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Exploring the utilization of single fraction radiation therapy for bone metastases at a community cancer centre. J Med Imaging Radiat Sci 2022; 53:S31-S38. [DOI: 10.1016/j.jmir.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
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Behavioral Determinants of Canadian Radiation Oncologists’ Use of Single Fraction Palliative Radiation Therapy for Uncomplicated Bone Metastases. Int J Radiat Oncol Biol Phys 2021; 109:374-386. [DOI: 10.1016/j.ijrobp.2020.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
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3
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Göksel F. Retrospective evaluation of palliative radiotherapy in patients with bone metastasis: a single center experience. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.663772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ong WL, Foroudi F, Milne RL, Millar JL. Variation in the Use of Single- Versus Multifraction Palliative Radiation Therapy for Bone Metastases in Australia. Int J Radiat Oncol Biol Phys 2019; 106:61-66. [PMID: 31505246 DOI: 10.1016/j.ijrobp.2019.08.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/22/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the use of single-fraction palliative radiation therapy (SFRT) for the management of bone metastases (BM) in Victoria, Australia. METHODS AND MATERIALS This is a population-based cohort of patients with cancer who received radiation therapy for BM between 2012 and 2017 as captured in the Victorian Radiotherapy Minimum Data Set. The primary outcome was proportion of SFRT use. The Cochrane-Armitage test for trend was used to evaluate changes in practice over time. Multivariable logistic regression was used to assess factors associated with SFRT use. RESULTS Of the 18,158 courses of radiation therapy for BM delivered to a total of 10,956 patients, 17% were SFRT. There was no significant change in SFRT use over time, from 18% in 2012 to 19% in 2017 (P = .07). SFRT was less commonly given to the skull (4%) and spine (14%), compared with the shoulder (37%) and ribs (53%). Patients with lung cancer (21%) were most likely to receive SFRT, followed by those with prostate cancers (18%) and gastrointestinal cancers (16%). Patients from regional/remote areas were more likely to have SFRT compared with those in major cities (22% vs 16%, P < .001). Patients treated in public institutions were more likely to have SFRT compared with those treated in private institutions (22% vs 10%, P < .001). In multivariable analyses, increasing age, lung cancer, higher socioeconomic status, residence in regional/ remote areas, and being treated in public institutions were factors independently associated with increased likelihood of receiving SFRT. CONCLUSIONS SFRT appears underused for BM in Australia over time, with variation in practice by patient, tumor, sociodemographic, geographical, and institutional provider factors.
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Affiliation(s)
- Wee Loon Ong
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia; School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdon; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia.
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology Services, Prahran, Australia; Central Clinical School, Monash University, Melbourne, Australia
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Di Lalla V, Fortin B, Pembroke C, Freeman C, Yassa M, Hijal T. Are radiation oncologists following guidelines? An audit of practice in patients with uncomplicated bone metastases. Tech Innov Patient Support Radiat Oncol 2019; 9:13-17. [PMID: 32095590 PMCID: PMC7033799 DOI: 10.1016/j.tipsro.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/12/2018] [Accepted: 12/22/2018] [Indexed: 12/18/2022] Open
Abstract
At our center single fraction radiotherapy is used in accordance with guidelines. Patient age, performance status and tumor histology influence treatment choice. We added a quality indicator to our performance dashboard to improve adherence. This strategy can be used in other complex practices and improve quality of care.
Background Best-practice guidelines recommend single-fraction (SFRT) instead of multi-fraction radiation therapy (MFRT) for uncomplicated symptomatic bone metastases. SFRT is comparable to MFRT in relieving pain, convenient for patients, and cost-effective. Patterns of practice in Canada reveal that SFRT is underused, with significant variability across the country. We audited SFRT use and studied factors that may influence treatment decisions at a large academic tertiary care center in Quebec, Canada. Methods Patients who received radiotherapy for uncomplicated bone metastases between February 2014 and March 2015 were reviewed. Age, gender, primary histology, site of metastases and performance status were identified as potential factors affecting fractionation. These were explored by Fisher's test on univariate analysis and logistic regression for multivariate analysis. Retreatment rates were analyzed with cumulative incidence and compared with Gray's test. Results 254 radiotherapy courses were administered to 165 patients, 85.4% of which were delivered using a single fraction of 8 Gy. Patients age less than 70 years and those with breast histology were more likely to receive MFRT (p = 0.04; p = 0.0046). Performance status (ECOG) was a significant predictor of fractionation because of high correlations between young age, breast histology, and ECOG status (p = 0.03). Follow-up was too short in 40% of patients to derive definitive conclusions on retreatment. Conclusions In accordance with current guidelines, our audit confirms that use of SFRT in patients with uncomplicated bone metastases at our center is high. We identified that patient age, primary histology, and performance status influenced fractionation. Incorporation of this quality indicator into our performance dashboard will allow assessment of retreatment differences and other criteria that may also influence treatment choice.
