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Mitchell RJ, Delaney GP, Arnolda G, Liauw W, Phillips JL, Lystad RP, Harrison R, Braithwaite J. Potentially burdensome care at the end-of-life for cancer decedents: a retrospective population-wide study. BMC Palliat Care 2024; 23:32. [PMID: 38302965 PMCID: PMC10835903 DOI: 10.1186/s12904-024-01358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Variation persists in the quality of end-of-life-care (EOLC) for people with cancer. This study aims to describe the characteristics of, and examine factors associated with, indicators of potentially burdensome care provided in hospital, and use of hospital services in the last 12 months of life for people who had a death from cancer. METHOD A population-based retrospective cohort study of people aged ≥ 20 years who died with a cancer-related cause of death during 2014-2019 in New South Wales, Australia using linked hospital, cancer registry and mortality records. Ten indicators of potentially burdensome care were examined. Multinominal logistic regression examined predictors of a composite measure of potentially burdensome care, consisting of > 1 ED presentation or > 1 hospital admission or ≥ 1 ICU admission within 30 days of death, or died in acute care. RESULTS Of the 80,005 cancer-related deaths, 86.9% were hospitalised in the 12 months prior to death. Fifteen percent had > 1 ED presentation, 9.9% had > 1 hospital admission, 8.6% spent ≥ 14 days in hospital, 3.6% had ≥ 1 intensive care unit admission, and 1.2% received mechanical ventilation on ≥ 1 occasion in the last 30 days of life. Seventeen percent died in acute care. The potentially burdensome care composite measure identified 20.0% had 1 indicator, and 10.9% had ≥ 2 indicators of potentially burdensome care. Compared to having no indicators of potentially burdensome care, people who smoked, lived in rural areas, were most socially economically disadvantaged, and had their last admission in a private hospital were more likely to experience potentially burdensome care. Older people (≥ 55 years), females, people with 1 or ≥ 2 Charlson comorbidities, people with neurological cancers, and people who died in 2018-2019 were less likely to experience potentially burdensome care. Compared to people with head and neck cancer, people with all cancer types (except breast and neurological) were more likely to experience ≥ 2 indicators of potentially burdensome care versus none. CONCLUSION This study shows the challenge of delivering health services at end-of-life. Opportunities to address potentially burdensome EOLC could involve taking a person-centric approach to integrate oncology and palliative care around individual needs and preferences.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Geoffrey P Delaney
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), UNSW, Sydney, Australia
- Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
- Collaboration for Cancer Outcomes Research and Evaluation, South-Western Sydney Clinical School, UNSW, Sydney, Australia
- University of New South Wales School of Clinical Medicine, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Winston Liauw
- University of New South Wales School of Clinical Medicine, Sydney, Australia
- Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - Jane L Phillips
- Maridulu Budyari Gumal - Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), UNSW, Sydney, Australia
- Faculty of Health, School of Nursing, QUT, Brisbane, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Gan DEH, Bustam AZ. Cancer trend and radiotherapy utilization at a tertiary academic hospital in Malaysia. J Cancer Res Ther 2024; 20:358-362. [PMID: 38554346 DOI: 10.4103/jcrt.jcrt_1953_22] [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: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 04/01/2024]
Abstract
AIMS To determine the trend of cancer cases referred to the Department of Clinical Oncology in UMMC in terms of patient volumes over a period of 10 years. To define the stage at presentation of the top five cancers in males and females, respectively. To determine the overall radiotherapy utilization rates. METHODS AND MATERIAL This is a retrospective analysis of all new cases seen at the Department of Clinical Oncology, University of Malaya Medical Centre (UMMC), from the year 2009 to 2018 inclusive. The top five cancers in males and females were defined in terms of patient volumes and stage at presentation. The overall actual radiotherapy utilization rates were determined. RESULTS A total of 12,672 patients were included for analysis. A total of 62.9% of the cases were females and 37.1% were males. The median age of presentation was 59 years old. Breast cancer was the most common cancer, followed by colorectal, lung, thyroid, and prostate cancer. The most common presenting stage was stage 4. The overall actual radiotherapy utilization rate (aRTU) was 40.1%. Curative intent makes up 74.3% of radiotherapy and 66.6% of chemotherapy utilization. CONCLUSIONS The cancer distribution and trends among our patients are comparable with national and regional data. The overall actual radiotherapy utilization rate in the UMMC was lower than the estimated optimal rate of 53% but higher than the actual rate of 28% for Malaysia. This study provides valuable insight into current cancer trends and treatment demands to facilitate service planning.
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Affiliation(s)
- Daniel E H Gan
- Department of Clinical Oncology, University of Malaya Medical Centre, Jln Profesor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur, Malaysia
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Thompson SR, Delaney GP. Radiation Therapy Caseload Treatment Volume: Does It Matter? Int J Radiat Oncol Biol Phys 2023; 117:1087-1089. [PMID: 37980139 DOI: 10.1016/j.ijrobp.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Stephen R Thompson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, New South Wales, Australia; School of Clinical Medicine, Randwick Clinical Campus, University of New South Wales, Sydney, New South Wales, Australia.
| | - Geoff P Delaney
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; School of Clinical Medicine, South-Western Sydney Campus, University of New South Wales, Sydney, New South Wales, Australia; Liverpool Hospital, South-Western Sydney Local Health District, Sydney, New South Wales, Australia
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Venchiarutti RL, Pearce A, Mathers L, Dawson T, Ch'ng S, Shannon K, Clark JR, Palme CE. Travel-associated cost savings to patients and the health system through provision of specialist head and neck surgery outreach clinics in rural New South Wales, Australia. Aust J Rural Health 2023; 31:932-943. [PMID: 37501345 DOI: 10.1111/ajr.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Centralisation of head and neck surgical services means that patients in regional and remote Australia need to travel long distances for treatment and follow-up, imparting a significant financial burden on patients and the health system. OBJECTIVE To estimate costs of travel to local outreach clinics and determine potential cost savings to patients and the health system by avoiding patient travel to major cities for head and neck surgical care. DESIGN Retrospective audit of three head and neck surgery outreach clinics in New South Wales, Australia over 4 years (2017-2020). Direct costs of travel from a patient's residence to their local outreach clinic were estimated. Costs of travel and accommodation to Sydney for an appointment were calculated for different travel modes. Estimated reimbursements for travel through government support schemes were calculated based on published rates. FINDINGS Some 657 patients attended the three clinics, accounting for 1981 appointments. Depending on mode of travel, the estimated median cost of return travel (including accommodation) to Sydney was $379 to $739 per patient per trip and the median government reimbursement ranged from $182 to $279 per trip. In comparison, the cost of return travel by car to local outreach clinics ranged from $28 to $163 per appointment. Outreach clinics were estimated to save patients a median of $285 per trip and avoided government reimbursements of $215 per trip. DISCUSSION Despite uptake in telehealth, outreach medical services remain an important asset for people living in regional areas to address inequities in access. However, the cost benefits are likely to be underestimated as our approach did not account for indirect costs associated with travel. CONCLUSION Outreach head and neck surgical services located in regional areas can reduce the financial burden on both patients and the healthcare system. Greater investment in outreach clinics could ensure sustainability of services to promote equitable access to specialised surgical services.
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Affiliation(s)
- Rebecca L Venchiarutti
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alison Pearce
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Lara Mathers
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Tania Dawson
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kerwin Shannon
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
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Tekatli H, Palacios MA, Schneiders FL, Haasbeek CJA, Slotman BJ, Lagerwaard FJ, Senan S. Local control and toxicity after magnetic resonance imaging (MR)-guided single fraction lung stereotactic ablative radiotherapy. Radiother Oncol 2023; 187:109823. [PMID: 37516364 DOI: 10.1016/j.radonc.2023.109823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Magnetic resonance imaging (MR)-guided radiotherapy permits continuous intrafraction visualization and use of automatic triggered beam delivery, with use of smaller planning target volumes (PTV). We report on long-term clinical outcomes following MR-guided single fraction (SF) lung SABR on a 0.35 T linac. MATERIALS AND METHODS Details of patients treated with SF-SABR for lung tumors were accessed from an ethics approved institutional database. A breath-hold 3D MR simulation scan was performed using a true FISP sequence, followed by a breath-hold 3D CT scan. The gross tumor volume (GTV) was first contoured on the breath-hold CT scan, which was then compared with contours on the 3D MR scan, before the GTV was finalized. SABR plans used step-and-shoot IMRT beams to a PTV derived by adding a 5 mm margin to the breath-hold GTV, and a 3 mm gating window was used. SABR was delivered during repeated breath-holds, using automatic beam gating with continuous visualization of the GTV in a sagittal MR plane. RESULTS Between 2018-2022, 50 consecutive patients were treated, and 69% had a primary non-small cell lung cancer. Median PTV was 11.2 cc (range 3.9-53.5); 80% of GTV's were located ≤2.5 cm from the chest wall. Prescribed doses were 34 Gy (in 58%), 30 Gy (32%), or between 20-28 Gy (10%). After a median follow-up of 18.1 months (95% CI 12.8-23.5), the 2-year survival was 82% (89% for primary NSCLC and 62% for metastases). After a median follow-up of 16.1 months (95% CI 11.2-21.1), local recurrences developed in 2 patients (4%). The 3-year local control rate was 97%, and just 1 patient developed grade ≥3 toxicity (chest wall pain). CONCLUSION MR-guided SF-SABR delivery to lung tumors on a 0.35 T linac, using repeated breath-holds with automatic beam gating, achieves good tumor control and low toxicity.
