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Chand CP, Greenley S, Macleod U, Lind M, Barton R, Kelly C. Geographical distance and reduced access to palliative radiotherapy: systematic review and meta-analysis. BMJ Support Palliat Care 2022:bmjspcare-2021-003356. [PMID: 35292512 DOI: 10.1136/bmjspcare-2021-003356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Palliative radiotherapy (PRT) is an effective way of reducing symptoms caused by advanced incurable cancer. Several studies have investigated factors that contribute to inequalities in access to PRT; distance to a radiotherapy centre has been identified as one potential barrier. AIM To assess whether there is an association between distance to a radiotherapy centre and utilisation rates of PRT in adults with cancer. METHODS A systematic review and meta-analysis protocol was registered in the PROSPERO database (CRD42020190772). MEDLINE, EMBASE, CINAHL and APA-PsycINFO were searched for relevant papers up to 28 February 2021. RESULTS Twenty-one studies were included. Twelve studies focused on whether patients with incurable cancer received PRT, as part of their treatment package. Pooled results reported that living ≥50 km vs <50 km from the radiotherapy centre was associated with a reduced likelihood of receiving PRT (OR 0.84 (95%CI 0.80, 0.88)). Nine focused on distance from the radiotherapy centre and compared single-fraction (SF) versus multiple-fraction PRT, indicating that patients living further away were more likely to receive SF. Pooled results comparing ≥50 km versus <50 km showed increased odds of receiving SF for those living ≥50 km (OR 1.48 (95%CI 1.26,1.75)). CONCLUSION Patients living further away from radiotherapy centres were less likely to receive PRT and those who received PRT were more likely to receive SF PRT, providing some evidence of inequalities in access to PRT treatment based on proximity to centres providing radiotherapy. Further research is needed to understand whether these inequalities are influenced by clinical referral patterns or by patients unwilling or unable to travel longer distances. PROSPERO REGISTRATION NUMBER CRD42020190772.
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Affiliation(s)
| | | | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mike Lind
- Hull York Medical School, University of Hull, Hull, UK
- Oncology, Hull University Teaching Hospital, Hull, UK
| | - Rachel Barton
- Oncology, Hull University Teaching Hospital, Hull, UK
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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Barton M, Batumalai V, Spencer K. Health Economic and Health Service Issues of Palliative Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:775-780. [DOI: 10.1016/j.clon.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
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Loudon J, Rozanec N, Clement A, Woo R, Grant A, Murray J, Wells W. Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy. Pract Radiat Oncol 2019; 10:1-7. [PMID: 31437605 DOI: 10.1016/j.prro.2019.08.002] [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: 05/09/2019] [Revised: 06/27/2019] [Accepted: 08/08/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Palliative radiation therapy (PRT) has an essential role in cancer symptom control but is underutilized in Ontario. This initiative aimed to implement an educational outreach intervention to improve knowledge of and access to PRT among interprofessional palliative health care teams across an Ontario Local Health Integration Network. METHODS AND MATERIALS A needs assessment was completed from June to September 2018 with interprofessional palliative health care teams. Participants completed a survey to identify perceived opportunities, barriers, and enablers to recommending or referring patients for PRT. Thematic analysis informed content of the educational outreach intervention and included how to access PRT, common indications, case studies, and side-effect management after completing PRT. The educational outreach intervention was completed from October 2018 to January 2019. Participants completed a survey, and results were analyzed using descriptive statistics. The number of patients who received PRT was determined by cross-referencing the regional database with the radiation oncology information system. RESULTS Although 22.9% of participants had previously recommended or referred patients, 96.2% of participants agreed or strongly agreed that they are likely to recommend or refer patients for PRT after the educational outreach intervention (n = 131). An increase was observed in the number of patients receiving PRT from the community during the intervention period. CONCLUSIONS The educational outreach intervention improved knowledge and the likelihood of interprofessional palliative health care teams providing access to PRT for patients in the community. More patients now receive PRT, conveying improved symptom control and quality of life.
