comprehensive Cancer Network currently recommends using a distress screening tool to screen patients for distress and facilitate referrals to social service resources. Its association with radiation oncology–specific clinical outcomes has remained relatively unexplored. Methods and materials With institutional review board approval, National Comprehensive Cancer Network distress scores were collected for patients presenting to our institution for external beam radiation therapy during a 1-year period from 2015 to 2016. The association between distress scores (and associated problem list items and process-related outcomes) and radiation oncology–related outcomes, including inpatient admissions during treatment, missed treatment appointments, duration of time between consultation and treatment, and weight loss during treatment, was considered. Results A total of 61 patients who received either definitive (49 patients) or palliative (12 patients) treatment at our institution and completed a screening questionnaire were included in this analysis. There was a significant association between an elevated distress score (7+) and having an admission during treatment (36% vs 11%; P = .04). Among the patients treated with definitive intent, missing at least 1 appointment (71% vs 26%; P = .03) and having an admission during treatment (57% vs 10%; P = .009) were significantly associated with our institutional definition of elevated distress. We found no correlation between distress score and weight loss during treatment or a prolonged time between initial consult and treatment start. Conclusions High rates of distress are common for patients preparing to receive radiation therapy. These levels may affect treatment compliance and increase rates of hospital admissions. There remains equipoise in the best method to address distress in the oncology patient population. These results may raise awareness of the consequences of distress among radiation oncology patients. Specific interventions to improve distress need further study, but we suggest a more proactive approach by radiation oncologists in addressing distress.
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Affiliation(s)
- Justin Anderson
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Alexander N Slade
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Philip Reed McDonagh
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Whitney Burton
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
| | - Emma C Fields
- Virginia Commonwealth University Health System, Massey Cancer Center, Department of Radiation Oncology, Richmond, Virginia
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Amsbaugh MJ, Yusuf M, Cash E, Silverman C, Potts K, Dunlap N. Effect of time to simulation and treatment for patients with oropharyngeal cancer receiving definitive radiotherapy in the era of risk stratification using smoking and human papillomavirus status. Head Neck 2018; 40:687-695. [DOI: 10.1002/hed.24963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/03/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mark J. Amsbaugh
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Mehran Yusuf
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Elizabeth Cash
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders; University of Louisville; Louisville Kentucky
| | - Craig Silverman
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Kevin Potts
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders; University of Louisville; Louisville Kentucky
| | - Neal Dunlap
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
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Forshaw K, Hall AE, Boyes AW, Carey ML, Martin J. Patients' Experiences of Preparation for Radiation Therapy: A Qualitative Study. Oncol Nurs Forum 2017; 44:E1-E9. [PMID: 27991606 DOI: 10.1188/17.onf.e1-e9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore patients' experiences of and preferences for preparation for radiation therapy.
. RESEARCH APPROACH Qualitative study.
. PARTICIPANTS 26 individuals who recently received radiation therapy for cancer.
. SETTING One Australian radiation oncology clinic located within a tertiary referral hospital in New South Wales.
. METHODOLOGIC APPROACH Semistructured interviews were conducted and analyzed based on a qualitative descriptive approach and content analysis of the transcribed interviews.
. FINDINGS Four main themes related to preparation techniques were identified. CONCLUSIONS The information gained in this study indicates what strategies may best prepare patients for radiation therapy.
. INTERPRETATION Providing patients with information that creates a realistic expectation of what radiation therapy involves both before and after treatment seems particularly important in helping them feel prepared.