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Affiliation(s)
- Hilâl Tekatli
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands.
| | - Miguel A Palacios
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Cornelis J A Haasbeek
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Ben J Slotman
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Frank J Lagerwaard
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Suresh Senan
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
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Bartholomew K, Ghafel M, Tin Tin S, Aye PS, Elwood JM, Hardie C, Scott N, Kidd J, Ramsaroop R, Campbell I. Receipt of mastectomy and adjuvant radiotherapy following breast conserving surgery (BCS) in New Zealand women with BCS-eligible breast cancer, 2010-2015: an observational study focusing on ethnic differences. BMC Cancer 2023; 23:766. [PMID: 37592208 PMCID: PMC10436661 DOI: 10.1186/s12885-023-11248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Women with early breast cancer who meet guideline-based criteria should be offered breast conserving surgery (BCS) with adjuvant radiotherapy as an alternative to mastectomy. New Zealand (NZ) has documented ethnic disparities in screening access and in breast cancer treatment pathways. This study aimed to determine whether, among BCS-eligible women, rates of receipt of mastectomy or radiotherapy differed by ethnicity and other factors. METHODS The study assessed management of women with early breast cancer (ductal carcinoma in situ [DCIS] and invasive stages I-IIIA) registered between 2010 and 2015, extracted from the recently consolidated New Zealand Breast Cancer Registry (now Te Rēhita Mate Ūtaetae NZBCF National Breast Cancer Register). Specific criteria were applied to determine women eligible for BCS. Uni- and multivariable analyses were undertaken to examine differences by demographic and clinicopathological factors with a primary focus on ethnicity (Māori, Pacific, Asian, and Other; the latter is defined as NZ European, Other European, and Middle Eastern Latin American and African). RESULTS Overall 22.2% of 5520 BCS-eligible women were treated with mastectomy, and 91.1% of 3807 women who undertook BCS received adjuvant radiotherapy (93.5% for invasive cancer, and 78.3% for DCIS). Asian ethnicity was associated with a higher mastectomy rate in the invasive cancer group (OR 2.18; 95%CI 1.72-2.75), compared to Other ethnicity, along with older age, symptomatic diagnosis, advanced stage, larger tumour, HER2-positive, and hormone receptor-negative groups. Pacific ethnicity was associated with a lower adjuvant radiotherapy rate, compared to Other ethnicity, in both invasive and DCIS groups, along with older age, symptomatic diagnosis, and lower grade tumour in the invasive group. Both mastectomy and adjuvant radiotherapy rates decreased over time. For those who did not receive radiotherapy, non-referral by a clinician was the most common documented reason (8%), followed by patient decline after being referred (5%). CONCLUSION Rates of radiotherapy use are high by international standards. Further research is required to understand differences by ethnicity in both rates of mastectomy and lower rates of radiotherapy after BCS for Pacific women, and the reasons for non-referral by clinicians.
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MESH Headings
- Female
- Humans
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/ethnology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Maori People/statistics & numerical data
- Mastectomy/statistics & numerical data
- Mastectomy, Segmental/statistics & numerical data
- New Zealand/epidemiology
- Radiotherapy, Adjuvant/statistics & numerical data
- Pacific Island People/statistics & numerical data
- Asian/statistics & numerical data
- European People/statistics & numerical data
- Middle Eastern People/statistics & numerical data
- African People/statistics & numerical data
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Affiliation(s)
- Karen Bartholomew
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Mazin Ghafel
- Te Whatu Ora Waitematā, Auckland, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Sandar Tin Tin
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Phyu S Aye
- Te Whatu Ora Waitematā, Auckland, New Zealand.
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - J Mark Elwood
- University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Claire Hardie
- Te Whatu Ora MidCentral, Palmerston North, New Zealand
| | - Nina Scott
- University of Auckland, Waikato Campus, Hamilton, New Zealand
| | - Jacquie Kidd
- Auckland University of Technology, Auckland, New Zealand
| | | | - Ian Campbell
- University of Auckland, Waikato Campus, Hamilton, New Zealand
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Edney LC, Roseleur J, Bright T, Watson DI, Arnolda G, Braithwaite J, Delaney GP, Liauw W, Mitchell R, Karnon J. DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5987. [PMID: 37297591 PMCID: PMC10252629 DOI: 10.3390/ijerph20115987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
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Affiliation(s)
- Laura C. Edney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jackie Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - David I. Watson
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Geoffrey P. Delaney
- Liverpool Cancer Therapy Centre, Liverpool, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW 2217, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
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Bierbaum M, Arnolda G, Braithwaite J, Rapport F. Clinician attitudes towards cancer treatment guidelines in Australia. BMC Res Notes 2023; 16:80. [PMID: 37194072 DOI: 10.1186/s13104-023-06356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES Clinical Practice Guidelines (CPGs) are designed to guide treatment decisions, yet adherence rates vary widely. To characterise perceived barriers and facilitators to cancer treatment CPG adherence in Australia, and estimate the frequency of previous qualitative research findings, a survey was distributed to Australian oncologists. RESULTS The sample is described and validated guideline attitude scores reported for different groups. Differences in mean CPG attitude scores across clinician subgroups and associations between frequency of CPG use and clinician characteristics were calculated; with 48 respondents there was limited statistical power to find differences. Younger oncologists (< 50 years) and clinicians participating in three or more Multidisciplinary Team Meetings were more likely to routinely or occasionally use CPGs. Perceived barriers and facilitators were identified. Thematic analysis was conducted on open-text responses. Results were integrated with previous interview findings and presented in a thematic, conceptual matrix. Most barriers and facilitators identified earlier were corroborated by survey results, with minor discordance. Identified barriers and facilitators require further exploration within a larger sample to assess their perceived impact on cancer treatment CPG adherence in Australia, as well as to inform future CPG implementation strategies. This research was Human Research Ethics Committee approved (2019/ETH11722 and 52019568810127, ID:5688).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia.
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
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Wood SM, Alston L, Beks H, Mc Namara K, Coffee NT, Clark RA, Wong Shee A, Versace VL. The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice. BMC Health Serv Res 2023; 23:330. [PMID: 37005659 PMCID: PMC10066971 DOI: 10.1186/s12913-023-09342-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature. METHODS A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures. RESULTS Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%). CONCLUSION This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.
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Affiliation(s)
- Sarah M Wood
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia.
