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Helical tomotherapy for asymptomatic chemotherapy-refractory or -unfit multiple (3 or more) metastases. Rep Pract Oncol Radiother 2022; 27:125-133. [PMID: 35402042 PMCID: PMC8989439 DOI: 10.5603/rpor.a2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background Despite chemotherapy innovations, prognosis of patients with chemotherapy-refractory or -unfit multiple metastases (CRMM/CUMM) remains poor. In this prospective study, the efficacy and toxicity of helical tomotherapy for CRMM/CUMM were evaluated. Materials and methods Between 2014 and 2020, asymptomatic patients with CRMM/CUMM with ≥ 3 lesions and no prior radiotherapy of the targets were enrolled. Patients who had intolerable toxicities to chemotherapy and those who refused chemotherapy were included in the CRMM and CUMM groups, respectively. Prostate cancer patients and patients with metastases mainly localized in the liver, lung, or brain were excluded. By helical tomotherapy, up to 10 lesions per patient were irradiated in order of volume. The standard dose was 50–60 Gy in 25–30 fractions. Results Forty-five patients (median age, 63 years; 35 CRMM/10 CUMM) were enrolled. Primary tumors included lung, gynecological, and gastrointestinal cancers. The most frequently treated targets were lymph node metastases, followed by peritoneal/pleural disseminations and bone tumors. The 1-year survival rate was 51% (median, 12.5 months). In the 35 patients with CRMM, the median survival time was 12.5 months, and the median pre-radiation chemotherapy period was 8.8 months (p > 0.05). The 6-month target control rate was 78%. Acute adverse events (grade ≥ 2) occurred in 33 patients: hematologic toxicities in 23, dermatitis in 6, and others in 8. Late grade ≥ 2 toxicities occurred in 6 patients: pneumonitis in 4 and gastric hemorrhage in 2. Conclusion Tomotherapy for CRMM/CUMM resulted in median survival times > 1 year. This treatment should be investigated further in larger prospective studies.
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Third-line Life-prolonging Drug Treatment in a Real-world Metastatic Castration-resistant Prostate Cancer Population: Results from the Dutch Castration-resistant Prostate Cancer Registry. Eur Urol Focus 2021; 7:788-796. [DOI: 10.1016/j.euf.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/17/2020] [Accepted: 03/24/2020] [Indexed: 01/11/2023]
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Mieras A, Becker-Commissaris A, Klop HT, Pasman HRW, de Jong D, Pronk L, Onwuteaka-Philipsen BD. Patients with Metastatic Lung Cancer and Oncologists' Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study. Med Decis Making 2021; 41:515-526. [PMID: 33783264 DOI: 10.1177/0272989x21998951] [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: 01/20/2023]
Abstract
BACKGROUND Previous studies have investigated patients' treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. AIM To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. DESIGN AND PARTICIPANTS A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. RESULTS According to patients and oncologists, treatment goals were achieved in 30% and 37% for 'quality of life,' 49% and 41% for 'life prolongation,' 26% and 44% for 'decrease in tumor size,' and 44% for 'cure', respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment even if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do 'something.' CONCLUSIONS Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing 'something.'
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Denise de Jong
- Department of Pulmonary Diseases, Haags Medisch Centrum, Leidschendam, Zuid-Holland, The Netherlands
| | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Mieras A, Pasman HRW, Klop HT, Onwuteaka-Philipsen BD, Tarasevych S, Tiemessen MA, Becker-Commissaris A. What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer? Clin Lung Cancer 2020; 22:242-251.e5. [PMID: 32698949 DOI: 10.1016/j.cllc.2020.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Metastatic lung cancer is an incurable disease that can be treated with systemic therapy. These treatments might prolong survival and reduce symptoms, but they may also cause serious adverse effects. We studied the treatment goals of patients with metastasized lung cancer and their oncologists before starting systemic therapy, concordance between patients' and oncologists' goals, and feasibility of these goals. PATIENTS AND METHODS This research was conducted between November 2016 and April 2018 in 1 academic and 5 nonacademic hospitals across the Netherlands. A total of 266 patients with metastatic lung cancer and their prescribing oncologists (n = 23) filled out a questionnaire about their treatment goals and the estimated feasibility of these goals before treatment was started. Additional interviews were conducted with patients and oncologists. RESULTS Patients and oncologists reported quality of life (respectively, 45% and 72%), life prolongation (45% and 55%), decrease in tumor size (39% and 66%), and cure (19% and 2%) as treatment goals. The interviews showed that the latter appeared to be often as motivation to stay alive. Concordances between patients' and oncologists' treatment goals were low (ranging from 24% to 33%). Patients had slightly higher feasibility scores than oncologists (6.8 vs. 5.8 on a 10-point scale). Educational level, age, religious views, and performance status of patients were associated with treatment goals. CONCLUSION Patients and oncologists set various goals for the treatment they receive/prescribe. Low concordance might exist because different goals are set or because the patient misunderstands something. Clear communication about treatment goals should be integrated into clinical care.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Svitlana Tarasevych
- Department of Pulmonary Diseases, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Marian A Tiemessen
- Department of Pulmonary Diseases, Dijklander Ziekenhuis Hoorn, Hoorn, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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