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Holmes EG, Holmes JA, Park EM. Psychiatric Care of the Radiation Oncology Patient. PSYCHOSOMATICS 2017; 58:457-465. [PMID: 28599843 PMCID: PMC5650081 DOI: 10.1016/j.psym.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND In recent decades, psychiatrists have become increasingly involved in the care of patients with cancer. Psychiatrists are often less familiar with the field of radiation oncology than with other medical specialties. OBJECTIVE Therefore, it is beneficial for consulting psychiatrists to be familiar with the basic principles of radiation therapy (RT) and its potential neuropsychiatric sequelae. METHODS We performed a PubMed search to identify articles describing neuropsychiatric symptoms resulting from RT, including anxiety, claustrophobia, posttraumatic stress disorder, and neurocognitive impairment. We also searched for other sequelae of RT that may produce psychiatric symptoms, such as radiation necrosis and endocrinopathies. We provide a basic introduction to the delivery of RT. RESULTS Psychiatrists may be involved in the treatment of patients before, during, or after RT, and each phase of treatment produces unique considerations. Anxiety about the treatment, especially the need for immobilization with a mask, can be treatment-limiting. Adverse effects from treatment, including cognitive impairment and endocrinopathies, can result in psychiatric symptoms. CONCLUSIONS Consulting psychiatrists should be familiar with the basic principles of RT and the neuropsychiatric sequelae that may result from the treatment. Further research is needed to identify strategies to help patients tolerate RT and to identify additional preventive and therapeutic options for RT-induced cognitive impairment.
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Affiliation(s)
- Emily G Holmes
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC.
| | - Jordan A Holmes
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Eliza M Park
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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30
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Habboush Y, Shannon RP, Niazi SK, Hollant L, Single M, Gaines K, Smart B, Chimato NT, Heckman MG, Buskirk SJ, Vallow LA, Tzou KS, Ko SJ, Peterson JL, Biers HA, Day AB, Nelson KA, Sloan JA, Halyard MY, Miller RC. Patient-reported distress and survival among patients receiving definitive radiation therapy. Adv Radiat Oncol 2017; 2:211-219. [PMID: 28740934 PMCID: PMC5514245 DOI: 10.1016/j.adro.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Patient-reported distress (PRD) has not been well assessed in association with survival after radiation therapy (RT). The aims of this study were to evaluate the association between PRD level and survival after definitive RT and to identify the main causes of distress in definitive RT patients. METHODS AND MATERIALS A total of 678 consecutive patients receiving definitive RT at our institution from April 2012 through May 2015 were included. All patients answered a PRD questionnaire that contained 30 items related to possible causes of distress, which could be rated from 1 (no distress) to 5 (high distress). Additionally, patients were asked to rate their overall distress level from 0 (no distress) to 10 (extreme distress). This overall distress level was our primary patient-reported distress measure and was examined as a continuous variable and as a categorical variable with 3 PRD levels (low, 0-3 [n = 295]; moderate, 4-6 [n = 222]; and high, 7-10 [n = 161]). RESULTS As a continuous variable in multivariable Cox regression analysis, a higher overall PRD level was associated with poorer survival after RT (hazard ratio [HR], 1.39; P = .004). As a categorical variable, compared with patients with low distress, survival was poorer for patients with moderate distress (HR, 1.62; P = .038) or high distress (HR, 1.49; P = .12), but the latter difference was not significant. When the moderate and high distress levels were combined, survival was significantly poorer compared with the low distress level (HR, 1.57; P = .034). The top 5 specific causes of distress that patients mentioned were "How I feel during treatment," "Fatigue," "Out-of-pocket medical costs," "Pain that affects my daily functioning," and "Sleep difficulties." CONCLUSIONS PRD before or during RT is a prognostic factor associated with decreased survival. Distress screening guidelines and interventions should be implemented for patients receiving definitive RT.
