E. Szumacher

Effectiveness of educational intervention on the congruence of prostate and rectal contouring as compared with a gold standard in three-dimensional radiotherapy for prostate.

PURPOSEnTo examine effects of a teaching intervention on precise delineation of the prostate and rectum during planning of three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer.nnnMETHODS AND MATERIALSnA pretest, posttest, randomized controlled group design was used. During pretest all participants contoured prostate and rectum on planning CT. Afterward, they participated in two types of workshops. The experimental group engaged in an interactive teaching session focused on prostate and rectum MR anatomy compared with CT anatomy. The control group focused on 3D-CRT planning without mention of prostate or rectal contouring. The experimental group practiced on fused MR-CT images, whereas the control group practiced on CT images. All participants completed the posttest.nnnRESULTSnThirty-one trainees (12 male, 19 female) were randomly assigned to two groups, 17 in the experimental arm, and 14 in the control group. Seventeen felt familiar or very familiar with pelvic organ contouring, 12 somewhat, and 2 had never done it. Thirteen felt confident with organ contouring, 13 somewhat, and 5 not confident. The demographics and composition of groups were analyzed with chi(2) and repeated-measures analysis of variance with the two groups (experimental or control) and two tests (pre- or posttest) as factors. Satisfaction with the course and long-term effects of the course on practice were assessed with immediate and delayed surveys. All performance variables showed a similar pattern of results.nnnCONCLUSIONSnThe training sessions improved the technical performance similarly in both groups. Participants were satisfied with the course content, and the delayed survey reflected that cognitively participants felt more confident with prostate and rectum contouring and would investigate opportunities to learn more about organ contouring.

Development of Patients' Decision Aid for Older Women With Stage I Breast Cancer Considering Radiotherapy After Lumpectomy

PURPOSEnTo develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients decision making.nnnMETHODS AND MATERIALSnA PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition.nnnRESULTSnThe PtDA is a booklet that details each adjuvant treatment options benefits, risks, and side effects tailored to the patients clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients choice predisposition scores that suggested potential differences in treatment decision after PtDA use.nnnCONCLUSIONSnThis study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options.

Patients' decision-making in radiation oncology

Recently, growing attention has been devoted to developing patient decision aids and decisional support interventions to aid patients in their decision-making when making treatment choices in oncology. Treatment discussions are challenging, both for physicians to transfer medical information to patients, and for patients to conceptualize these risks and benefits and to form a treatment decision. This article provides an overview of the recent literature on decision-making preferences, treatment preferences and decisional support development in radiation oncology. We review the findings from studies that were conducted in radiation oncology that investigated patients’ preferences for radical or palliative radiotherapy across all cancer sites and discuss the challenges of transferring medical information to patients.

Decisional Support throughout the Cancer Journey for Older Women Diagnosed with Early Stage Breast Cancer: A Single Institutional Study

To determine if older women with early stage breast cancer have sufficient decisional support during their breast cancer journey, a questionnaire-based study was conducted at the Sunnybrook Odette Cancer Centre, in Toronto, Ontario, Canada. Women with stages I and II breast cancer, ≥60xa0years, were contacted upon completion of their adjuvant treatment. A questionnaire was developed based on focus groups, the literature, and consultation with patients and a multidisciplinary team of experts. The questionnaire was divided into six domains as follows: (1) information support surrounding diagnosis, (2) impact of cancer diagnosis on the patient, (3) quality of interaction with healthcare team, (4) decisional support from the healthcare team, (5) additional information needs surrounding treatment decision, and (6) information support during radiation treatment. Ninety-two of 137 patients approached were included in the analysis. Ninety percent wereu2009>u200960xa0years at the time of diagnosis and 65xa0% had stage I invasive breast cancer. The majority of women received adequate decisional support during their cancer journey. Approximately 90xa0% of women indicated that they received a high level of support during their cancer diagnosis. We found no significant differences in overall decisional support based on age at diagnosis, education level, ethnicity, or the presence of co-morbidities. However, participants desired additional educational resources such as a worksheet, consultation summary, or workbook to assist in making a treatment decision. The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer.