| | - Laura Alston
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Research Unit, Colac Area Health, Colac, Vic, Australia
| | - Hannah Beks
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
| | - Kevin Mc Namara
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
| | - Neil T Coffee
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- University of Canberra, Canberra, ACT, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Anna Wong Shee
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
| | - Vincent L Versace
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
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Arcidiacono F, Anselmo P, Casale M, Zannori C, Ragusa M, Mancioli F, Marchetti G, Loreti F, Italiani M, Bracarda S, Maranzano E, Trippa F. STereotactic Ablative RadioTherapy in NEWly Diagnosed and Recurrent Locally Advanced Non-Small Cell Lung Cancer Patients Unfit for ConcurrEnt RAdio-Chemotherapy: Early Analysis of the START-NEW-ERA Non-Randomised Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 115:886-896. [PMID: 36288758 DOI: 10.1016/j.ijrobp.2022.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE This is a single arm phase 2 trial (Clinical trials.gov NCT05291780) to assess local control (LC) and safety of SAbR in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) unfit for concurrent chemo-radiation therapy (ChT-RT). METHODS Neoadjuvant ChT was prescribed in fit patients. The tumor volume included primary tumor and any regionally positive node/s. The coprimary study endpoints were LC and safety. RESULTS Between December 31, 2015, and December 31, 2020, 50 patients with LA-NSCLC were enrolled. Histology was squamous cell carcinoma and adenocarcinoma (ADC) in 52% and 48%, respectively. Forty (80%) patients had ultracentral tumor. Twenty-seven (54%) received neoadjuvant ChT and 7 (14%) adjuvant durvalumab. Median prescribed dose was 45 Gy (range, 35-55) and 40 Gy (35-45) in 5 daily fractions to tumor and node/s, respectively. After a median follow-up of 38 months (range, 12-80), 19 (38%) patients had experienced local recurrence (LR) at a median time of 13 months (range, 7-34). The median LR-free survival (FS) was not reached (95% confidence interval [CI], 28 to not reached). The 1-, 2-, and 3-year LR-FS rates were 86% ± 5%, 66% ± 7%, and 56% ± 8%, respectively. At last follow-up, 33 (66%) patients were alive. Median overall survival (OS) was 55 months (95% CI, 43-55 months). The 1-, 2-, and 3-year OS rates were 94% ± 3%, 79% ± 6%, and 72% ± 7%, respectively. No patients developed ≥ grade (G) 3 toxicity. ADC (hazard ratio [HR], 3.61; 95% CI, 1.15-11.35) was a significant predictor of better LC, while OS was significantly conditioned by smaller planning target volumes (HR, 1.004; 95% CI, 1.001-1.010) and tumor, node, and metastasis stage (HR, 4.8; 95% CI, 1.34-17). CONCLUSIONS Patients with LA-NSCLC treated with SABR had optimal LC and promising OS in absence of ≥G3 toxicity. Our early outcomes would suggest the feasibility of using this approach in patients with LA-NSCLC unfit for concurrent ChT-RT.
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Affiliation(s)
| | | | | | | | | | | | | | - Fabio Loreti
- Nuclear Medicine Service, "S. Maria" Hospital, Terni, Italy
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11
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Ong WL, MacManus M, Milne RL, Foroudi F, Millar JL. Large variation in radiation therapy fractionation for multiple myeloma in Australia. Asia Pac J Clin Oncol 2023; 19:149-157. [PMID: 35599450 PMCID: PMC10084224 DOI: 10.1111/ajco.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 01/20/2023]
Abstract
AIM To evaluate the patterns of use of different radiation therapy (RT) fractionation for multiple myeloma (MM) bone disease. METHODS This is a population-based cohort of patients with MM who had RT between 2012 and 2017 as captured in the statewide Victorian Radiotherapy Minimum Data Set in Australia. Data linkage was performed to identify subsets of RT delivered within 3 months of death. RT fractionation was classified into four groups: single-fraction (SFRT), 2-5, 6-10, and > 10 fractions. Changes in RT fractionation use over time were evaluated with the Cochran-Armitage test for trend. Factors associated with RT fractionation were evaluated using multivariate logistic regressions. RESULTS Nine hundred and sixty-seven courses of RT were delivered in 623 patients. The proportion of SFRT, 2-5, 6-10 and > 10 fractions RT was 18%, 47%, 28%, and 7%, respectively. There was an increase in the use of 2-5 fractions, from 48% in 2012 to 60% in 2017 (p-trend < .001), with corresponding decrease in the use of 6-10 fractions, from 26% in 2012 to 20% in 2017 (p-trend = .003). Nine percent (40/430) of RT courses at private institutions were SFRT, compared to 25% (135/537) in public institutions (p < .001). In multivariate analyses, treatment in private institution was the strongest predictor of multifraction RT use. SFRT use was more common closer to the end of life-18%, 14%, and 33% of RT within 2-3, 1-2, < 1 month of death, respectively. CONCLUSION There is increasing use of shorter course RT (2-5 fractions) for MM over time. SFRT use remains low, with large variation in practice.
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Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
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12
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Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
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13
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Hande V, Chan J, Polo A. Value of Geographical Information Systems in Analyzing Geographic Accessibility to Inform Radiotherapy Planning: A Systematic Review. JCO Glob Oncol 2022; 8:e2200106. [PMID: 36122318 PMCID: PMC9812498 DOI: 10.1200/go.22.00106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Vulnerable populations face geographical barriers in accessing radiotherapy (RT) facilities, resulting in heterogeneity of care received and cancer burden faced. We aimed to explore the current use of Geographical Information Systems (GIS) in access to RT and use these findings to create sustainable solutions against barriers for access in low- and middle-income countries. MATERIALS AND METHODS A systematic review using the PRISMA search strategy was done for studies using GIS to explore outcomes among patients with cancer. Included studies were reviewed and classified into three umbrella categories of how GIS has been used in studying access to RT. RESULTS Forty articles were included in the final review. Thirty-eight articles were set in high-income countries and two in upper-middle-income countries. Included studies were published from 2000 to 2020, and were comprised of patients with all-cancers combined, breast, colon, skin, lung, prostate, ovarian, and rectal carcinoma patients. Studies were categorized under three groups on the basis of how they used GIS in their analyses: to describe geographic access to RT, to associate geographic access to RT with outcomes, and for RT planning. Most studies fell under multiple categories. CONCLUSION Although this field is relative nascent, there is a wide array of functions possible through GIS for RT planning, including identifying high-risk populations, improving access in high-need areas, and providing valuable information for future resource allocation. GIS should be incorporated in future studies, especially set in low- and middle-income countries, which evaluate access to RT.
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Affiliation(s)
- Varsha Hande
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jessica Chan
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria,Alfredo Polo, MD, PhD, Applied Radiation Biology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria; e-mail:
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14
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Ong WL, Finn N, Te Marvelde L, Hornby C, Milne RL, Hanna GG, Pitson G, Elsaleh H, Millar JL, Foroudi F. Disparities in radiation therapy utilization for cancer patients in Victoria. J Med Imaging Radiat Oncol 2022; 66:830-839. [PMID: 35357080 PMCID: PMC9543524 DOI: 10.1111/1754-9485.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
Introduction To evaluate the proportion of cancer patients who received radiation therapy (RT) within 12 months of cancer diagnosis (RTU12) and identify factors associated with RTU12. Methods This is a population‐based cohort of individuals with incident cancer, diagnosed between 2013 and 2017 in Victoria. Data linkages were performed between the Victorian Cancer Registry and Victorian Radiotherapy Minimum Dataset. The primary outcome was the proportion of patients who had RTU12. For the three most common cancers (i.e., prostate, breast and lung cancer), the time trend in RTU12 and factors associated with RTU12 were evaluated. Results The overall RTU12 in our study cohort was 26–20% radical RT and 6% palliative RT. Of the 21,735 men with prostate cancer, RTU12 was 17%, with no significant change over time (P‐trend = 0.53). In multivariate analyses, increasing age and lower socioeconomic status were independently associated with higher RTU12 for prostate cancer. Of the 20,883 women with breast cancer, RTU12 was 64%, which increased from 62% in 2013 to 65% in 2017 (P‐trend < 0.05). In multivariate analyses, age, socioeconomic status and area of residency were independently associated with RTU12 for breast cancer. Of the 13,093 patients with lung cancer, RTU12 was 42%, with no significant change over time (P‐trend = 0.16). In multivariate analyses, younger age, male and lower socioeconomic status were independently associated with higher RTU12. Conclusion In this large population‐based state‐wide cohort of cancer patients, only 1 in 4 had RT within 12 months of diagnosis. There were marked sociodemographic disparities in RTU12 for prostate, breast and lung cancer patients.
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Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, Victoria, UK
| | - Norah Finn
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Luc Te Marvelde
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia.,Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Colin Hornby
- Department of Health, State Government of Victoria, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Center for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Graham Pitson
- Department of Cancer Services, Barwon Health, Geelong, Victoria, Australia
| | - Hany Elsaleh
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology Services, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Farshad Foroudi
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
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15
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James M, Munro PL, Adams G, Keogh S. The changing radiation oncology landscape in New Zealand. J Med Imaging Radiat Oncol 2022; 66:694-700. [PMID: 35343068 DOI: 10.1111/1754-9485.13402] [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: 11/09/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This paper outlines the New Zealand (NZ) responses to the biennial facilities surveys of the Royal Australian and New Zealand College of Radiation Oncologists (RANZCR), Faculty of Radiation Oncology (FRO) from 2011 to 2019. METHODS The facilities survey is conducted by the FRO Economics and Workforce Committee (FROEWC) and focuses on equipment, treatment activities and staffing. RESULTS The number of facilities increased by two to 10, both in the private sector. The total number of linear accelerators (linacs) increased by four; one in public and three in private. The majority of linacs were over 8 years old (62.5%). Treatment courses have increased by 19% and fraction numbers by 13.7%. Courses per linac have remained relatively constant. There was growth in IMRT, orthovoltage, high dose rate brachytherapy and paediatric treatments. There was a slow increase in number of radiation oncologists and trainees. The number of radiation therapists was unchanged with a 20% increase in treatment courses per radiation therapist. Physicist numbers have increased but 61.4% of physicists are overseas-trained and vacancies persist. CONCLUSION The survey results indicate a rapidly changing radiation oncology landscape in NZ between 2011 and 2019. The challenges of increases in cancer numbers, treatment courses and complexity of treatments and a need to focus on quality standards against a set of minimal increase in machine numbers, ageing machines, static or slowly increasing staffing numbers and heavy reliance on overseas staffing require a national review of radiation oncology services to ensure a sustainable future.