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Affiliation(s)
- Yacob Habboush
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Laeticia Hollant
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Megan Single
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Katherine Gaines
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Bridget Smart
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | | | | | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Katherine S. Tzou
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Heather A. Biers
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Atiya B. Day
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Kimberly A. Nelson
- Division of Hematology/Oncology/Cancer Center/Breast Clinic, Mayo Clinic, Jacksonville, Florida
| | - Jeff A. Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Michele Y. Halyard
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Robert C. Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Liang H, Xiang YQ, Lv X, Xie CQ, Cao SM, Wang L, Qian CN, Yang J, Ye YF, Gan F, Ke LR, Yu YH, Liu GY, Qiu WZ, Huang XJ, Wen CH, You N, Wang XQ, Guo X, Xia WX. Survival impact of waiting time for radical radiotherapy in nasopharyngeal carcinoma: A large institution-based cohort study from an endemic area. Eur J Cancer 2017; 73:48-60. [PMID: 28161498 DOI: 10.1016/j.ejca.2016.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/27/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Whether the waiting time for radical radiotherapy (WRT) detrimentally impacts nasopharyngeal carcinoma (NPC) prognosis is unclear. We estimated the influence of WRT on overall survival (OS) and disease-specific survival (DSS) of NPC. PATIENTS AND METHODS Patients were identified from prospectively maintained database. WRT was calculated from histological diagnosis to initiation of radiotherapy (RT). Survival analysis was estimated using Weibull parametric model and propensity score analysis (PSA). Recursive partitioning analysis (RPA) identified optimal WRT threshold via conditional inference trees to estimate the greatest survival differences based on randomly selected training and validation sets, and this process was repeated 1000 times to ensure threshold robustness. Sensitivity analysis estimated effects of potential unmeasured confounders. RESULTS A total of 9896 patients were included. In multivariate analysis, WRT of 31-60°d, of 61-90°d and of greater than 90°d independently increased mortality risk compared to less than 30°d. Upon RPA, ranges of 30-35°d with the peak of 30°d were confirmed with 89% of simulations validating optimal thresholds. In threshold-based groups, adjusted hazard ratios (HRs) for WRT of greater than 30°d by both Weibull model and PSA were significantly higher than for WRT of less than 30°d [OS: HR = 1.13, 95% confidence interval (CI) 1.04-1.23, P = 0.003; DSS: HR = 1.15, 95% CI 1.05-1.26, P = 0.002]. Sensitivity analysis revealed robustness of results. CONCLUSIONS WRT independently affects survival. Increasing WRT beyond 30°d was most consistently detrimental to survival. WRT of NPC should be as short as reasonably achievable (ASARA).
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Affiliation(s)
- Hu Liang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yan-Qun Xiang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xing Lv
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chang-Qing Xie
- Vidant Medical Center, East Carolina University, Greenville, NC, USA
| | - Su-Mei Cao
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Epidemiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lin Wang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jing Yang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yan-Fang Ye
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feng Gan
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Medical Information, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Liang-Ru Ke
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ya-Hui Yu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Guo-Ying Liu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wen-Ze Qiu
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xin-Jun Huang
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Can-Hong Wen
- Southern China Center for Statistical Science, School of Mathematics, Sun Yat-Sen University, Guangzhou, China
| | - Na You
- Southern China Center for Statistical Science, School of Mathematics, Sun Yat-Sen University, Guangzhou, China
| | - Xue-Qin Wang
- Southern China Center for Statistical Science, School of Mathematics, Sun Yat-Sen University, Guangzhou, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Wei-Xiong Xia
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China.
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Kırca K, Kutlutürkan S. Symptoms of patients with head and neck cancers undergoing radiotherapy. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27726226 DOI: 10.1111/ecc.12584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/26/2022]
Abstract
Radiotherapy is a reliable and effective treatment method for the treatment of head and neck cancers. This study was conducted as a descriptive work with the purpose of determining the symptoms experienced by patients with head and neck cancer who are undergoing radiotherapy. The study was carried out on 47 patients receiving treatment in oncology clinics. Data were obtained at mid-radiotherapy (RT), at the end of radiotherapy and 1 month after the end of radiotherapy using the Memorial Symptom Assessment Scale (MSAS) and Personal Information Forms. The mean scores of MSAS GDI (Global Distress Index), MSAS Physical, MSAS Psychological and Total Memorial Symptom Assessment Scale, which were highest by the end of radiotherapy, declined during the 1-month period following the end of radiotherapy. A statistically significant difference (p < .05) was found between the subscale groups in the evaluations made at mid-RT, at the end of RT and 1 month after the end of RT. Patients generally experienced symptom frequency, severity and distress levels at highest rates at the end of RT. During the radiotherapy process, determining these symptoms will contribute to improve the well-being of the patient. These results may be useful to control symptoms effectively.
