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Skelton K, Gorayski P, Tee H, Anderson N, Le H. Travelling overseas for proton beam therapy: A retrospective interview study. J Med Radiat Sci 2024; 71 Suppl 2:10-18. [PMID: 37622485 PMCID: PMC11011578 DOI: 10.1002/jmrs.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Travelling for cancer treatment comes with unique challenges, particularly for a young patient and his or her family. The aims of this study were to (1) gain an understanding of the experiences of families and patients who travelled overseas (OS) from Australia for proton beam therapy (PBT) and (2) identify the supportive care needs patients and their families require when living away from home, while having PBT. METHODS This was a retrospective, qualitative study using semi-structured interviews, conducted with participants aged under 25 years and their families who travelled OS for PBT between 2017 and 2020. Data were analysed using Microsoft Excel Software, where key themes were identified and coded based on their responses. A total of 17 participants were included in interviews from seven Australian families who travelled to America or Europe for PBT. RESULTS The majority of participants reported a lack of coordination with travel and treatment arrangements prior to arrival OS. Families who stayed in hotel accommodation while OS reported greater feelings of isolation compared with those who stayed in share house-style accommodation. The acuity of cancer diagnosis played a significant part in patient experience, with those patients requiring the greatest amount of supportive care and availability of service provision at stand-alone centres reporting a lack of appropriate care provision. CONCLUSIONS This study has identified services, accommodation provisions and care coordination requirements that are largely missing from the travel and treatment experience in patients travelling OS for PBT. Future use of consumer-led working groups or committees in creating models of care for families travelling for PBT treatment could be advantageous, with many families willing to share their experiences and provide support to others who are travelling for PBT.
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Affiliation(s)
- Kelly Skelton
- Australian Bragg Centre for Proton Therapy and Research, South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- University of MelbourneMelbourneVictoriaAustralia
| | - Peter Gorayski
- Australian Bragg Centre for Proton Therapy and Research, South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Department of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Hui Tee
- Australian Bragg Centre for Proton Therapy and Research, South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Nigel Anderson
- University of MelbourneMelbourneVictoriaAustralia
- Department of Radiation OncologyOlivia Newton‐John Cancer Wellness & Research Centre, Austin HealthMelbourneSouth AustraliaAustralia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health CareMonash UniversityClaytonVictoriaAustralia
| | - Hien Le
- Australian Bragg Centre for Proton Therapy and Research, South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Department of Radiation OncologyRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Department of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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Choi KY, Patel SD, Lane C, Tucker J, Chan K, Pradhan S, Mahase SS, Tam SH, King TS. Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings. Head Neck 2024; 46:398-407. [PMID: 38087455 DOI: 10.1002/hed.27588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/19/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Differences in treatment outcomes between community or academic centers are incompletely understood. METHODS Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan-Meier curves and log-rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. RESULTS Two hundred and forty-eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). CONCLUSION Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.
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Affiliation(s)
- Karen Y Choi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shivam D Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ciaran Lane
- Department of Otolaryngology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jacqueline Tucker
- Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kimberly Chan
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sean S Mahase
- Department of Radiation Oncology, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Samantha H Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Medical Center, Detroit, Michigan, USA
| | - Tonya S King
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Rhodes SS, Berlin E, Yegya-Raman N, Doucette A, Gentile M, Freedman GM, Taunk NK. Factors Associated With Travel Distance in the Receipt of Proton Breast Radiation Therapy. Int J Part Ther 2022; 9:1-9. [PMID: 36721480 PMCID: PMC9875828 DOI: 10.14338/ijpt-22-00018.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023] Open
Abstract