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Affiliation(s)
- Melissa James
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Philip L Munro
- Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
| | - Gerard Adams
- GenesisCare Bundaberg, Rural Clinical School, The University of Queensland, Bundaberg, Queensland, Australia
| | - Sandra Keogh
- Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
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16
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Ghandourh W, Holloway L, Batumalai V, Chlap P, Field M, Jacob S. Optimal and actual rates of Stereotactic Ablative Body Radiotherapy (SABR) utilisation for primary lung cancer in Australia. Clin Transl Radiat Oncol 2022; 34:7-14. [PMID: 35282142 PMCID: PMC8907547 DOI: 10.1016/j.ctro.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Stereotactic Ablative Body Radiotherapy (SABR) plays a major role in the management of early-stage non-small cell lung cancer (NSCLC). An evidence-based model is developed to estimate optimal rates of lung SABR utilisation within the Australian population. Optimal utilisation rates are compared against actual utilisation rates to evaluate service provision.
Background and purpose Radiotherapy utilisation rates considerably vary across different countries and service providers, highlighting the need to establish reliable benchmarks against which utilisation rates can be assessed. Here, optimal utilisation rates of Stereotactic Ablative Body Radiotherapy (SABR) for lung cancer are estimated and compared against actual utilisation rates to identify potential shortfalls in service provision. Materials and Methods An evidence-based optimal utilisation model was constructed after reviewing practice guidelines and identifying indications for lung SABR based on the best available evidence. The proportions of patients likely to develop each indication were obtained, whenever possible, from Australian population-based studies. Sensitivity analysis was performed to account for variations in epidemiological data. Practice pattern studies were reviewed to obtain actual utilisation rates. Results A total of 6% of all lung cancer patients were estimated to optimally require SABR at least once during the course of their illness (95% CI: 4–6%). Optimal utilisation rates were estimated to be 32% for stage I and 10% for stage II NSCLC. Actual utilisation rates for stage I NSCLC varied between 6 and 20%. For patients with inoperable stage I, 27–74% received SABR compared to the estimated optimal rate of 82%. Conclusion The estimated optimal SABR utilisation rates for lung cancer can serve as useful benchmarks to highlight gaps in service delivery and help plan for more adequate and efficient provision of care. The model can be easily modified to determine optimal utilisation rates in other populations or updated to reflect any changes in practice guidelines or epidemiological data.
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17
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Merie R, Shafiq J, Soon PS, Delaney GP. Surgical and radiotherapy patterns of care in the management of breast cancer in NSW and ACT Australia. J Med Imaging Radiat Oncol 2021; 66:442-454. [PMID: 34851031 DOI: 10.1111/1754-9485.13357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION This study aims to report on the surgical and radiotherapy patterns of breast cancer care in New South Wales (NSW) and Australian Capital Territory (ACT) in Australia, to identify factors that impact on utilisation of evidence-based treatment and to report on the overall survival (OS) rate and the influencing factors on OS. METHODS Cancer registry data linked to hospital records for all patients with breast cancer diagnosis in NSW and ACT between 2009 and 2014 were used to calculate rates of breast conserving surgery (BCS), mastectomy, sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND) and radiotherapy. Multivariate analysis used to identify factors that led to variations in care. 5-year OS was calculated and cox regression model assessed factors that influenced survival. RESULTS Data for 30,337 patients were analysed. BCS and mastectomy rates were 64% and 36%, respectively. The SLNB, ALND and ALND after SLNB rates were 61.5%, 32.1% and 6.4%, respectively. Radiotherapy was utilised in 63%. Younger age, socio-economic disadvantage, longer distance to a radiotherapy facility and overseas place of birth were factors that predicted for increased rates of mastectomy and ALND. Radiotherapy was more likely to be utilised in later years of diagnosis, patients between 40-69 years old, and those who lived in major cities and closer to a radiotherapy facility. 5-year OS was 80.5%. Older patients, the socioeconomically disadvantaged and those advanced tumours had worse survival. CONCLUSION Variations in breast cancer care continue to exist in certain patient groups that we identified. Targeted strategic planning and further research to identify other drivers of existing disparities remain a priority.
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Affiliation(s)
- Roya Merie
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jesmin Shafiq
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Patsy S Soon
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia.,Medical Oncology Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,BreastScreen South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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Chelvarajah R, Windsor A, Nicholls L, Bravery B, Shi K, Turner S, Tieu MT. Junior Doctor Evaluation of Radiation Oncology Education and Training in Medical Schools and Prevocational Training in Australia. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:646-651. [PMID: 31873855 DOI: 10.1007/s13187-019-01678-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study is to evaluate radiation oncology (RO)-specific education, confidence and knowledge of junior doctors in Australian teaching hospitals. A 38-item web-based survey was emailed to prevocational junior doctors working in Australian hospitals in New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between November 2017 and January 2018. The survey evaluated RO educational and clinical exposure of participants during medical school, and prevocational training and their confidence and knowledge of the specialty. A total of 183 respondents across 17 Australian hospital networks completed the survey. During medical school, 53.4% had RO incorporated into their formal curriculum, 19.5% had no formal lectures and 51.7% had never visited a RO department. As a junior doctor, 73.8% of respondents did not receive any formal RO education. When compared with other oncology specialties, fewer junior doctors were confident in consulting the RO team (21.0%) compared with medical oncology (42.0%), palliative care (75.2%) and haematology (40.1%). Majority of respondents (61.6%) showed limited understanding of radiation safety. On multivariate sub-group analysis, both confidence and knowledge in RO improved when RO was incorporated into the formal medical school curriculum. This survey highlights the current low confidence and poor knowledge standard amongst Australian junior doctors on RO due to inadequate teaching during medical school and prevocational training and suggests improvement through standardisation of formal RO curriculum teaching within medical school and prevocational training.
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Affiliation(s)
- Revadhi Chelvarajah
- Liverpool Cancer Therapy Centre, Liverpool Hospital, 1 Campbell Street, Liverpool, New South Wales, 2170, Australia.
| | - Apsara Windsor
- Central Coast Cancer Centre, Gosford, New South Wales, Australia
- School of Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Faculty of Radiation Oncology, Royal Australia and New Zealand College of Radiologists, Sydney, New South Wales, Australia
| | - Luke Nicholls
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Ben Bravery
- Blacktown Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Kate Shi
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Sandra Turner
- Faculty of Radiation Oncology, Royal Australia and New Zealand College of Radiologists, Sydney, New South Wales, Australia
- Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia
| | - Minh Thi Tieu
- School of Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Calvary Mater Hospital, Newcastle, New South Wales, Australia
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Conway P, Leach M, Tejani N, Robinson A, Shethia Y, Solo I. Oesophageal cancer treatment patterns, timeliness of care and outcomes in the Loddon Mallee region of Victoria: A retrospective cohort study. J Med Imaging Radiat Oncol 2021; 65:242-250. [PMID: 33634598 DOI: 10.1111/1754-9485.13167] [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: 04/07/2020] [Revised: 10/16/2020] [Accepted: 02/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Few studies have investigated oesophageal cancer care in regional areas. This study aimed to describe treatment patterns for oesophageal cancer in a regional area, and to identify factors associated with radiotherapy utilisation, timeliness of care, and death. METHODS In a retrospective cohort study, medical records were reviewed to source data on all patients diagnosed with and/or treated for oesophageal cancer at two regional Victorian hospitals over July 2015-June 2018. Cox proportional hazards regression was employed to identify factors associated with time from diagnosis to death while binary logistic regression was used to identify factors associated with radiotherapy utilisation and treatment within 28 days of diagnosis - a time frame derived from the relevant optimal care pathway. RESULTS Of 95 patients, 72% had radiotherapy, 32% received any treatment within 28 days, and 78% died over a median time of nine months. Odds of not receiving radiotherapy were decreased (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.08-0.87) for histology other than adenocarcinoma. Odds of timely care were increased for any palliative radiotherapy (OR = 3.47, 95% CI = 1.15-10.5) and decreased for older age (OR = 0.95, 95% CI = 0.91.0.999). Hazard of death was elevated for stage IV disease (hazard ratio [HR] = 2.73, 95% CI = 1.64-4.54) and reduced for radical intent (HR = 0.27, 95% CI = 0.15-0.48). CONCLUSION Nearly three-quarters of regional oesophageal cancer patients had radiotherapy while approximately one-third received any treatment within the recommended 28 days. Any palliative radiotherapy and younger age were associated with timely treatment. Future studies could further investigate factors related to timely oesophageal cancer care.