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Affiliation(s)
| | | | | | | | - Michael Yassa
- Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Tarek Hijal
- McGill University Health Centre, Montreal, Quebec, Canada
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Le Fèvre C, Antoni D, Thiéry A, Noël G. Radiothérapie des métastases osseuses : revue multi-approches de la littérature. Cancer Radiother 2018; 22:810-825. [DOI: 10.1016/j.canrad.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/20/2017] [Accepted: 10/12/2017] [Indexed: 12/18/2022]
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Liu E, Santibáñez P, Puterman ML, Weber L, Ma X, Sauré A, Olivotto IA, Halperin R, French J, Tyldesley S. A Quantitative Analysis of the Relationship Between Radiation Therapy Use and Travel Time. Int J Radiat Oncol Biol Phys 2015; 93:710-8. [DOI: 10.1016/j.ijrobp.2015.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
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Ashworth A, Kong W, Chow E, Mackillop WJ. Fractionation of Palliative Radiation Therapy for Bone Metastases in Ontario: Do Practice Guidelines Guide Practice? Int J Radiat Oncol Biol Phys 2015; 94:31-39. [PMID: 26454681 DOI: 10.1016/j.ijrobp.2015.07.2291] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/20/2015] [Accepted: 07/29/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the effect of a provincial practice guideline on the fractionation of palliative radiation therapy for bone metastases (PRT.B) in Ontario. METHODS AND MATERIALS The present retrospective study used electronic treatment records linked to Ontario's population-based cancer registry. Hierarchical multivariable regression analysis was used to evaluate temporal trends in the use of single fractions (SFs), controlling for patient-related factors associated with the use of SFs. RESULTS From 1984 to 2012, 43.9% of 161,835 courses of PRT.B were administered as SFs. The percentage of SF courses was greater for older patients (age <50 years, 39.8% vs age >80 years, 52.5%), those with a shorter life expectancy (survival >12 months, 36.9% vs < 1 month, 53.6%), and those who lived farther from a radiation therapy center (<10 km, 42.1% vs > 50 km, 47.3%). The percentage of SFs to spinal fields was lower than that to other skeletal sites (31.5% vs 57.1%). The percentage of SFs varied among the cancer centers (range, 26.0%-67.8%). These differences were all highly significant in the multivariable analysis (P<.0001). In 2004, Cancer Care Ontario released a practice guideline endorsing the use of SFs for uncomplicated bone metastases. The rate of use of SFs increased from 42.3% in the pre-guideline period (1999-2003) to 52.6% in the immediate post-guideline period (2004-2007). However, it subsequently decreased again to 44.0% (2009-2012). These temporal trends were significant after controlling for patient-related factors in the multivariable analysis (P<.0001). Large intercenter variations in the use of SFs persisted after publication of the guideline. CONCLUSIONS The publication of an Ontario practice guideline endorsing the use of SF PRT.B was associated with only a transient increase in the use of SFs in Ontario and did little to reduce intercenter variations in fractionation.
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Affiliation(s)
- Allison Ashworth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada; Cancer Center of Southeastern Ontario, Kingston, Ontario, Canada
| | - Weidong Kong
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Edward Chow
- Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
| | - William J Mackillop
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada; Cancer Center of Southeastern Ontario, Kingston, Ontario, Canada.