Improving Access to Radiotherapy Services in the Simcoe-Muskoka Region of Ontario: Needs Assessment Study

Abstract Introduction The Simcoe-Muskoka region of Ontario, Canada, is underserviced with respect to radiotherapy utilization. A group from the Toronto Sunnybrook Regional Cancer Centre and the Royal Victoria Hospital (RVH) of Barrie, Ontario, conducted a study investigating health-care needs and access to radiotherapy services in the region. Methods A questionnaire evaluating access to and knowledge about palliative radiotherapy was distributed to health-care providers from the region, and two radiation therapy education focus groups were organized at RVH to investigate regional knowledge and utilization of radiotherapy. Results Of 400 distributed, 167 questionnaires were returned (41 percent). The major barrier to radiotherapy access was distance to regional radiation cancer centres. Only 37 percent of respondents felt very comfortable with treatment of pain and palliative care symptoms, and only 8.4 percent felt very knowledgeable about palliative radiotherapy. Most participants wanted to learn more about radiotherapy through smallgroup teaching, and different topics were suggested for such presentations. Two focus groups proposed five potential educational strategies. Conclusion Many respondents were unaware of the effectiveness of palliative radiotherapy for cancer patients; however, most would like to learn more about radiotherapy. The focus groups identified several ways to offer health-care providers in Simcoe-Muskoka up-to-date information about palliative radiotherapy.

Breast Cancer Patients’ Preferences for Adjuvant Radiotherapy Post Lumpectomy: Whole Breast Irradiation vs. Partial Breast Irradiation—Single Institutional Study

This study was conducted to elucidate patients with early breast cancer preference for standard whole breast irradiation (WBI) or partial breast irradiation (PBI) following lumpectomy, as well as identify important factors for patients when making their treatment decisions. Based on relevant literature and ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. Consenting, eligible women reviewed the educational tool and completed the trade-off questionnaire. Descriptive statistics were calculated, as well as chi-squares and a logistic regression model. Of the 90 patients who completed the study, 62xa0% preferred WBI, 30xa0% preferred PBI, 4xa0% required more information, and 3xa0% had no preferences. Of the patients who chose WBI, 58xa0% preferred hypofractionated RT, whereas 25xa0% preferred the conventional RT regimen. The majority of patients rated recurrence rate [WBIu2009=u200955/55 (100xa0%), PBIu2009=u200926/26 (100xa0%)] and survival [WBIu2009=u200954/55 (98xa0%), PBIu2009=u200926/26 (100xa0%)] as important factors contributing to their choice of treatment preference. Financial factors [WBIu2009=u200921/55 (38xa0%), PBIu2009=u200914/26 (53xa0%)] and convenience [WBIu2009=u200936/54 (67xa0%), PBIu2009=u200918/26 (69xa0%)] were rated as important less frequently. Significantly, more patients who preferred WBI also rated standard method of treatment as important when compared to patients who preferred PBI [WBIu2009=u200952/54 (96xa0%), PBIu2009=u200916/26 (61xa0%), χ2u2009=u200916.63, pu2009=u20090.001]. The majority of patients with early breast cancer who were surveyed for this study preferred WBI as an adjuvant treatment post lumpectomy, yet there was a sizeable minority who preferred PBI. This was associated with the importance patients place on standard treatment. These results will help medical professionals treat patients according to patient values.

Patient engagement in research with older adults with cancer

OBJECTIVEnCancer is a disease that mostly affects older adults. Older adults have been under-represented in clinical cancer research. Around the world there is a push for patient engagement on study teams as it is anticipated to improve study design, recruitment and dissemination of findings. In the current overview we examined the evidence with regard to: 1) the history of patient engagement in research and frameworks developed; 2) impact of patient engagement on patient and research outcomes; 3) use of patient engagement in geriatrics and oncology, 4) recommendations for successful engagement; and 5) gaps in the literature that should be studied further.nnnMETHODSnA narrative review was conducted. Articles published in English were searched in Medline with the help of a librarian.nnnRESULTSnPatient engagement has been shown to improve the conduct of studies by making the study design more relevant and feasible, and improving recruitment rates and uptake of research findings by patients. However, the best way to engage patients is not clear yet. Several resources have been developed to support researchers engaging older adults with cancer in research.nnnCONCLUSIONSnWhile patient engagement in research seems promising to improve study outcomes, little evidence is available thus far in geriatric oncology settings. Several gaps in the literature are identified that should be further studied to determine the value of, and best approaches to, patient engagement with older adults with cancer.