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Affiliation(s)
- Paul Conway
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Leach
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia.,School of Rural Health, Monash University, Bendigo, Victoria, Australia
| | - Neetu Tejani
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Amanda Robinson
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia
| | - Yachna Shethia
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia
| | - Ilana Solo
- Loddon Mallee Integrated Cancer Service, Bendigo, Victoria, Australia
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Mackenzie P, Vajdic C, Delaney G, Gabriel G, Agar M, Comans T, Barton M. Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia. Tech Innov Patient Support Radiat Oncol 2021; 16:17-23. [PMID: 33385070 PMCID: PMC7769853 DOI: 10.1016/j.tipsro.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 12/26/2022] Open
Abstract
Background and Purpose Large non-age-specific radiotherapy utilisation rate (RTU) studies have demonstrated that actual RTU is below the optimal recommended utilisation rate for both curative and palliative intent radiotherapy indications. The optimal utilisation rate for the geriatric oncology cohort of patients has not yet been determined. The purpose of this research was to examine the actual RTU for patients treated in New South Wales (NSW), Australia as a function of increasing age, and the relationship between RTU and tumour site, travelling distance and socio-economic status. Materials & Methods NSW Central Cancer Registry data (2009-2011) were linked to the NSW Radiotherapy Dataset (2009-2012). RTU was calculated for patients aged <80 years and ≥80 years. RTU was defined as the proportion of patients receiving at least a single course of radiotherapy within 12 months of a cancer diagnosis. Results 110,645 patients were diagnosed with cancer, of whom 27,721 received at least one course of radiotherapy. The overall RTU was 25%. RTU for patients aged <80 years was 28% compared to 14% for patients aged 80+ years (p < 0.001). On both univariate and multivariate analysis, increasing age, residential address in disadvantaged socioeconomic areas and increasing distance to the nearest radiotherapy department were associated with a reduction in RTU. Conclusion Geriatric oncology patients are less likely to receive radiotherapy than their younger counterparts. Some of the reduction in RTU may be justifiable on the basis of limited life expectancy and co-morbidity. Further research is required to determine the co-morbidity adjusted optimal RTU in older patients.
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Affiliation(s)
- Penny Mackenzie
- St Andrew's Hospital, Icon Cancer Care, Toowoomba, QLD, Australia.,Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | | | - Geoff Delaney
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Meera Agar
- University of Technology, Sydney, Australia
| | | | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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A population perspective on the use of external beam radiotherapy in Catalonia, Spain. Clin Transl Oncol 2020; 22:2222-2229. [PMID: 32424700 DOI: 10.1007/s12094-020-02355-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the use of external beam radiotherapy in Catalonia (Spain), overall and by health management area. METHODS We assessed radiotherapy treatments in a cohort of patients diagnosed with cancer from 2009 to 2011, using the population-based cancer registries in Girona and Tarragona. Participants had to have a minimum follow-up of 5 years from the time the cancer registry database was linked to the catalan health service database for financing radiation oncology. Outcomes included the proportion of patients receiving radiotherapy within 1 and 5 years of diagnosis. A log-binomial model was used to assess age-related trends in the use of radiotherapy by tumour site. Finally, we calculated the standardized utilization rate and 95% confidence intervals by health management area covered by the radiation oncology services, using indirect methods. RESULTS At 1 and 5 years from diagnosis, 21.4 and 24.4% of patients, respectively, had received external beam radiotherapy. Patients aged 40-64 years had the most indications for the treatment, and there was a negative correlation between the patients' age and the use of radiotherapy for most tumour sites (exceptions were cervical, thyroid, and uterine cancers). There were no statistically significant differences in the use of radiotherapy according to th health management area. CONCLUSIONS Population-based data show that external beam radiotherapy is underutilized in Catalonia. This situation requires a careful analysis to understand the causes, as well as an improvement of the available resources, oriented toward achieving realistic targets for the optimal use of external beam radiotherapy in our country.
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Lievens Y, Borras JM, Grau C. Provision and use of radiotherapy in Europe. Mol Oncol 2020; 14:1461-1469. [PMID: 32293084 PMCID: PMC7332207 DOI: 10.1002/1878-0261.12690] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/07/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022] Open
Abstract
Radiation therapy is one of the core components of multidisciplinary cancer care. Although ~ 50% of all European cancer patients have an indication for radiotherapy at least once in the course of their disease, more than one out of four cancer patients in Europe do not receive the radiotherapy they need. There are multiple reasons for this underutilisation, with limited availability of the necessary resources – in terms of both trained personnel and equipment – being a major underlying cause of suboptimal access to radiotherapy. Moreover, large variations across European countries are observed, not only in available radiotherapy equipment and personnel per inhabitant or per cancer patient requiring radiotherapy, but also in workload. This variation is in part determined by the country's gross national income. Radiation therapy and technology are advancing quickly; hence, recommendations supporting resource planning and investment should reflect this dynamic environment and account for evolving treatment complexity and fractionation schedules. The forecasted increase in cancer incidence, the rapid introduction of innovative cancer treatments and the more active involvement of patients in the healthcare discussion are all factors that should be taken under consideration. In this continuously changing oncology landscape, reliable data on the actual provision and use of radiotherapy, the optimal evidence‐based demand and the future needs are crucial to inform cancer care planning and address and overcome the current inequalities in access to radiotherapy in Europe.
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Affiliation(s)
- Yolande Lievens
- Department of Radiation OncologyGhent University Hospital and Ghent UniversityBelgium
| | - Josep M. Borras
- Department of Clinical SciencesIDIBELLUniversity of BarcelonaSpain
| | - Cai Grau
- Department of Oncology and Danish Center for Particle TherapyAarhus University HospitalDenmark
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23
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Yap ML, O'Connell DL, Goldsbury D, Weber M, Barton M. Factors Associated With Radiotherapy Utilisation In New South Wales, Australia: Results From The 45 and Up Study. Clin Oncol (R Coll Radiol) 2020; 32:282-291. [PMID: 32007353 DOI: 10.1016/j.clon.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/28/2022]
Abstract
AIMS Actual radiotherapy utilisation rates tend to be lower than the estimated optimal rates. Little is known about the factors contributing to this difference. Our aim was to identify factors associated with radiotherapy receipt for a cohort of cancer patients in New South Wales (NSW), Australia. MATERIALS AND METHODS In total, 267 153 participants in the NSW 45 and Up Study completed a questionnaire during 2006-2009 providing detailed health and socio-demographic information and consented to record linkage with administrative health datasets. Single primary cancers diagnosed after study enrolment were identified through linkage with the NSW Cancer Registry to December 2013. Radiotherapy receipt was determined from claims to the Medicare Benefits Schedule and/or records in the NSW Admitted Patient Data Collection (2006 to June 2016). Competing risks regression was used to examine associations between health and socio-demographic characteristics and radiotherapy treatment. RESULTS Of 17 873 patients with an incident cancer, 5414 (30.3%) received radiotherapy during follow-up (median 5.3 years). Patients less likely to receive radiotherapy were aged <60 or 80+ years, female, had a Charlson co-morbidity index of 1+, needed help with daily tasks or lived ≥100 km from the nearest radiotherapy centre. CONCLUSION Distinct subgroups of patients are less likely to receive radiotherapy. Advocacy and/or policy changes are needed to improve access.