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A Comparison of Evidence-Based Estimates and Empirical Benchmarks of the Appropriate Rate of Use of Radiation Therapy in Ontario. Int J Radiat Oncol Biol Phys 2015; 91:1099-107. [DOI: 10.1016/j.ijrobp.2014.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/31/2014] [Accepted: 11/17/2014] [Indexed: 11/21/2022]
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Factors Affecting the Use of Single-Fraction Radiotherapy for the Palliation of Bone Metastases in Australia. Clin Oncol (R Coll Radiol) 2015; 27:205-12. [DOI: 10.1016/j.clon.2014.11.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/13/2014] [Accepted: 11/30/2014] [Indexed: 12/25/2022]
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Zhang-Salomons J, Salomons G. Determine the therapeutic role of radiotherapy in administrative data: a data mining approach. BMC Med Res Methodol 2015; 15:11. [PMID: 25649372 PMCID: PMC4350984 DOI: 10.1186/1471-2288-15-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 01/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical data gathered for administrative purposes often lack sufficient information to separate the records of radiotherapy given for palliation from those given for cure. An absence, incompleteness, or inaccuracy of such information could hinder or bias the study of the utilization and outcome of radiotherapy. This study has three specific purposes: 1) develop a method to determine the therapeutic role of radiotherapy (TRR); 2) assess the accuracy of the method; 3) report the quality of the information on treatment "intent" recorded in the clinical data in Ontario, Canada. A general purpose is to use this study as a prototype to demonstrate and test a method to assess the quality of administrative data. METHODS This is a population based retrospective study. A random sample was drawn from the treatment records with "intent" assigned in treating hospitals. A decision tree is grown using treatment parameters as predictors and "intent" as outcome variable to classify the treatments into curative or palliative. The tree classifier was applied to the entire dataset, and the classification results were compared with those identified by "intent". A manual audit was conducted to assess the accuracy of the classification. RESULTS The following parameters predicted the TRR, from the strongest to the weakest: radiation dose per fraction, treated body-region, disease site, and time of treatment. When applied to the records of treatments given between 1990 and 2008 in Ontario, Canada, the classification rules correctly classified 96.1% of the records. The quality of the "intent" variable was as follows: 77.5% correctly classified, 3.7% misclassified, and 18.8% did not have an "intent" assigned. CONCLUSIONS The classification rules derived in this study can be used to determine the TRR when such information is unavailable, incomplete, or inaccurate in administrative data. The study demonstrates that data mining approach can be used to effectively assess and improve the quality of large administrative datasets.
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Affiliation(s)
- Jina Zhang-Salomons
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada. .,Department of Oncology, Queen's University, Kingston, ON, Canada. .,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
| | - Greg Salomons
- Department of Oncology, Queen's University, Kingston, ON, Canada. .,Department of Physics, Queen's University, Kingston, ON, Canada. .,Kingston General Hospital, Kingston, ON, Canada.
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Rutter CE, Yu JB, Wilson LD, Park HS. Assessment of national practice for palliative radiation therapy for bone metastases suggests marked underutilization of single-fraction regimens in the United States. Int J Radiat Oncol Biol Phys 2014; 91:548-55. [PMID: 25542310 DOI: 10.1016/j.ijrobp.2014.10.045] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions. PATIENTS AND METHODS The National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details. RESULTS We included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05). CONCLUSIONS Single-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such that evidence-based and cost-conscious care becomes more commonplace.
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Affiliation(s)
- Charles E Rutter
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut
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Fairchild A. Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine? World J Clin Oncol 2014; 5:845-857. [PMID: 25493222 PMCID: PMC4259946 DOI: 10.5306/wjco.v5.i5.845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 04/28/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy (EBRT) for bone metastases (BM) from lung cancer were sought via literature search (2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter (range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impending pathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.
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McDonald R, Chow E, Lam H, Rowbottom L, Soliman H. International patterns of practice in radiotherapy for bone metastases: A review of the literature. J Bone Oncol 2014; 3:96-102. [PMID: 26909305 PMCID: PMC4723651 DOI: 10.1016/j.jbo.2014.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/26/2014] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Radiation therapy is the standard treatment for symptomatic bone metastases. Several randomized control trials and meta-analyses have concluded a similar efficacy in pain relief when comparing single versus multiple fraction regimes. However, there continues to be reluctance to conform to published guidelines that recommend a single treatment for the palliation of painful bone metastases. The purpose of this literature review is to summarize international patterns of practice, and to determine if guidelines recommending single fraction treatment have been implemented in clinical care. METHODS A literature search was conducted in Ovid Medline, Embase, and Cochrane Central. Search words included, 'bone metastases', 'radiation therapy', 'radiotherapy', 'patterns of practice', and 'dose fractionation'. Both prospective and retrospective studies that investigated the prescription of radiotherapy to bone metastases using actual patient databases were included. Articles were excluded if they investigated hypothetical scenarios. RESULTS Six hundred and thirteen results were generated from the literature search. Twenty-six articles met the inclusion criteria. Of these, 11 were Canadian, 8 were European, 6 were American, and 1 was Australian. The use of single fraction radiotherapy (SFRT) ranged from 3% to 75%, but was generally lower in American studies. Choice of fractionation depended on a variety of factors, including patient age, prognosis, site of irradiation, and physician experience. CONCLUSION Despite the publication of robust randomized control trials, meta-analyses, and clinical practice guidelines recommending the use of a single treatment to palliate uncomplicated bone metastasis, SFRT is internationally underutilized.