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Affiliation(s)
- K Kırca
- Department of Nursing, Faculty of health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - S Kutlutürkan
- Department of Nursing, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Borrayo EA, Scott KL, Drennen AR, Macdonald T, Nguyen J. Determinants of Treatment Delays among Underserved Hispanics with Lung and Head and Neck Cancers. Cancer Control 2016; 23:390-400. [DOI: 10.1177/107327481602300410] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Evidence is lacking to explain the reasons why treatment is delayed among disadvantaged Hispanic patients diagnosed with lung and head and neck cancers. Data indicate that treatment delays beyond 46 days increase the risk of death for individuals with these cancers. Methods A mixed-methods design was used to explore determinants of treatment delays by analyzing data from the medical records of 40 Hispanic patients and data from interviews with 29 Hispanic patients, care-givers, health care professionals, and patient navigators from a safety-net hospital. Results Of the 40 Hispanic patients, 35% initiated treatment 46 days or more after being diagnosed, but women experienced longer delays than men (average of 48 days). Women with few comorbid diseases (≤ 4) were more likely to experience treatment delays. Institutional-related determinants at publicly funded hospitals appear to delay treatment for patients at the safety-net hospital, and patient-related determinants common to underserved patients (eg, no health insurance coverage) are likely to further contribute to these delays. Conclusions Delayed treatment is associated with poor outcomes and low rates of survival in patients with lung and head and neck cancers. Therefore, action should be taken to improve the time between diagnosis and the initiation of treatment for disadvantaged Hispanic patients.
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Affiliation(s)
- Evelinn A. Borrayo
- Department of Psychology, Salud Family Health Centers, Fort Collins, Colorado
| | - Katie L. Scott
- Colorado State University, Colorado School of Public Health, University of Colorado, Denver, Colorado, Department of Neurology, Salud Family Health Centers, Fort Collins, Colorado
| | - Ava R. Drennen
- Spectrum Health Medical Group, Grand Rapids, Michigan, and the Department of Behavioral Health, Salud Family Health Centers, Fort Collins, Colorado
| | - Tiare Macdonald
- Department of Psychology, Salud Family Health Centers, Fort Collins, Colorado
| | - Jennifer Nguyen
- Department of Psychology, Salud Family Health Centers, Fort Collins, Colorado
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Hernández Blázquez M, Cruzado JA. A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy. J Psychosom Res 2016; 87:14-21. [PMID: 27411747 DOI: 10.1016/j.jpsychores.2016.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 05/10/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the presence of anxiety, depressive and adjustment disorders, suicide ideation, and symptoms of anxiety and depression in patients with cancer before (T1), and after radiotherapy (T2) and at the 1-month follow-up (T3). METHODS A longitudinal study on 103 patients with cancer treated as outpatients undergoing radiotherapy was carried out, evaluating them three times (T1-T2-T3) according to DSM-IV criteria with the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale. RESULTS Prevalence of the depressive disorders was: T1=6.8%, T2=3.9% and T3=3.9%; for anxiety disorders: T1=16.5%, T2=18.4% and T3=16.5%; for adjustment disorder: 10.7%, 5.8% and 7.8%; and for suicide ideation: T1=11.7%, T2=7.8% and T3=7.8%. In all, the presence of disorders was: T1=35%, T2=26.2%0.4% and T3=29.1%. At least one mental disorder was diagnosed in 46.6% of patients in one of the three times of the study. In relation to the symptoms, the prevalence of the possible cases of clinical anxiety was: T1=35.9%, T2=18.4% and T3=22.3%; the prevalence of possible cases of clinical depression was 19.4%, 16.5% and 10.7%, respectively; and the prevalence of emotional distress was 27.2%, 17.5% and 18.4%, respectively. All symptoms decreased significantly from T1 to T2 and from T1 to T3, with moderate effect sizes. No changes were observed between the end of the radiotherapy and the follow-up period. CONCLUSIONS High prevalence of mental disorders and symptoms of anxiety, depression and distress were observed in the patients with cancer before finishing radiotherapy treatment and during the follow-up. FUNDING Basurto University Hospital and Basque Foundation for Innovation and Research in Health-BIOEF.
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Affiliation(s)
| | - Juan Antonio Cruzado
- Faculty of Psychology, Complutense University of Madrid, , 28223 - Madrid, Spain.