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Affiliation(s)
- James Loudon
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada.
| | - Natalie Rozanec
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Ashley Clement
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Rachel Woo
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Anne Grant
- Hospice Palliative Care Teams for the Central Local Health Integration Network, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Judy Murray
- Hospice Palliative Care Teams for the Central Local Health Integration Network, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Woodrow Wells
- Radiation Medicine Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, 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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Åsli LM, Myklebust TÅ, Kvaløy SO, Jetne V, Møller B, Levernes SG, Johannesen TB. Factors influencing access to palliative radiotherapy: a Norwegian population-based study. Acta Oncol 2018; 57:1250-1258. [PMID: 29706109 DOI: 10.1080/0284186x.2018.1468087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Palliative radiotherapy (PRT) comprises half of all radiotherapy use and is an effective and important treatment modality for improving quality of life in incurable cancer patients. We have described the use of PRT in Norway and aimed to identify and quantify the impact of factors associated with PRT utilization. MATERIAL AND METHODS Population-based data from the Cancer Registry of Norway identified 25,281 patients who died of cancer, 1 July 2009-31 December 2011. Additionally, individual-level data on socioeconomic status and community-level data on travel distance were collected. The proportion of patients who received PRT in the last two years of life (PRT2Y) was calculated, and multivariable logistic regression was used to determine factors that influenced the PRT2Y. Analyses of geographic variation in PRT use were also performed for the time period 2012-2016. RESULTS PRT2Y for all cancer sites combined was 29.6% with wide geographic variations (standardized inter-county range; 21.8-36.6%). Female gender, increasing age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100-499 km, were also less likely to receive PRT. Patients with low household income (adjusted odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.56-0.72) and those diagnosed in hospitals without radiotherapy facility (OR = 0.70; 95% CI = 0.64-0.77) had especially low likelihood of receiving PRT. Significant inter-county variation in use of PRT remained during the time period 2012-2016. CONCLUSIONS Despite a publicly funded, universal healthcare system with equity as a stated health policy aim, utilization of PRT in Norway is significantly associated with factors such as household income and availability of radiotherapy facility at the diagnosing hospital. Even after adjustments for relevant factors, unexplained geographic variations in PRT utilization exist.
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Affiliation(s)
- Linn M. Åsli
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Tor Å. Myklebust
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Stein O. Kvaløy
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vidar Jetne
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | | | - Tom B. Johannesen
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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Jin CJ, Kong W, Mackillop WJ. Estimating the need for palliative radiotherapy for non-small cell lung cancer: A criterion-based benchmarking approach. Radiother Oncol 2018; 128:541-547. [PMID: 29934108 DOI: 10.1016/j.radonc.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Estimates of appropriate treatment rates are required for monitoring and improving access to cancer care. Optimal utilization rates for palliative radiotherapy (PRT) for patients with non-small cell lung cancer (NSCLC) remain undefined. We aim to estimate the appropriate PRT rate for the general NSCLC population. MATERIALS AND METHODS Ontario's population-based cancer registry identified patients with NSCLC who died of their disease between 2006 and 2010. Multivariate analysis identified factors affecting PRT use, enabling us to define a benchmark population with unimpeded access to PRT. Proportion of cases treated in the last 2 years of life (PRT2y) was standardized to overall population characteristics. Benchmarks were compared to province-wide PRT2y rates. RESULTS Availability of RT at the diagnosing hospital was the dominant determinant of increased PRT utilization. Patients diagnosed at hospitals with on site RT were therefore designated the benchmark population. The standardized benchmark for PRT2y was 56%, compared to the province-wide rate of 49%. The gap between actual and optimal rates varied across patient ages, treatment indications, and geographic regions. CONCLUSIONS Approximately 56% of patients who die of NSCLC in Ontario need PRT, but many are never treated.