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Affiliation(s)
- M L Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia; Sydney Medical School - Public Health, University of Sydney, Sydney, NSW, Australia.
| | - D L O'Connell
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia; Sydney Medical School - Public Health, University of Sydney, Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - D Goldsbury
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia
| | - M Weber
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia; Sydney Medical School - Public Health, University of Sydney, Sydney, NSW, Australia
| | - M Barton
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia
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Merie R, Gabriel G, Shafiq J, Vinod S, Barton M, Delaney GP. Radiotherapy underutilisation and its impact on local control and survival in New South Wales, Australia. Radiother Oncol 2019; 141:41-47. [PMID: 31606225 DOI: 10.1016/j.radonc.2019.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/05/2019] [Accepted: 09/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to identify the actual radiotherapy utilisation rate (A-RUR) in New South Wales (NSW) Australia for 2009-2011 and compare that to the published evidence-based optimal radiotherapy utilisation rate (O-RUR) and to previously reported A-RUR in NSW in 2004-2006. It also aimed to estimate the effect of underutilisation on 5-year local control (LC) and overall survival (OS) and identify factors that predict for underutilisation. MATERIALS AND METHODS All cases of registered cancer diagnosed in NSW between 2009 and 2011 were identified from the NSW Central Cancer Registry and linked with data from all radiotherapy departments. The A-RUR was calculated and compared with O-RURs for all cancers. The difference for each indication was used to estimate 5-year OS and LC shortfall. Univariate and multivariate analyses were performed to identify factors that correlated with reduced radiotherapy utilisation. RESULTS 110,645 cancer cases were identified. 25% received radiotherapy within one year of diagnosis compared to an estimated optimal rate of 45%. This has marginally improved from previously reported rate of 22% in NSW in 2004-2006. We estimated that 5-year OS and LC were compromised in 1162 and 5062 patients respectively. Factors that predicted for underuse of radiotherapy were older age, male gender, lower socioeconomic status, increasing distance to nearest radiotherapy centre and localised disease. CONCLUSION The identified deficit in radiotherapy use has a significant negative impact on patient outcomes. Strategies to overcome such shortfalls need to be developed to improve radiotherapy use and patient outcomes.
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Affiliation(s)
- Roya Merie
- Liverpool Cancer Therapy Centre, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia.
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
| | - Jesmin Shafiq
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
| | - Michael Barton
- Liverpool Cancer Therapy Centre, New South Wales, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
| | - Geoff P Delaney
- Liverpool Cancer Therapy Centre, New South Wales, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Australia
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Yahya N, Sukiman NK, Suhaimi NA, Azmi NA, Manan HA. How many roads must a Malaysian walk down? Mapping the accessibility of radiotherapy facilities in Malaysia. PLoS One 2019; 14:e0213583. [PMID: 30897166 PMCID: PMC6428267 DOI: 10.1371/journal.pone.0213583] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background The accessibility to radiotherapy facilities may affect the willingness to undergo treatment. We sought to quantify the distance and travel time of Malaysian population to the closest radiotherapy centre and to estimate the megavoltage unit (MV)/million population based on the regions. Materials & methods Data for subdistricts in Malaysia and radiotherapy services were extracted from Department of Statistics Malaysia and Directory of Radiotherapy Centres (DIRAC). Data from DIRAC were validated by direct communication with centres. Locations of radiotherapy centres, distance and travel time to the nearest radiotherapy were estimated using web mapping service, Google Map. Results The average distance and travel time from Malaysian population to the closest radiotherapy centre were 82.5km and 83.4mins, respectively. The average distance and travel were not homogenous; East Malaysia (228.1km, 236.1mins), Central (14.4km, 20.1mins), East Coast (124.2km, 108.8mins), Northern (42.9km, 42.8mins) and Southern (36.0km, 39.8mins). The MV/million population for the country is 2.47, East Malaysia (1.76), Central (4.19), East Coast (0.54), Northern (2.40), Southern (2.36). About 25% of the population needs to travel >100 km to get to the closest radiotherapy facility. Conclusion On average, Malaysians need to travel far and long to reach radiotherapy facilities. The accessibility to radiotherapy facilities is not equitable. The disparity may be reduced by adding centres in East Malaysia and the East Coast.
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Affiliation(s)
- Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Nur Khalis Sukiman
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nani Adilah Suhaimi
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nor Aniza Azmi
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Hanani A. Manan
- Department of Radiology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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Yap ML, O'Connell DL, Goldsbury D, Weber M, Barton M. Comparison of four methods for estimating actual radiotherapy utilisation using the 45 and Up Study cohort in New South Wales, Australia. Radiother Oncol 2019; 131:14-20. [DOI: 10.1016/j.radonc.2018.10.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/15/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
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Osagiede O, Spaulding AC, Frank RD, Merchea A, Uitti R, Ailawadhi S, Kelley S, Colibaseanu D. Predictors of palliative treatment in stage IV colorectal cancer. Am J Surg 2018; 218:514-520. [PMID: 30578033 DOI: 10.1016/j.amjsurg.2018.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Palliative treatment may be associated with prolonged survival and improved quality of life, but remains underutilized in stage IV colorectal (CRC). We examined a national cohort of stage IV CRC patients to determine the factors associated with palliative treatment. METHODS Stage IV CRC patients, classified based on their survival length (<6 months, 6-24 months, and 24 + months), were analyzed using the American College of Surgeons National Cancer Data Base (2004-2013). Multivariable analysis was performed to evaluate factors associated with palliative treatment. RESULTS Of 85,981 patients analyzed, 10.9% received palliative treatment. For 6-24 months survival, a more recent year of diagnosis, Medicaid, uninsured status, Mountain and Pacific regions were associated with higher odds of palliative treatment. For those who survived < 6months, older patients had lower odds, while academic centers and residence > 20 miles from treating institutions were associated with increased likelihood of palliative treatment. CONCLUSIONS Palliative treatment in stage IV CRC is associated with a more recent year of diagnosis, Medicaid, academic centers, Mountain and Pacific regions of the US.
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Affiliation(s)
- Osayande Osagiede
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan D Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Amit Merchea
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ryan Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Scott Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dorin Colibaseanu
- Department of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA
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28
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Batumalai V, Shafiq J, Gabriel G, Hanna TP, Delaney GP, Barton M. Impact of radiotherapy underutilisation measured by survival shortfall, years of potential life lost and disability-adjusted life years lost in New South Wales, Australia. Radiother Oncol 2018; 129:191-195. [DOI: 10.1016/j.radonc.2018.06.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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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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30
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Barton MB, Gabriel GS, Delaney GP. Testing criterion-based benchmarking for the appropriate use of radiotherapy. Radiother Oncol 2018; 128:406-410. [DOI: 10.1016/j.radonc.2018.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/14/2018] [Accepted: 05/19/2018] [Indexed: 10/14/2022]
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Nicholls L, Bravery B, Chelvarajah R, Shi K, Tieu MT, Turner S, Windsor A. The status of radiation oncology teaching in Australian and New Zealand medical schools. J Med Imaging Radiat Oncol 2018; 62:828-834. [PMID: 30074292 DOI: 10.1111/1754-9485.12788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/11/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Radiation therapy is a core component of curative and palliative cancer treatment; however, its indications and benefits remain poorly understood across the medical profession. METHODS An electronic survey focussing on curriculum content, teaching and assessment in radiation oncology and plans for curriculum change was developed. The Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiology (RANZCR) distributed the survey to all 24 Australian and New Zealand medical schools. The survey was conducted from November 2017 to January 2018 following ethics approval. RESULTS Sixteen of the 24 (67%) medical Faculties in Australia and New Zealand responded. Ninety-four percent of Faculties had no formal radiation oncology curriculum. Most Faculties (87%) dedicated <15% of the total medical course to oncology, of which the majority (63%) dedicated <10% to radiation oncology. At least 50% of Faculties did not offer formal radiation oncology teaching to all students. When offered, students' exposure to radiation oncology was often <5 days over the entire course (44%). The majority of medical schools (73%) are planning curriculum changes in the next 5 years; however, most have no intention of changing radiation oncology teaching. CONCLUSION Radiation oncology continues to be underrepresented in medical curricula throughout Australia and New Zealand with no plans for improvement by Faculties. This study supports the need for formal advocacy for improving radiation oncology education in medical schools and will form the basis of new national recommendations for radiation oncology curriculum development.