Patterns of Care Related to Post-Operative Radiotherapy for Patients with Prostate Cancer among Canadian Radiation Oncologists and Urologists

The American Society for Radiation Oncology (ASTRO) and American Urological Association (AUA) developed post-prostatectomy radiotherapy (RT) guidelines to aid patient counseling on adjuvant (ART) and salvage radiotherapy (SRT). Our study compared how aware and compliant Canadian radiation oncologists and urologists are to these guidelines. Our online survey was distributed through the Canadian Association of Radiation Oncology (CARO) and Canadian Urology Association (CUA) to radiation oncologists and urologists that treat prostate cancer. We used Wilcoxon rank-sum test and Chi-square test to compare radiation oncologists and urologists. P values for significant findings are reported. A total of 128 participants responded the survey, 52 radiation oncologists, and 76 urologists. The majority (82%) of radiation oncologists had read these guidelines, compared to only 49% of urologists (pxa0<xa00.001). Radiation oncologists were more likely to recommend ART >50% for adverse pathological findings post-radical prostatectomy compared to urologists (76 vs. 51%, pxa0=xa00.011). Urologists were more likely to monitor their patient’s PSA level post-prostatectomy compared to radiation oncologists (93 vs. 77%, pxa0=xa00.016). Post-thematic analysis of open-ended questions revealed that urologists rarely refer patients to radiation oncologists for ART, with radiation oncologists confirming that they rarely receive referrals. This study demonstrates the low compliance to ASTRO/AUA guidelines. While radiation oncologists were more aware and compliant to guidelines, urologists were significantly more likely to monitor their patient’s PSA. This study highlighted the need for better communication between urologists and radiation oncologists, especially in referrals for ART, to facilitate treatment delivery that is concordant with ASTRO/AUA guidelines.

National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology

Currently, there is no formal curriculum addressing geriatric oncology within Canadian radiation oncology (RO) residency programs. Knowledge related to geriatric medicine may help radiation oncologists modify RT based on frailty status and geriatric considerations. Understanding specific learning needs allow program coordinators to align the current curriculum with residents’ geriatric oncology learning needs. The purpose of this study is to determine the geriatric oncology educational needs of the Canadian RO residents and to inform Canadian RO residency training. A cross-sectional survey, with Likert, multiple choice, and open-ended questions, was pretested and distributed electronically by program directors to Canadian RO residents over 6xa0weeks. Responses were analyzed with descriptive statistics and common themes. One-hundred and thirty-five Canadian RO residents were contacted and 63 responded (47%). Half (49%) lacked confidence managing the elderly with multiple comorbidities, polypharmacy, functional and cognitive impairment, and challenging social circumstances;73% agreed additional training would be helpful. Forty-four percent lacked confidence regarding psychogeriatric referrals, fall prevention, palliative and hospice care, and community resources preventing re-hospitalization; 63% agreed additional training would be helpful. Seventy-six percent believed discussion groups, continuing education, geriatric oncology electives, and journal clubs would provide learning opportunities. Seventy-one percent agreed integrating geriatric assessment into RO curricula would improve care. Seventy-nine percent believed geriatric oncology principles have not been adequately integrated into radiation oncology curricula. There are significant gaps specific to geriatric assessment and management of older cancer patients in the current Canadian RO curricula. Most residents agreed that it is important to integrate geriatric oncology training to improve and personalize the care of older cancer patients.

Assessing the Psychological Impact of Daily Bowel Preparation on Prostate Patients Who Receive Radiation Therapy

Abstract Purpose Evidence has shown that the prostate moves depending on filling of the rectum and to a lesser extent the bladder; many radiation therapy departments have adopted standardized bladder filling/rectal emptying protocols for radiotherapy treatment. Dailyxa0treatments may be delayed until appropriate volumes are attained; the resultant psychological impact of these delays on patients is unknown. The purpose of this study was to determine levels of anxiety, depression, distress, and bother related to bowel preparation for prostate cancer patients undergoing radiation therapy treatment. Methods A prospective cohort analysis of prostate cancer patients undergoing external beam radiation therapy was completed. Patients were assigned to one of three groups; Group A was standard of care, Group B was standard of care plus increased educational information regarding bowel preparation, Group C was standard of care plus increased educational information regarding bowel preparation plus an anti-flatulent medication. Hospital Anxiety and Depression Scale, Distress Thermometer, and a Bowel Status Bother survey were completed by participants at the start of theircourse of radiation treatment, mid-way through, and at the end. Analysis of variance testing was completed to determine differences in mean scores between the three groups. Results Mean age of patients (N = 30) was 66xa0years; 50% of the participants had a university education; 80% were married. Anxiety levels decreased over time in all groups ( P = .039) with no difference between groups ( P = 0.447). Depression levels across time for each group remained low ( P = .577). Overall distress levels associated with bowel preparation were low among each group, and no significant differencesxa0were reported ( P = .978). All groups reported high rates of quality of life. Conclusions Findings from this study indicate that collectively across three groups and over time, there were low levels of anxiety, depression, and distress from bowel preparation. Amount, timing, quality, and approach to educational information are important factors to ensure patients feel prepared for their radiation therapy treatments.