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Forshaw KL, Carey ML, Hall AE, Boyes AW, Sanson-Fisher R. Preparing patients for medical interventions: A systematic review of the psychometric qualities of published instruments. PATIENT EDUCATION AND COUNSELING 2016; 99:960-973. [PMID: 26774681 DOI: 10.1016/j.pec.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Preparing patients for medical interventions improves patient outcomes and is an ethical and legal imperative. This review examines the characteristics and psychometric properties of published instruments which assess patients' preparation for medical interventions. METHODS Medline, CINAHL, EMBASE and PsycINFO electronic databases were searched from the date of their inception to November 2015. Data-based publications describing the development or validation of a self-report instrument designed to assess the quality of adult patients' perceived preparation for a medical intervention were included. RESULTS Nine publications described the development or validation of seven instruments which met inclusion criteria. The psychometric qualities of the instruments varied. None met all of the accepted criteria for psychometric rigour. Although the Satisfaction with Cancer Information Profile met the highest number (n=5) of the defined psychometric properties, the study sample size was less than 100. Overall, content validity of the included instruments was the most frequently assessed criteria. CONCLUSION Few instruments have been specifically developed to assess patients' self-reported preparation for medical interventions. Of the available instruments, none demonstrated adequate rigour across essential psychometric properties. PRACTICE IMPLICATIONS The need to develop instruments examining patient preparation for medical interventions is apparent given the limitations of the instruments reviewed.
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Affiliation(s)
- Kristy L Forshaw
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Alix E Hall
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
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Mullaney T, Olausson K, Sharp L, Zackrisson B, Edvardsson D, Nyholm T. The influence of a department's psychosocial climate and treatment environment on cancer patients' anxiety during radiotherapy. Eur J Oncol Nurs 2016; 20:113-8. [DOI: 10.1016/j.ejon.2015.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 05/05/2015] [Accepted: 06/19/2015] [Indexed: 11/27/2022]
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Rash D, Hess C, Lentz S, Tait L, Michaud A, Mayadev J. Prospective evaluation of patient satisfaction after the use of brachytherapy specific educational materials for cervical cancer. Brachytherapy 2016; 15:65-70. [DOI: 10.1016/j.brachy.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/19/2015] [Accepted: 09/09/2015] [Indexed: 11/16/2022]
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Adjuvant treatments of breast cancer increase the risk of depressive disorders: A population-based study. J Affect Disord 2015; 182:44-9. [PMID: 25973782 DOI: 10.1016/j.jad.2015.04.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Previous studies have posited conflicting results regarding depressive disorders among breast cancer survivors who received adjuvant therapies including chemotherapy, radiotherapy, selective estrogen receptor modulator (e.g. tamoxifen), third-generation aromatase inhibitors (AIs; e.g. anastrozole, letrozole or exemestane), and monoclonal antibody (e.g. trastuzumab). We therefore performed a population-based study with a defined breast cancer cohort to investigate the risk of depressive disorders in breast cancer patients who received adjuvant therapies. METHODS We conducted a retrospective study of a breast cancer cohort of 36,586 participants who were selected from the National Health Insurance Research Database(NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidences of newly onset depressive disorders. Kaplan-Meier and Cox regression analyses were used to identify the risk factors associated with depressive disorders in breast cancer patients who underwent adjuvant therapies RESULTS Of the total 36,586 patients, 1342 (3.7%) were ascertained with depressive disorders. The Cox multivariate proportional hazards analysis showed that age of 40-59 (adjusted hazard ratio (aHR) 1.327, 95% CI 1.123-1.567, p=0.001), chemotherapy (aHR 1.555, 95% CI 1.387-1.743, p<0.001), radiotherapy (aHR 1.385 95% CI 1.220-1.571, p<0.001), tamoxifen (aHR 1.458, 95% CI 1.110-1.914, p=0.007), AIs (aHR 1.360, 95% CI 1.193-1.550, p<0.001), and trastuzumab (aHR 1.458, 95% CI 1.110-1.914, p=0.007) were independent risk factors for developing depressive disorders. LIMITATIONS The dosage effect of adjuvant treatments, cancer staging, genetic or environmental confounders associated with the risk of depressive disorders were not comprehensively evaluated. CONCLUSION Developing depressive disorders are at higher risk in breast cancer survivors aged 40-59 who received adjuvant treatments including chemotherapy, radiotherapy, tamoxifen, AIs or trastuzumab. Psychological evaluation and support are necessarily needed in breast cancer survivors who received adjuvant therapies.