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Affiliation(s)
- Luke Nicholls
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ben Bravery
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | | | - Kate Shi
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Minh Thi Tieu
- University of Newcastle, Callaghan, New South Wales, Australia.,Radiation Oncology Department, Calvary Mater Hospital, Newcastle, New South Wales, Australia
| | - Sandra Turner
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia
| | - Apsara Windsor
- University of Newcastle, Callaghan, New South Wales, Australia.,Faculty of Radiation Oncology, Royal Australian and New Zealand College of Radiologists, Sydney, New South Wales, Australia.,Central Coast Cancer Centre, Gosford, New South Wales, Australia
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Rose PM. Patients' characteristics informing practice: improving individualized nursing care in the radiation oncology setting. Support Care Cancer 2018; 26:3609-3618. [PMID: 29728842 DOI: 10.1007/s00520-018-4210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE A large number of patients attend for radiotherapy daily. Primary nurses in the study settings aim to individualize care for their patients. The individual characteristics of patients may determine their perceptions of nursing care, and provide guidance in tailoring their care. This study aimed to assess patients' personal characteristics on their perceptions of individualized care (IC) provided by nurses during a course of radiotherapy, and to determine predictor variables that may inform nursing practice. METHODS This cross-sectional, exploratory study was conducted in three radiotherapy departments in Australia. Patients (n = 250) completed the Individualized Care Scale_Patient (ICS_P). Data were analyzed using descriptive and inferential statistics, univariate analysis, and multiple regression analysis. RESULTS Males reported significantly higher perceptions of IC than females in 7/9 subscales. Patients with head and neck and prostate cancer, as well as those requiring hospitalization during radiotherapy, scored significantly higher in 5/9 subscales. Courses > 30 days, those not receiving chemotherapy, and partnered patients reported greater IC across all subscales. Gender and hospitalization were the main predictor variables for IC. CONCLUSION Patients reported moderately high levels of IC during their radiotherapy; however, standard demographic information may provide limited insight into improving care for the individual. Patient characteristics routinely chosen, such as age, gender, and education may not predict how patients perceive their care or support the tailoring of interventions to improve IC. Researching a range of related patient characteristics may prove a more useful concept for future nursing studies aiming to predict outcomes to tailor nursing practice.
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Affiliation(s)
- Pauline M Rose
- Radiation Oncology, Princess Alexandra Hospital, Queensland Health, 31 Raymond Terrace, South Brisbane, Queensland, 4101, Australia.
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Mee T, Kirkby NF, Kirkby KJ. Mathematical Modelling for Patient Selection in Proton Therapy. Clin Oncol (R Coll Radiol) 2018; 30:299-306. [PMID: 29452724 DOI: 10.1016/j.clon.2018.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
Abstract
Proton beam therapy (PBT) is still relatively new in cancer treatment and the clinical evidence base is relatively sparse. Mathematical modelling offers assistance when selecting patients for PBT and predicting the demand for service. Discrete event simulation, normal tissue complication probability, quality-adjusted life-years and Markov Chain models are all mathematical and statistical modelling techniques currently used but none is dominant. As new evidence and outcome data become available from PBT, comprehensive models will emerge that are less dependent on the specific technologies of radiotherapy planning and delivery.
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Affiliation(s)
- T Mee
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University, Manchester Academic Health Science Centre, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - N F Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University, Manchester Academic Health Science Centre, Manchester, UK
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University, Manchester Academic Health Science Centre, Manchester, UK
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Stracci F, Bianconi F, Lupi C, Margaritelli M, Gili A, Aristei C. Spatial barriers impact upon appropriate delivery of radiotherapy in breast cancer patients. Cancer Med 2018; 7:370-379. [PMID: 29356463 PMCID: PMC5806099 DOI: 10.1002/cam4.1304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/25/2017] [Accepted: 11/28/2017] [Indexed: 01/21/2023] Open
Abstract
Radiotherapy (RT) is the standard treatment for breast cancer patients after conserving surgery or mastectomy when patients are at high risk of relapse. Major obstacles to appropriate RT delivery are journey times. Since studies on access to RT were carried out mostly in large countries, this study investigated factors in an Italian region and the influence of RT delivery on survival. A total of 4735 female candidates for RT were included in the study. A geographic information system calculated journey times from patients' homes and surgery hospitals to RT centers. Logistic regression analyzed the influence of journey times, socioeconomic status, and other factors on RT delivery. Survival probabilities and excess mortality were assessed in 4364 propensity score-matched patients. Journey times of 40 min or less from residence and from surgery hospital to RT center played a major role in access to RT. A large survival difference emerged between treated and untreated breast cancer patients. The excess mortality for untreated patients compared with propensity score-matched women receiving RT was 3.1 (95% CI: 2.2-4.3). Expansion of RT facilities during the 11-year study period improved RT delivery and outcomes by increasing availability but mainly by shortening journey times.
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Affiliation(s)
- Fabrizio Stracci
- Department of Experimental MedicineSection of Public HealthUniversity of PerugiaPerugiaItaly
- Umbria Cancer RegistryPerugiaItaly
| | | | | | | | | | - Cynthia Aristei
- Department of Surgery and Biomedical SciencesSection of Radiation OncologyUniversity of Perugia and Perugia General HospitalPerugiaItaly
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Moran MS. Advancements and Personalization of Breast Cancer Treatment Strategies in Radiation Therapy. Cancer Treat Res 2018; 173:89-119. [PMID: 29349760 DOI: 10.1007/978-3-319-70197-4_7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Significant technologic advances in radiation treatment delivery now allow for more personalized delivery considerations which incorporate individual patient characteristics (such as tumor location and patient anatomy) and more precise delivery in the breast conservation or post-mastectomy setting. The combined advancements with other treatment modalities (i.e., systemic therapy, surgical management) have had direct effects on local-regional management and outcomes such that currently, local-regional relapses after definitive treatment for localized disease are now rarely experienced. Recent advances in the radiation therapy field have come from careful patient selection for a variety of three-dimensional treatment delivery techniques and alternatives to conventional tangential radiation. These advances have been demonstrated to diminished acute/long-term toxicity, minimized dose to surrounding normal tissue structures such as the heart and lung, and ultimately result in an improvement in the therapeutic ratio for radiation treatment. This chapter discusses recent radiation innovations and appropriate patient selection for their application, for a more personalized approach to radiation therapy for breast cancer patients.
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Affiliation(s)
- Meena S Moran
- Therapeutic Radiology, Yale Radiation Therapy Program, Yale University School of Medicine, New Haven, USA.
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Radiotherapy access in Belgium: How far are we from evidence-based utilisation? Eur J Cancer 2017; 84:102-113. [PMID: 28802187 DOI: 10.1016/j.ejca.2017.07.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/05/2017] [Accepted: 07/11/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Underutilisation of radiotherapy has been observed worldwide. To evaluate the current situation in Belgium, optimal utilisation proportions (OUPs) adopted from the European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project were compared to actual utilisation proportions (AUPs) and with radiotherapy advised during the multidisciplinary cancer team (MDT) meetings. In addition, the impact of independent variables was analysed. MATERIALS AND METHODS AUPs and advised radiotherapy were calculated overall and by cancer type for 110,810 unique cancer diagnoses in 2009-2010. Radiotherapy utilisation was derived from reimbursement data and distinguished between palliative and curative intent external beam radiotherapy (EBRT) and/or brachytherapy (BT). Sensitivity analyses regarding the influence of the follow-up period, the survival length and patient's age were performed. Advised radiotherapy was calculated based on broad treatment categories as reported at MDT meetings. RESULTS The overall AUP of 37% (39% including BT) was lower than the OUP of 53%, but in line with advised radiotherapy (35%). Large variations by tumour type were observed: in some tumours (e.g. lung and prostate cancer) AUP was considerably lower than OUP, whereas in others there was reasonable concordance (e.g. breast and rectal cancer). Overall, 84% of treatments started within 9 months following diagnosis. Survival time influenced AUP in a cancer type-dependent way. Elderly patients received less radiotherapy. CONCLUSION Although the actually delivered radiotherapy in Belgium aligns well to MDT advices, it is lower than the evidence-based optimum. Further analysis of potential barriers is needed for radiotherapy forecasting and planning, and in order to promote adequate access to radiotherapy.
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Butler SM. Changes to radiotherapy utilisation in Western NSW after the opening of a local service. J Med Radiat Sci 2017; 64:251-258. [PMID: 28160454 PMCID: PMC5715255 DOI: 10.1002/jmrs.204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 10/22/2016] [Accepted: 11/18/2016] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION In 2011, the first radiotherapy centre in Western NSW Local Health District (WNSWLHD) was opened in the city of Orange. Prior to this, patients travelled outside the health service, primarily to Sydney, to receive treatment. The aim of this study was to investigate if the establishment of the new rural radiotherapy service has changed the demographic profile, cancer type, treatment intent and number of patients treated. METHODS Data were collected on WNSWLHD patients, 17 years of age and above, who received radiotherapy in either 2010 or 2012 in New South Wales (NSW) or Australian Capital Territory (ACT). The age, gender, treatment intent, cancer type and residential town were recorded. RESULTS The number of patients who accessed radiation increased from 573 to 667 between 2010 and 2012. The corresponding radiotherapy utilisation (RTU) rates were 29.3% in 2010 and 33.4% in 2012, an improvement of 4.1% (P = 0.01, 95% CI 1-7%). Patients travelled 128.5 km less for treatment in 2012 than in 2010 (338.7 km vs. 210.2 km, CI 111-145.5 km, P > 0.0001). All regions had an improvement in the RTU rates apart from the Remote region which decreased by 9% (31-20% in 2012). The number of palliative treatments increased significantly only within the Orange region. The number of male patients for treatments also significantly increased as there were 81 additional treatments (292 vs. 373) as did patients with a respiratory cancer (66 vs. 97). CONCLUSIONS A new radiotherapy service in a sparsely populated health district significantly changed the pattern of radiotherapy use for those who lived only in the Orange region. Treatment capacity at the Orange radiotherapy centre has doubled with the opening of a second linear accelerator since this study was conducted. Thus, a follow-up study is recommended to ascertain if radiotherapy rates remain low in the regions beyond Orange.
