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Howard K, Norris S, Salisbury A, Pearce A, Hay L, Stapleton B, Lean C, Last A, Kwedza R, White K, Rushton S. Women's Preferences for Hypofractionated Radiation Therapy for Treatment of Early-Stage Breast Cancer: A Discrete Choice Experiment. Int J Radiat Oncol Biol Phys 2024; 119:172-184. [PMID: 38110105 DOI: 10.1016/j.ijrobp.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/19/2023] [Accepted: 11/11/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE The primary treatment recommended for early-stage breast cancer is breast conserving surgery followed by external beam radiation therapy of the whole breast. Previously, radiation therapy for early-stage breast cancer was given using more fractions over longer durations. Guidelines support treatments with fewer fractions over a shorter time (hypofractionated radiation therapy). This study aimed to understand women's preferences for different features of treatments for early-stage breast cancer. METHODS AND MATERIALS A discrete choice experiment with 12 choice tasks was conducted, describing the treatments by extent of surgery, duration of radiation treatment, need to relocate for treatment, local side effects, changes in breast appearance, costs, and difficulty with daily activities during and after treatment. Participants were women with breast cancer and from the general population. Mixed logit analyses were conducted and trade-offs between attributes estimated. RESULTS Four hundred twenty respondents completed the discrete choice experiment. The relative importance of attributes varied by respondent characteristics; the most influential attribute for younger women was type of surgery (breast conserving surgery). Type of surgery did not influence older women's preferences. Shorter treatment duration, avoiding relocation, fewer local side effects, and less difficulty with daily activities all positively influenced treatment preference. Younger women were willing to accept 32 to 40 days of radiation treatment before a treatment that included mastectomy was potentially acceptable. CONCLUSIONS Attributes of treatment such as duration, need for relocation, side effects, and effects on normal daily activities during and after treatment significantly influenced women's preference for treatment, including surgery. Our findings have the potential for real impact for patients and services including supporting one-on-one clinical discussions, supporting program and patient resource development, and informing service funding, organization, and delivery.
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Affiliation(s)
- Kirsten Howard
- Menzies Centre for Health Policy and Economics; School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
| | | | | | - Alison Pearce
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Liz Hay
- NSW Ministry of Health, St Leonards, New South Wales, Australia
| | | | - Cynthia Lean
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Andrew Last
- School of Clinical Medicine, Rural Clinical Campus, UNSW Medicine & Health, Port Macquarie, New South Wales, Australia
| | - Ru Kwedza
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Kahren White
- Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Shelley Rushton
- Cancer Institute NSW, St Leonards, New South Wales, Australia
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Vinod SK, Merie R, Harden S. Quality of Decision Making in Radiation Oncology. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00067-0. [PMID: 38342658 DOI: 10.1016/j.clon.2024.02.001] [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: 11/09/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.
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Affiliation(s)
- S K Vinod
- Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - R Merie
- Icon Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - S Harden
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Melidis C, Seghour S, Noblet S. Does cost minimization of hypofractionated radiation therapy content all health stakeholders? J Med Imaging Radiat Sci 2023; 54:405-409. [PMID: 37328357 PMCID: PMC10266558 DOI: 10.1016/j.jmir.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Christos Melidis
- Radiation Therapy Department, CAP Santé, Bastia, France; milliVolt.eu, Bastia, France.