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Affiliation(s)
- Chunzi Jenny Jin
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Weidong Kong
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - William J Mackillop
- Department of Oncology, Queen's University, Kingston, Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
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Giuliani M, Hope A, Guckenberger M, Mantel F, Peulen H, Sonke JJ, Belderbos J, Werner-Wasik M, Ye H, Grills IS. Stereotactic Body Radiation Therapy in Octo- and Nonagenarians for the Treatment of Early-Stage Lung Cancer. Int J Radiat Oncol Biol Phys 2017; 98:893-899. [PMID: 28258901 DOI: 10.1016/j.ijrobp.2017.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/26/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the safety and efficacy of lung stereotactic body radiation therapy (SBRT) in octo- and nonagenarians and to compare their outcomes with those of younger patients. METHODS AND MATERIALS Patients with primary lung cancer treated with SBRT were identified from a multi-institutional (5 institutions) database of 1083 cases. Details of patient factors, treatment specifics, toxicity, and clinical outcomes were extracted from the database. All events were calculated from the end of radiation therapy. Estimates of local recurrence, regional recurrence, and distant metastases were calculated using the competing risk method. Cause-specific survival (CSS) and overall survival (OS) were calculated using the Kaplan-Meier method. Outcomes were compared for those aged <70, 70 to 79, and ≥80 years. Univariable and multivariable analyses were performed to determine associations with CSS and OS in patients aged ≥80 years. RESULTS The median (range) follow-up was 1.7 (1-10) years, and median age was 75 (41-94) years. There were 305 patients aged <70 years (28%), 448 aged 70 to 79 years (41%), and 330 aged ≥80 years (30%). There was no difference in 2-year local recurrence (4.2% vs 5.4% vs 3.7%, respectively, P=.7), regional recurrence (10.4% vs 7.8% vs 5.3%, P=.1), distant metastases (12.2% vs 7.7% vs 9.5%, P=.2), or CSS (90.6% vs 90.3% vs 90.4%, P=.6). Those aged ≥80 years had significantly lower 2-year OS (73.6% vs 67.2% vs 63.3%, P<.01). The grade 3+ pneumonitis rate was 1.3% versus 1.6% versus 1.5% (P=1.0) in patients aged <70, 70 to 79, and ≥80 years, respectively. The 90-day mortality rates for patients aged <70, 70 to 79, and ≥80 years were 1.3%, 2.5%, and 2.4% (P=.01), respectively. In patients aged ≥80 years OS was associated with T category (hazard ratio 1.7; P<.01). CONCLUSION Stereotactic body radiation therapy is a safe treatment modality in elderly patients (aged ≥80 years). Despite larger tumor volumes, the tumor control outcomes were comparable to those in younger patients treated with SBRT. All patients with early-stage lung cancer, regardless of age, should be considered for treatment with SBRT.
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Affiliation(s)
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Matthias Guckenberger
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland; Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Frederick Mantel
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Heike Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - José Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Inga S Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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Sundaresan P, Stockler MR, Milross CG. What is access to radiation therapy? A conceptual framework and review of influencing factors. AUST HEALTH REV 2016; 40:11-18. [PMID: 26072910 DOI: 10.1071/ah14262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/22/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in 'RT access'. We aimed to develop a conceptual framework for the consideration of 'RT access' by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing 'RT access'. METHODS Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for 'RT access'. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFO via OvidSP,1806 to October 2014. RESULTS The framework developed demonstrates that 'RT access' encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. CONCLUSION 'Access' is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of 'RT access' so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects.