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Affiliation(s)
- Sally M Butler
- Central West Cancer Service, Orange Health Service, Orange, New South Wales, Australia
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Innovations in Radiotherapy Technology. Clin Oncol (R Coll Radiol) 2017; 29:120-128. [DOI: 10.1016/j.clon.2016.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/26/2016] [Accepted: 10/11/2016] [Indexed: 11/23/2022]
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Feain I, Shieh CC, White P, O'Brien R, Fisher S, Counter W, Lazarakis P, Stewart D, Downes S, Jackson M, Baxi S, Whelan B, Makhija K, Huang CY, Barton M, Keall P. Functional imaging equivalence and proof of concept for image-guided adaptive radiotherapy with fixed gantry and rotating couch. Adv Radiat Oncol 2016; 1:365-372. [PMID: 28740907 PMCID: PMC5514241 DOI: 10.1016/j.adro.2016.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 10/12/2016] [Accepted: 10/19/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose The purpose of this article is to present the first imaging experiments to demonstrate the functional equivalence between a conventional rotational gantry and a fixed-beam imaging geometry, and the feasibility of an iterative image-reconstruction technique under gravitational deformation. Methods and materials Experiments were performed using an Elekta Axesse with Agility MLC and XVI, a custom-built rotating phantom stage, a Catphan QA phantom, and a porcine heart. For the imaging equivalence, a conventional cone beam computed tomography (CBCT) of the Catphan was acquired, as well as a set of 660 x-ray projections with a static gantry and rotating Catphan. Both datasets were reconstructed with the Feldkamp-Davis-Kress (FDK) algorithm, and the resultant volumetric images were compared using standard metrics. For imaging under gravitational deformation, a conventional CBCT of the Catphan and a set of 660 x-ray projections with a static gantry and rotating Catphan were also acquired with a porcine heart. The conventional CBCT was reconstructed using FDK. The projections that were acquired with the heart rotating were sorted into angular bins and reconstructed with prior image constrained compressed sensing using a deformation-blurred FDK prior. Deformation was quantified with B-spline transformation-based deformable image registration. Results For imaging equivalence, the difference between the two Catphan images was consistent with Poisson noise. For imaging under gravitational deformation, the conventional CBCT porcine heart image (ground truth at 0 degrees) matched the static gantry, rotating heart reconstruction with a mean magnitude of <3 mm and maximum magnitude of <5 mm of the deformation vector field. The mean deformation of the rotating heart was 3.0 to 8.9 mm, up to 16.1 mm maximum deformation. Deformation was mainly observed in the direction of gravity. Conclusions We have demonstrated imaging equivalence in cone beam CT reconstructions between rigid phantom images acquired with a conventional rotating gantry and with a fixed-gantry and rotating phantom. We have presented a method for image reconstruction under a fixed-beam imaging geometry using a deformable phantom.
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Affiliation(s)
- Ilana Feain
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chun-Chien Shieh
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul White
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ricky O'Brien
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra Fisher
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - William Counter
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Lazarakis
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David Stewart
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Simon Downes
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Michael Jackson
- Department of Radiation Oncology, School of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Siddhartha Baxi
- Department of Radiation Oncology, South West Radiation Oncology Service, Bunbury, Western Australia, Australia
| | - Brendan Whelan
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - Kuldeep Makhija
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Chen-Yu Huang
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - Paul Keall
- Radiation Physics Laboratory, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Survey on gynecological cancer treatment by Piedmont, Liguria, and Valle d'Aosta group of AIRO (Italian Association of Radiation Oncology). J Contemp Brachytherapy 2016; 8:128-34. [PMID: 27257417 PMCID: PMC4873552 DOI: 10.5114/jcb.2016.59286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/19/2016] [Indexed: 01/08/2023] Open
Abstract
Purpose We focused the attention on radiation therapy practices about the gynecological malignancies in Piedmont, Liguria, and Valle d'Aosta to know the current treatment practice and to improve the quality of care. Material and methods We proposed a cognitive survey to evaluate the standard practice patterns for gynecological cancer management, adopted from 2012 to 2014 by radiotherapy (RT) centers with a large amount of gynecological cancer cases. There were three topics: 1. Taking care and multidisciplinary approach, 2. Radiotherapy treatment and brachytherapy, 3. Follow-up. Results Nineteen centers treated gynecological malignancies and 12 of these had a multidisciplinary dedicated team. Radiotherapy option has been used in all clinical setting: definitive, adjuvant, and palliative. In general, 1978 patients were treated. There were 834 brachytherapy (BRT) treatments. The fusion between diagnostic imaging (magnetic resonance imaging – MRI, positron emission tomography – PET) and computed tomography (CT) simulation was used for contouring in all centers. Conformal RT and intensity modulated radiation therapy (IMRT) were the most frequent techniques. The image guided radiation therapy (IGRT) was used in 10/19 centers. There were 8 active BRT centers. Brachytherapy was performed both with radical intent and as boost, mostly by HDR (6/8 centers). The doses for exclusive BRT were between 20 to 30 Gy. The doses for BRT boost were between 10 and 20 Gy. Four centers used CT-MRI compatible applicators but only one used MRI for planning. The BRT plans on vaginal cuff were still performed on traditional radiographies in 2 centers. The plan sum was evaluated in only 1 center. Only 1 center performed in vivo dosimetry. Conclusions In the last three years, multidisciplinary approach, contouring, treatment techniques, doses, and control systems were similar in Liguria-Piedmont and Valle d'Aosta. However, the technology implementation didn't translate in a real treatment innovation so far.
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Tekatli H, Haasbeek N, Dahele M, De Haan P, Verbakel W, Bongers E, Hashemi S, Nossent E, Spoelstra F, de Langen AJ, Slotman B, Senan S. Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with "Ultracentral" Non-Small Cell Lung Cancer. J Thorac Oncol 2016; 11:1081-9. [PMID: 27013408 DOI: 10.1016/j.jtho.2016.03.008] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We defined "ultracentral" lung tumors as centrally located non-small cell lung cancers with planning target volumes overlapping the trachea or main bronchi. Increased toxicity has been reported after both conventional and stereotactic radiotherapy for such lesions. We studied outcomes after 12 fractions of 5 Gy (BED10 = 90 Gy, heterogeneous dose distribution) to ultracentral tumors in patients unfit for surgery or conventional chemoradiotherapy. METHODS Clinical outcomes and dosimetric details were analyzed in 47 consecutive patients with single primary or recurrent ultracentral non-small cell lung cancer treated between 2010 and 2015. Those irradiated previously or with metastasis to sites other than the brain and adrenal glands were excluded. Treatments were delivered using volumetric modulated arc therapy. RESULTS The median age was 77.5 years, 49% of patients had a World Health Organization performance score of 2 or higher, and the median planning target volume was 104.5cm(3) (range 17.7-508.5). At a median follow-up of 29.3 months, median overall survival was 15.9 months, and 3-year survival was 20.1%. No isolated local recurrences were observed. Grade 3 or higher toxicity was recorded in 38% of patients, with 21% scored as having a "possible" (n = 2) or "likely" (n = 8) treatment-related death between 5.2 and 18.2 months after treatment. Fatal pulmonary hemorrhage was observed in 15% of patients. CONCLUSIONS Unfit patients with ultracentral tumors who were treated using this scheme had a high local control and a median survival of 15.9 months. Despite manifestation of rates of a fatal lung bleeding comparable to those seen with conventional radiotherapy for endobronchial tumors, the overall rate of G5 toxicity is of potential concern. Additional work is needed to identify tumor and treatment factors related to hemorrhage.
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Affiliation(s)
- Hilâl Tekatli
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels Haasbeek
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia De Haan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilko Verbakel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Bongers
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sayed Hashemi
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Nossent
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Femke Spoelstra
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Adrianus J de Langen
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Forstner DF, Yap ML. Advances in radiation therapy. Med J Aust 2015; 203:394-5. [PMID: 26561898 DOI: 10.5694/mja15.00410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/09/2015] [Indexed: 11/17/2022]
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