Introduction Proton radiation therapy (PBT) may reduce cardiac doses in breast cancer treatment. Limited availability of proton facilities could require significant travel distances. This study assessed factors associated with travel distances for breast PBT. Materials and Methods Patients receiving breast PBT at the University of Pennsylvania from 2010 to 2021 were identified. Demographic, cancer, and treatment characteristics were summarized. Straight-line travel distances from the department to patients' addresses were calculated using BatchGeo. Median and mean travel distances were reported. Given non-normality of distribution of travel distances, Wilcoxon rank sum or Kruskal-Wallis test was used to determine whether travel distances differed by race, clinical trial participation, disease laterality, recurrence, and prior radiation. Results Of 1 male and 284 female patients, 67.8% were White and 21.7% Black. Median travel distance was 13.5 miles with interquartile range of 6.1 to 24.8 miles, and mean travel distance was 13.5 miles with standard deviation of 261.4 miles. 81.1% of patients traveled less than 30 and 6.0% more than 100 miles. Black patients' travel distances were significantly shorter than White patients' and non-Black or non-White patients' travel distances (median = 4.5, 16.5, and 11.3 miles, respectively; P < .0001). Patients not on clinical trials traveled more those on clinical trials (median = 14.7 and 10.2 miles, respectively; P = .032). There was no difference found between travel distances of patients with left-sided versus right-sided versus bilateral disease (P = .175), with versus without recurrent disease (P = .057), or with versus without prior radiation (P = .23). Conclusion This study described travel distances and demographic and clinicopathologic characteristics of patients receiving breast PBT at the University of Pennsylvania. Black patients traveled less than White and non-Black or non-White patients and comprised a small portion of the cohort, suggesting barriers to travel and PBT. Patients did not travel further to receive PBT for left-sided or recurrent disease.
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Affiliation(s)
- Sylvia S. Rhodes
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eva Berlin
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil Yegya-Raman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail Doucette
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Gentile
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary M. Freedman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil K. Taunk
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Knibbs V, Manley S. Being away from home for cancer treatment: a qualitative study of patient experience and supportive care needs during radiation therapy. J Med Radiat Sci 2022; 69:336-347. [PMID: 35373930 PMCID: PMC9442298 DOI: 10.1002/jmrs.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/12/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Supportive care needs (SCN) refer to support required by patients and their families to better cope with cancer. Many rural radiation therapy (RT) patients stay away from home for significant periods, which can lead to the negative effects of both social isolation and cultural disparity. They may demonstrate complex SCN. This study aimed to explore experiences of being away from home by considering patient perspectives of their own SCN. The objectives were to provide a deeper understanding of how these patients think and feel and present a foundation of patient-centred insights for further research. METHODS Thirteen patients participated in semi-structured interviews; all stayed away from home for RT at the North Coast Cancer Institute for >3 days a week for >3 weeks. The data were subject to interpretive phenomenological analysis: a thorough process of understanding and analysis that is accompanied by reflection to improve researcher transparency. RESULTS Two themes influenced patient experiences of their care: values and identity, and expectations. Patients discussed the value they place on rural life, community connections and health care and referred to information for managing expectations. SCN discussed fell into practical, physical and psycho-social needs. CONCLUSIONS Experiences of culturally appropriate patient-centred supportive care improve control and confidence. Patient well-being is influenced by compassionate, caring and respectful connections with others. Several practical ways of managing expectations and promoting the psycho-social well-being of patients are discussed, for example, tailored packing lists and easy access to green spaces. Future research can be shaped by lived experiences.
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Affiliation(s)
- Vanessa Knibbs
- North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Stephen Manley
- North Coast Cancer Institute, Lismore, New South Wales, Australia
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Lunt N, Fung KW. Scoping the literature on patient travel abroad for cancer screening, diagnosis and treatment. Int J Health Plann Manage 2021; 37:66-77. [PMID: 34523157 DOI: 10.1002/hpm.3315] [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: 02/24/2021] [Revised: 06/04/2021] [Accepted: 08/19/2021] [Indexed: 11/11/2022] Open
Abstract
The incidence of cancer is on the rise globally. Under particular circumstances, patients are willing to travel abroad for healthcare treatments. We know relatively little however about patients travelling overseas for cancer-related screening, diagnosis and treatment. Where do patients go, for what treatments, what are their motivations, decision-making processes and treatment experiences? What do we know about patient safety and risk, and outcomes? More broadly, what are the ethical and legal implications? This review presents the first published assessment of what we term 'transnational oncology treatment', defined as patients travelling overseas or across borders for cancer screening, diagnosis and treatment. The review undertakes detailed search and retrieval of the literature, using an accepted scoping review method. We present a narrative review of existing knowledge and themes, identifying coverage and gaps. There is a five-fold agenda for future investigation: trajectories and itineraries; in depth focus on treatment decisions, experiences and outcomes; locating patient travel within wider health system analysis; exploration of professional perspectives and coordination; and situating travel within the context of health trade. Such an agenda is multidisciplinary and wide-ranging, encompassing epidemiology, health economics, health policy ethics, health politics, health management, and health policy.