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Merchant S, O'Connor M, Halkett G. Time, space and technology in radiotherapy departments: how do these factors impact on patients' experiences of radiotherapy? Eur J Cancer Care (Engl) 2015; 26. [DOI: 10.1111/ecc.12354] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- S. Merchant
- Faculty of Health Sciences; School of Nursing & Midwifery; Curtin University; Perth WA Australia
| | - M. O'Connor
- Faculty of Health Sciences; School of Psychology & Speech Pathology; Curtin University; Perth WA Australia
| | - G. Halkett
- Faculty of Health Sciences; School of Nursing & Midwifery; Curtin University; Perth WA Australia
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Hess CB, Singer M, Khaku A, Malinou J, Juliano JJ, Varlotto JM, Wagner H, Liao J, Myers KR, Levine MP, Mackley HB. Optimal Frequency of Psychosocial Distress Screening in Radiation Oncology. J Oncol Pract 2015; 11:298-302. [DOI: 10.1200/jop.2014.003392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Thirty-seven percent of radiation oncology patients reported distress at least once during treatment. Screening at every-other-week intervals optimized efficiency and frequency, identifying nearly 90 distressed patients with 12 screening events.
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Affiliation(s)
- Clayton B. Hess
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Maria Singer
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Aliasgher Khaku
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Justin Malinou
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Justin J. Juliano
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - John M. Varlotto
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Henry Wagner
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Jason Liao
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Kimberly R. Myers
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Martha P. Levine
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
| | - Heath B. Mackley
- Penn State Hershey College of Medicine; Penn State Hershey Cancer Institute; The Drs Kienle Center for Humanistic Medicine, Penn State Hershey College of Medicine, Hershey, PA; University of California Davis Comprehensive Cancer Center, Sacramento, CA; University of Texas Southwestern-Austin Transitional Residency Program, Austin, TX; and University of Massachusetts Medical School, Worcester, MA
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Murphy CT, Galloway TJ, Handorf EA, Wang L, Mehra R, Flieder DB, Ridge JA. Increasing time to treatment initiation for head and neck cancer: an analysis of the National Cancer Database. Cancer 2014; 121:1204-13. [PMID: 25490875 DOI: 10.1002/cncr.29191] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to identify trends and predictors of the time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC). METHODS The National Cancer Database (NCDB) was reviewed for the following head and neck cancer sites: oral tongue, oropharynx, larynx, and hypopharynx. TTI was defined as the number of days from diagnosis to the initiation of definitive treatment and was measured according to covariates. Significant differences in the median TTI across each covariate were measured using the Kruskal-Wallis test, and the Spearman test was used to measure trends within covariates. For multivariate analysis, a zero-inflated, negative, binomial regression model was used to estimate the expected TTI, which was expressed in the predicted number of days; and the Vuong test was used to identify the predictors of TTI. RESULTS In total, 274,630 patients were included. Between 1998 and 2011, the median TTI for all patients was 26 days, and it increased from 19 days to 30 days (P < .0001). Treatment with chemoradiation (CRT) (P < .0001), treatment at academic facilities (P < .0001), and stage IV disease (P < .0001) were associated with increased TTI. TTI significantly increased for each disease stage (P < .0001), treatment modality (P < .0001), and facility type (P < .0001) over time. In addition, patients became more likely to transition care between facilities after diagnosis for treatment initiation (P < .0001) over time. On multivariate analysis, treatment at academic facilities (33 days), transitioning care (37 days), and receipt of CRT (39 days) predicted for a longer TTI. CONCLUSIONS TTI is rising for patients with HNSCC. Those who have advanced-stage disease, receive treatment with CRT, are treated at academic facilities, and who have a transition in care realized the greatest increases in TTI.
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Affiliation(s)
- Colin T Murphy
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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