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Affiliation(s)
| | | | | | | | - Hany Soliman
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N3M5
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Olson RA, Tiwana MS, Barnes M, Kiraly A, Beecham K, Miller S, Hoegler D, Olivotto I. Use of single- versus multiple-fraction palliative radiation therapy for bone metastases: population-based analysis of 16,898 courses in a Canadian province. Int J Radiat Oncol Biol Phys 2014; 89:1092-1099. [PMID: 25035213 DOI: 10.1016/j.ijrobp.2014.04.048] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/07/2014] [Accepted: 04/23/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE There is abundant evidence that a single fraction (SF) of palliative radiation therapy (RT) for bone metastases is equivalent to more protracted and costly multiple fraction courses. Despite this, there is low utilization of SFRT internationally. We sought to determine the utilization of SFRT in a population-based, publicly funded health care system. METHODS AND MATERIALS All consecutive patients with bone metastases treated with RT during 2007 to 2011 in British Columbia (BC) were identified. Associations between utilization of SFRT and patient and provider characteristics were investigated. RESULTS A total of 16,898 courses of RT were delivered to 8601 patients. SFRT was prescribed 49% of the time. There were positive relationships among SFRT utilization and primary tumor group (P<.001; most commonly in prostate cancer), worse prognosis (P<.001), increasing physician experience (P<.001), site of metastases (P<.001; least for spine metastases), and area of training (P<.001; most commonly for oncologists trained in the United Kingdom). There was wide variation in the prescription of SFRT across 5 regional cancer centers, ranging from 25.5% to 73.4%, which persisted after controlling for other, potentially confounding factors (P<.001). CONCLUSIONS The large variability in SFRT utilization across BC Cancer Agency (BCCA) cancer centers suggests there is a strong cultural effect, where physicians' use of SFRT is influenced by their colleagues' practice. SFRT use in BC was similar to that in other Canadian and western European reports but strikingly higher than in the United States. Further work is needed to standardize SFRT prescribing practices internationally for this common indication for RT, with the potential for huge health system cost savings and substantial improvements in patients' quality of life.
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Affiliation(s)
- Robert A Olson
- BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
| | - Manpreet S Tiwana
- BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Mark Barnes
- BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada
| | - Andrew Kiraly
- BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Kwamena Beecham
- BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Stacy Miller
- BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - David Hoegler
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Agency Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Ivo Olivotto
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Agency Vancouver Centre, Victoria, British Columbia, Canada
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Nieder C, Pawinski A, Dalhaug A. Continuous controversy about radiation oncologists' choice of treatment regimens for bone metastases: should we blame doctors, cancer-related features, or design of previous clinical studies? Radiat Oncol 2013; 8:85. [PMID: 23574944 PMCID: PMC3643865 DOI: 10.1186/1748-717x-8-85] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/07/2013] [Indexed: 12/25/2022] Open
Abstract
Recent studies from Italy, Japan and Norway have confirmed previous reports, which found that a large variety of palliative radiotherapy regimens are used for painful bone metastases. Routine use of single fraction treatment might or might not be the preferred institutional approach. It is not entirely clear why inter-physician and inter-institution differences continue to persist despite numerous randomized trials, meta-analyses and guidelines, which recommend against more costly and inconvenient multi-fraction regimens delivering total doses of 30 Gy or more in a large number of clinical scenarios. In the present mini-review we discuss the questions of whether doctors are ignoring evidence-based medicine or whether we need additional studies targeting specifically those patient populations where recent surveys identified inconsistent treatment recommendations, e.g. because of challenging disease extent. We identify open questions and provide research suggestions, which might contribute to making radiation oncology practitioners more confident in selecting the right treatment for the right patient.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, 8092, Norway.