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Affiliation(s)
- Neil Lunt
- Department of Social Policy and Social Work, University of York, York, UK
| | - Ka-Wo Fung
- Department of Social Work, Soochow University, Taipei, Taiwan
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Nash SH, Zimpelman G, Schulz L, Hirschfeld M. Pediatric Cancers among Alaska Native People. J Pediatr 2020; 227:288-294.e1. [PMID: 32679200 PMCID: PMC8108443 DOI: 10.1016/j.jpeds.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the descriptive epidemiology of pediatric cancers among Alaska Native people. STUDY DESIGN We used data from the Alaska Native Tumor Registry, a population-based registry capturing cancer information among Alaska Native people 1969-present. Specifically, we examined all cases of cancer diagnosed among individuals ages 0-19 years. Cases were classified according to the International Classification of Childhood Cancers, 3rd edition (ICCC-3). We estimated incidence and distribution of cases by ICCC-3 cancer site, comparing between the time periods 1969-1996 and 1997-2016. We assessed 12-month and 5-year cause-specific survival, and examined differences over the time period, adjusted for age, sex, and ICCC-3 site. RESULTS Incidence rates of pediatric cancers increased between 1969 and 1996 (n = 134) and 1997 and 2016 (n = 186) among Alaska Native people, from 139.8 in 1 000 000 (95% CI, 116.99-165.7) to 197.54 in 1 000 000 (95% CI, 170.1-228.1). Distribution of ICCC-3 sites differed between time periods (P < .0001). Finally, cancer survival was high; the 12-month survival probability from all ICCC-3 sites combined was 0.88 (95% CI, 0.84-0.92) and the 5-year survival probability was 0.76 (95% CI, 0.70-0.81) for 1969-2016. After adjusting for age, sex, and ICCC-3 site, we observed a 57% decrease in the risk of death when comparing Alaska Native pediatric cancer cases diagnosed in 1997-2016 with those diagnosed in 1969-1996. CONCLUSIONS This information will be of value for our understanding of pediatric cancers among Indigenous peoples of the US, and will also be informative for clinicians providing care to this population.
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Affiliation(s)
- Sarah H Nash
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK.
| | - Garrett Zimpelman
- Alaska Native Epidemiology Center, Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK
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Sullivan CB, Al-Qurayshi Z, Anderson CM, Seaman AT, Pagedar NA. Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer. Laryngoscope 2020; 131:1019-1025. [PMID: 32846018 DOI: 10.1002/lary.29033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer. STUDY DESIGN Retrospective cohort analysis. METHODS Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan-Meier analysis. RESULTS A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002). CONCLUSIONS PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower-income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1019-1025, 2021.
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Affiliation(s)
- Christopher B Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Möllerberg M, Langegård U, Ohlsson‐Nevo E, Fransson P, Johansson B, Ahlberg K, Sjövall K. Managing an altered social context-Patients experiences of staying away from home while undergoing proton beam therapy. Nurs Open 2020; 7:1157-1163. [PMID: 32587735 PMCID: PMC7308677 DOI: 10.1002/nop2.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/09/2020] [Indexed: 01/10/2023] Open
Abstract
Aim To illuminate the experience of an altered social context for patients with primary brain tumours living away from home while undergoing proton beam therapy. Design A descriptive, qualitative cross-sectional interview study. Methods Nineteen patients were interviewed between December 2015-August 2016, either during (N = 7) or before and after (N = 12) their proton beam therapy. A hermeneutical analysis was performed. Results Participants made adjustments to achieve control and well-being during the treatment period. The analysis also revealed two interrelated patterns that helped participants adjust: being part of the family from a distance and seeking affinity. Conclusion It is important that patients receiving treatment far from home find a way to remain a part of their family and find affinity in the altered social context. Health professionals can prepare patients for the treatment period and can implement interventions to promote well-being for both patients and their relatives.