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Affiliation(s)
- Puma Sundaresan
- The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email
| | - Martin R Stockler
- The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email
| | - Christopher G Milross
- The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email
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Mackillop WJ, Kong W. Estimating the Need for Palliative Radiation Therapy: A Benchmarking Approach. Int J Radiat Oncol Biol Phys 2016; 94:51-59. [DOI: 10.1016/j.ijrobp.2015.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/24/2015] [Accepted: 09/18/2015] [Indexed: 12/25/2022]
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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 Phase 1/2 Trial of Brief Androgen Suppression and Stereotactic Radiation Therapy (FASTR) for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2015; 92:856-62. [DOI: 10.1016/j.ijrobp.2015.02.046] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
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Examining Determinants of Radiotherapy Access: Do Cost and Radiotherapy Inconvenience Affect Uptake of Breast-conserving Treatment for Early Breast Cancer? Clin Oncol (R Coll Radiol) 2015; 27:465-71. [PMID: 26009548 DOI: 10.1016/j.clon.2015.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/18/2015] [Accepted: 04/29/2015] [Indexed: 11/24/2022]
Abstract
AIMS Radiotherapy utilisation is likely affected by multiple factors pertaining to radiotherapy access. Radiotherapy is an integral component of breast-conserving treatment (BCT) for early breast cancer. We aimed to determine if stepwise improvements in radiotherapy access in regional Australia affected the uptake of BCT and thus radiotherapy. MATERIALS AND METHODS Breast cancer operations in the Central Coast of New South Wales between January 2010 and March 2014 for T1-2N0-1M0 invasive or in situ (≤5 cm) disease in female patients eligible for BCT were examined. BCT uptake was calculated for three 1 year periods: period 1 (local radiotherapy available at cost to user or out of area radiotherapy with travel cost and inconvenience); period 2 (as per period 1 + publicly funded transport and radiotherapy at out of area facilities at no cost to user); period 3 (as per period 1 + publicly funded local radiotherapy at no cost to user). RESULTS In total, 574 cases met eligibility criteria. BCT declined with increasing distance to publicly funded radiotherapy (P = 0.035). BCT rates for periods 1, 2 and 3 were 63% (113/180), 61% (105/173) and 71% (156/221). There were no statistically significant differences in BCT between periods 1 and 2 in the whole cohort or within age, histology or tumour size subgroups. Overall, there was a 9% increase in BCT in the whole cohort in period 3 compared with periods 1 and 2 (P = 0.031). This increase was statistically significant for women over 70 years (19% increase, P = 0.034), for women with ductal carcinoma in situ (25% increase, P = 0.013) and for women with primary tumours that were ≤10 mm (21% increase, P = 0.016). CONCLUSIONS Improving the affordability of radiotherapy through publicly funded transport and radiotherapy at out of area facilities did not improve BCT uptake in a region where radiotherapy was locally available, albeit at cost to the user. Improving both affordability and convenience through the provision of local publicly funded radiotherapy increased BCT uptake. Service availability and affordability have long been recognised as important determinants of radiotherapy access. Our findings suggest that inconvenience may also influence radiotherapy utilisation.
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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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Kong W, Jarvis C, Mackillop W. Estimating the Need for Palliative Radiotherapy for Brain Metastasis: A Benchmarking Approach. Clin Oncol (R Coll Radiol) 2015; 27:83-91. [DOI: 10.1016/j.clon.2014.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 11/30/2022]
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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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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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Dosimetric and clinical impact of 3D vs. 2D planning in palliative radiotherapy for bone metastases. Support Care Cancer 2013; 21:2229-35. [DOI: 10.1007/s00520-013-1777-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/25/2013] [Indexed: 12/25/2022]
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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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Gillan C, Briggs K, Pazos AG, Maurus M, Harnett N, Catton P, Wiljer D. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol 2012; 7:167. [PMID: 23062109 PMCID: PMC3551743 DOI: 10.1186/1748-717x-7-167] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/26/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Radiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers. METHODS MEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context. RESULTS 535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n = 26, 34.7%), distance to treatment centre (n = 23, 30.7%), wait times (n = 22, 29.3%), and lack of physician understanding about the use of RT (n = 16, 21.6%). CONCLUSIONS Barriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.
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Affiliation(s)
- Caitlin Gillan
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Kaleigh Briggs
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
| | | | - Melanie Maurus
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| | - Nicole Harnett
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Pamela Catton
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
| | - David Wiljer
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- ELLICSR: Health, Wellness, and Cancer Survivorship Centre, Toronto, Canada
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current World Literature. Curr Opin Support Palliat Care 2011; 5:297-305. [DOI: 10.1097/spc.0b013e32834a76ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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