| | | | - Sandrine Noblet
- University of Corsica Pascal Paoli, UMR CNRS LISA 6240, Corte, France
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Robards S, Brown A, Pain T, Patel D, Tan A, Carter H. A value-based approach to prostate cancer image-guidance in a regional radiation therapy centre: a cost-minimisation analysis. Tech Innov Patient Support Radiat Oncol 2022; 24:131-136. [PMID: 36561985 PMCID: PMC9763936 DOI: 10.1016/j.tipsro.2022.11.002] [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: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background and objectives Usual practice for the insertion of prostate fiducial markers involves at least one week delay between insertion and simulation. An evidence-based practice change was implemented whereby fiducial marker insertion occurred on the same day as radiotherapy simulation. The aim of this study was to quantify the health service costs and clinical outcomes associated with this practice change. Methods A cost-minimisation analysis was undertaken from the perspective of the local health service. A retrospective chart audit was conducted to collect data on 149 patients in the pre-implementation cohort and 138 patients in the post-implementation cohort. Associated costs with insertion and simulation were calculated and compared across the two cohorts; this included subsided travel costs for rural and remote patients. Fiducial marker positions on planning CT and first treatment CBCT were measured for all patients as the surrogate clinical outcome measure for oedema. Results The health service saved an average of AU$ 361 (CI $311 - $412) per patient after the practice change. There was no significant difference in fiducial marker position pre- and post- implementation (p < 0.05). Conclusion The practice change to perform insertion and radiotherapy simulation on the same day resulted in substantial savings to the health system, without compromising clinical outcomes. The decrease in number of required patient attendances is of real consequence to rural and remote populations. The practice change increases both the value and accessibility of best-practice health care to those most at risk of missing out.
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Affiliation(s)
- Shannon Robards
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Amy Brown
- Townsville Hospital and Health Service, Townsville, Queensland, Australia,Corresponding author at: PO Box 670, Townsville University Hospital, Queensland 4815, Australia
| | - Tilley Pain
- Townsville Hospital and Health Service, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia
| | - Deepti Patel
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Alex Tan
- Townsville Hospital and Health Service, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia
| | - Hannah Carter
- Queensland University of Technology, Brisbane, Queensland, Australia
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Brown A, Yim J, Jones S, Tan A, Callander E, Watt K, De Abreu Lourenco R, Pain T. Men's perceptions and preferences regarding prostate cancer radiation therapy: A systematic scoping review. Clin Transl Radiat Oncol 2022; 38:28-42. [PMID: 36345391 PMCID: PMC9636414 DOI: 10.1016/j.ctro.2022.10.007] [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: 07/17/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the literature on men's preferences and perceptions regarding prostate cancer radiation therapy. METHODS A scoping review was undertaken as per JBI guidelines. Searches were conducted in PubMed, CINAHL, Scopus and Science Direct with search terms including "prostate cancer," "radiotherapy," "radiation therapy," "radiation oncology," "patient preferences," "patient perceptions" and "patient experience." The resultant studies were mapped and grouped according to the emergent themes and pathway stages. RESULTS A total of 779 titles and abstracts were screened by two independent reviewers. Fifty-two full-text studies were reviewed, with 27 eligible for inclusion. There were 4 pre-treatment, 13 during treatment and 10 post-treatment studies covering broad themes of information needs (n = 3), preferences and decisions (n = 6), general experiences (n = 8), side effects (n = 6), and support (n = 4). There were a mix of methodologies, including 11 qualitative, 14 quantitative (including four preference studies), one mixed methods and one narrative review. CONCLUSION There were only four preference studies, with the remaining 23 reporting on perceptions. Overall, there is a paucity of literature regarding patient preferences and perceptions of prostate cancer radiation therapy, particularly when considering how many clinical and technical studies are published in the area. This highlights opportunities for future research.
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Affiliation(s)
- Amy Brown
- Townsville University Hospital, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia,Corresponding author at: Townsville University Hospital, PO Box 670, Queensland 4815, Australia.
| | - Jackie Yim
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Scott Jones
- Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Metro South Health Service, South Brisbane, Queensland, Australia
| | - Alex Tan
- James Cook University, Townsville, Queensland, Australia,Radiation Oncology, Genesis Cancer Care, Nambour, Queensland, Australia
| | | | - Kerrianne Watt
- James Cook University, Townsville, Queensland, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tilley Pain
- Townsville University Hospital, Townsville, Queensland, Australia,James Cook University, Townsville, Queensland, Australia
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Gillespie EF, Khan AJ, Braunstein LZ. In Reply to Rabinovitch. Pract Radiat Oncol 2022; 12:e243-e244. [PMID: 35512994 DOI: 10.1016/j.prro.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Erin F Gillespie
- Department of Radiation Oncology; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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