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Affiliation(s)
| | - Ulrica Langegård
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Emma Ohlsson‐Nevo
- Faculty of Medicine and HealthUniversity Healthcare Research CentreÖrebro UniversityÖrebroSweden
| | - Per Fransson
- Department of NursingUmeå UniversityUmeåSweden
- Department of CancercentrumNorrlands University HospitalUmeåSweden
| | - Birgitta Johansson
- Experimental OncologyDepartment of Immunology, Genetics and PathologyUppsala UniversityUppsala University HospitalUppsalaSweden
| | - Karin Ahlberg
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Katarina Sjövall
- Department of OncologySkåne University HospitalLundSweden
- Department of OncologyLund UniversityLundSweden
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Fitch MI, Coronado AC, Schippke JC, Chadder J, Green E. Exploring the perspectives of patients about their care experience: identifying what patients perceive are important qualities in cancer care. Support Care Cancer 2019; 28:2299-2309. [DOI: 10.1007/s00520-019-05057-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
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Gilbertson-White S, Yeung C, Wickersham KE. "Just Living With Them": Symptom Management Experiences of Rural Residents With Advanced Cancer. Oncol Nurs Forum 2019; 46:531-542. [PMID: 31424451 DOI: 10.1188/19.onf.531-542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand how rural residents with advanced cancer experience and manage their symptoms. PARTICIPANTS & SETTING 16 adult patients with a diagnosis of advanced cancer, who were receiving antineoplastic treatment and living in rural areas of southeastern Iowa, participated in the study. METHODOLOGIC APPROACH Data were collected through semistructured, audio-recorded interviews using open-ended questions. Data were analyzed using content and dimensional analyses. FINDINGS Four themes were developed from the completed interviews, including (a) barriers and challenges associated with rural cancer care, (b) physical symptoms experienced from the time of diagnosis through the cancer trajectory, (c) symptom management strategies used to control physical symptoms, and (d) perceptions of having cancer and the use of technology in managing symptoms. IMPLICATIONS FOR NURSING Rural residents with advanced cancer experience a wide range of physical symptoms that may affect their quality of life. Although residents may develop self-management strategies to cope with symptoms, additional guidance on and interventions for how best to manage physical symptoms are needed.
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Loughery J, Woodgate RL. Supportive care experiences of rural women living with breast cancer: An interpretive descriptive qualitative study. Can Oncol Nurs J 2019; 29:170-176. [PMID: 31966013 DOI: 10.5737/23688076293170176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer is the leading cause of female cancer in Canada. However, there is limited research on the health and supportive needs of rural women living with this illness. The purpose of this qualitative study was to arrive at an increased understanding of the supportive care experiences of rural women requiring treatment for invasive breast cancer who reside in rural Manitoba. To explore this phenomenon, an interpretive descriptive qualitative study was completed. Twenty women from four regional health authorities participated in the study. Data were collected using face-to-face, semi-structured interviews and analyzed by content analysis through an interpretative qualitative lens. The findings presented emphasize a holistic overview of the experiences of women living with breast cancer that captured both the positive aspects of living rurally and the described rural challenges. Pragmatic recommendations have been generated from the study findings that have implications for nursing practice and service delivery.