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17
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The Use of Palliative Whole Brain Radiotherapy in the Management of Brain Metastases. Clin Oncol (R Coll Radiol) 2012; 24:e149-58. [PMID: 23063070 DOI: 10.1016/j.clon.2012.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 11/20/2022]
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Urquhart R, Kendell C, Sargeant J, Buduhan G, Johnson P, Rayson D, Grunfeld E, Porter GA. How do surgeons decide to refer patients for adjuvant cancer treatment? Protocol for a qualitative study. Implement Sci 2012; 7:102. [PMID: 23098262 PMCID: PMC3503754 DOI: 10.1186/1748-5908-7-102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 10/22/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer, breast cancer, and colorectal cancer are commonly diagnosed cancers in Canada. Patients diagnosed with early-stage non-small cell lung, breast, or colorectal cancer represent potentially curable populations. For these patients, surgery is the primary mode of treatment, with (neo)adjuvant therapies (e.g., chemotherapy, radiotherapy) recommended according to disease stage. Data from our research in Nova Scotia, as well as others', demonstrate that a substantial proportion of non-small cell lung cancer and colorectal cancer patients, for whom practice guidelines recommend (neo)adjuvant therapy, are not referred for an oncologist consultation. Conversely, surveillance data and clinical experience suggest that breast cancer patients have much higher referral rates. Since surgery is the primary treatment, the surgeon plays a major role in referring patients to oncologists. Thus, an improved understanding of how surgeons make decisions related to oncology services is important to developing strategies to optimize referral rates. Few studies have examined decision making for (neo)adjuvant therapy from the perspective of the cancer surgeon. This study will use qualitative methods to examine decision-making processes related to referral to oncology services for individuals diagnosed with potentially curable non-small cell lung, breast, or colorectal cancer. METHODS A qualitative study will be conducted, guided by the principles of grounded theory. The study design is informed by our ongoing research, as well as a model of access to health services. The method of data collection will be in-depth, semi structured interviews. We will attempt to recruit all lung, breast, and/or colorectal cancer surgeons in Nova Scotia (n ≈ 42), with the aim of interviewing a minimum of 34 surgeons. Interviews will be audiotaped and transcribed verbatim. Data will be collected and analyzed concurrently, with two investigators independently coding and analyzing the data. Analysis will involve an inductive, grounded approach using constant comparative analysis. DISCUSSION The primary outcomes will be (1) identification of the patient, surgeon, institutional, and health-system factors that influence surgeons' decisions to refer non-small cell lung, breast, and colorectal cancer patients to oncology services when consideration for (neo)adjuvant therapy is recommended and (2) identification of potential strategies that could optimize referral to oncology for appropriate individuals.
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Affiliation(s)
- Robin Urquhart
- Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada
| | - Cynthia Kendell
- Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada
| | - Joan Sargeant
- Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
- Continuing Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gordon Buduhan
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Johnson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Rayson
- Division of Medical Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey A Porter
- Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Hanna T, Richardson H, Peng Y, Kong W, Zhang-Salomons J, Mackillop W. A Population-Based Study of Factors Affecting the Use of Radiotherapy for Endometrial Cancer. Clin Oncol (R Coll Radiol) 2012; 24:e113-24. [DOI: 10.1016/j.clon.2012.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 12/14/2011] [Accepted: 01/27/2012] [Indexed: 11/28/2022]
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Retreatment with radiotherapy for symptomatic bone, brain or visceral metastases. Clin Transl Oncol 2012; 15:72-8. [PMID: 22855179 DOI: 10.1007/s12094-012-0895-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 04/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The need for reirradiation in the metastatic disease appears when other modalities of treatment lose their efficacy. The aim of reirradiation in the metastatic disease is mainly palliative to control a particular symptom. However, this theoretical benefit must be confronted against the risk of an undesirable toxicity. MATERIALS AND METHODS Experience with reirradiation for symptomatic bone, brain or visceral metastases are reviewed. Twenty-two patients were found to have a second palliative radiotherapy on the same location. Locatión of metastases were visceral in 5 (23 %) patients, brain in 4 (18 %) patients, spine in 1 (4.5 %) patient and bone metastasis other than spine in 12 (54.5 %) patients. Median dose delivered in the first treatment was 30 Gy (range 20-30 Gy) and 20 Gy for the second treatment (range 6-32.4 Gy). RESULTS A good symptomatic response after first irradiation (complete response or disappearance of >50 % of symptoms) was reached in 21 (95.5 %) of the 22 patients analyzed. After second irradiation, 82 % (18 patients) achieved a good response, 3 (14 %) patients had a moderate response (relief of symptoms <50 %) whereas no response was observed in 1 (4 %) patient. Acute toxicity was limited to grade 1-2 proctitis in 2 and 3 patients after the first and second irradiation, respectively. No cases of late toxicity after the first or second irradiation were recorded. CONCLUSION A second treatment with palliative radiotherapy is feasible and well tolerated and offers the possibility of symptomatic relief in a high percentage of patients with symptomatic metastases.
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Sutton DS, Kong W, Ding K, Mackillop WJ. The use of palliative radiotherapy for bone metastasis. Radiother Oncol 2010; 97:548-53. [DOI: 10.1016/j.radonc.2010.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 09/20/2010] [Accepted: 09/20/2010] [Indexed: 11/28/2022]
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Hanna TP, Kangolle ACT. Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2010; 10:24. [PMID: 20942937 PMCID: PMC2978125 DOI: 10.1186/1472-698x-10-24] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 10/13/2010] [Indexed: 01/01/2023]
Abstract
Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important.
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Affiliation(s)
- Timothy P Hanna
- Cancer Centre of Southeastern Ontario 25 King Street West, Kingston, ON, K7L 5P9, Canada.
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Estimating need for palliative external beam radiotherapy in adult cancer patients. Int J Radiat Oncol Biol Phys 2010; 76:207-11. [PMID: 19362788 DOI: 10.1016/j.ijrobp.2009.01.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 01/16/2009] [Accepted: 01/21/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE Older surveys and benchmark data from different sources have suggested that 46-53% of all radiotherapy courses were administered with palliative intent. In Sweden, 87 annual palliative treatment courses per 100,000 inhabitants were registered in 2001, mainly for the treatment of bone and brain metastases (95% confidence interval [CI] 85-89). The corresponding number for Norway was 95 (95% CI 93-98) in 2004. New data are lacking, although new systemic treatment options might alter this number. METHODS AND MATERIALS We collected prospective data on the use of palliative external beam radiotherapy for adult cancer patients during a 12-month period between 2007 and 2008. All patients (median age 69 years) were treated in one Norwegian county and had unlimited, rapid access to treatment. Efforts were made to account for potential overuse. RESULTS Most irradiated patients had skeletal target volumes, followed by nonbony thoracic targets and brain metastases. In the present population, 133 annual treatments per 100,000 inhabitants were registered (after correction for overuse, but not accounting for radiosurgery of brain metastases and emerging treatment options; e.g., stereotactic radiotherapy for lung and liver metastases; 95% CI 119-149). Because some patients received simultaneous treatment to different target volumes, the annual number of target volumes amounted to 175 per 100,000 inhabitants (95% CI 161-191). CONCLUSION The need for palliative radiotherapy has not decreased and might be greater than previously estimated. In regions with a significantly different cancer incidence, age structure, and other socioeconomic factors than northern Europe, separate analyses should be conducted.
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Wu JSY, Kerba M, Wong RKS, Mckimmon E, Eigl B, Hagen NA. Patterns of practice in palliative radiotherapy for painful bone metastases: impact of a regional rapid access clinic on access to care. Int J Radiat Oncol Biol Phys 2009; 78:533-8. [PMID: 19910133 DOI: 10.1016/j.ijrobp.2009.07.1716] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 07/22/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE External beam radiotherapy (RT) is commonly indicated for the palliation of symptomatic bone metastases, but there is evidence of underutilization of this treatment modality in palliative care for cancer populations. This study was conducted to investigate factors that influenced the use of palliative RT services at a regional comprehensive cancer center. METHODS AND MATERIALS A cohort of patients with radiographically confirmed bone metastases and first-time users of palliative RT between 2003 and 2005 was retrospectively reviewed from the time of initial diagnosis of bone metastases to death or last follow-up. Type of radiation treatment service provider used (rapid access or routine access) and patient-, tumor-, and treatment-related factors were analyzed for their influences on the number of treatment courses given over the duration of disease. RESULTS A total of 887 patients received 1,354 courses of palliative RT for bone metastases at a median interval of 4.0 months between courses. Thirty-three percent of patients required more than one RT course. Increased age and travel distance reduced the likelihood and number of treatment courses, while service through a rapid access clinic was independently associated with an increase in subsequent use of palliative RT. CONCLUSIONS A rapid access service model for palliative RT facilitated access to RT. Travel distance and other factors remained substantial barriers to use of palliative RT services. The pattern of practice suggests an unmet need for symptom control in patients with bone metastases.
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Affiliation(s)
- Jackson S Y Wu
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Alberta, Canada.
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