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Affiliation(s)
- Joanne Loughery
- Nursing Instructor, College of Nursing, Red River College, 2055 Notre Dame Avenue, Winnipeg, MB, R3H 0J9, 1-204-294-3919;
| | - Roberta L Woodgate
- Canadian Research Chair (Tier 1) in Child and Family Engagement, in Health Research and Healthcare. Professor, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba,
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Vindrola-Padros C, Brage E, Chambers P. On the road and away from home: a systematic review of the travel experiences of cancer patients and their families. Support Care Cancer 2018; 26:2973-2982. [PMID: 29796709 DOI: 10.1007/s00520-018-4266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/10/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Traveling for cancer care is difficult as patients might be suffering from the side effects of treatment, need to cover additional costs, and face disruption of daily life. The aim of this review was to synthesize the evidence on travel needs and experiences during cancer treatment from the point of view of patients and their families. METHODS This is a systematic review of the literature. The PRISMA statement was used to guide the reporting of the methods and findings. We searched for peer-reviewed articles in MEDLINE, CINAHL PLUS, and Web of Science and selected articles based on the following criteria: focused on patients and their families; presented findings from empirical studies; and examined travel and transport experiences for cancer screening, treatment, and related care. The MMAT was used to assess the quality of the studies. RESULTS A total of 16 articles were included in the review. Most of the studies used a qualitative design, were carried out in high-income countries and were conducted more than 10 years ago. Several problems were reported regarding travel and relocation: social and physical demands of transport, travel, and relocation; life disruption and loss of daily routines; financial impact; and anxieties and support needs when returning home. CONCLUSIONS Patients and carers consistently reported lack of support when traveling, relocating, and returning home. Future research needs to explore patient experiences under current treatment protocols and healthcare delivery models, in a wider range of geographical contexts, and different stages of the patient pathway.
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Affiliation(s)
- Cecilia Vindrola-Padros
- Department of Applied Health Research, University College London (UCL), 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Eugenia Brage
- Instituto de Ciencias Antropológicas, Sección Antropología Social, Facultad de Filosofía y Letras, Universidad de Buenos Aires, CONICET, Puan 480, 1420, Buenos Aires, Argentina
| | - Pinkie Chambers
- Cancer Division, University College London Hospitals NHS Foundation Trust, 250 EustonRoad, NW1 2BU, London, UK.,Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
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Are Patients Traveling for Intraoperative Radiation Therapy? Int J Breast Cancer 2017; 2017:6395712. [PMID: 29130001 PMCID: PMC5654333 DOI: 10.1155/2017/6395712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose One benefit of intraoperative radiation therapy (IORT) is that it usually requires a single treatment, thus potentially eliminating distance as a barrier to receipt of whole breast irradiation. The aim of this study was to evaluate the distance traveled by IORT patients at our institution. Methods Our institutional prospective registry was used to identify IORT patients from 10/2011 to 2/2017. Patient's home zip code was compared to institution zip code to determine travel distance. Characteristics of local (<50 miles), regional (50-100 miles), and faraway (>100 miles) patients were compared. Results 150 were patients included with a median travel distance of 27 miles and mean travel distance of 121 miles. Most were local (68.7%), with the second largest group living faraway (20.0%). Subset analysis of local patients demonstrated 20.4% traveled <10 miles, 34.0% traveled 10-20 miles, and 45.6% traveled 20-50 miles. Six patients traveled >1000 miles. The local, regional, and faraway patients did not differ with respect to age, race, tumor characteristics, or whole breast irradiation. Conclusions Breast cancer patients are traveling for IORT, with 63% traveling >20 miles for care. IORT is an excellent strategy to promote breast conservation in selected patients, particularly those who live remote from a radiation facility.
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In a bad place: Carers of patients with head and neck cancer experiences of travelling for cancer treatment. Eur J Oncol Nurs 2017; 30:29-34. [DOI: 10.1016/j.ejon.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/21/2017] [Accepted: 07/01/2017] [Indexed: 11/24/2022]
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Appleton L, Perkins E. The construction of help during radiotherapy: Redefining informal care. Psychooncology 2017; 26:2057-2062. [PMID: 28294461 DOI: 10.1002/pon.4420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study will explore how help is constructed during and following radiotherapy for patients with cancer. METHODS Grounded theory methods were used in the study to explore the way in which family members and friends constructed a role for themselves in relation to patients receiving radiotherapy. A total of 22 helpers were interviewed. Patients were being treated for a range of cancers including breast, prostate, colorectal, and head and neck. RESULTS Respondents in this study consistently defined themselves as "helpers" rather than "carers." While radiotherapy as a treatment modality was mostly seen as noninvasive, the cancer diagnosis cast a long shadow over the lives of helpers and patients creating a separation in longstanding relationships. Helpers experienced this separation as "otherness." Help became an important vehicle for bridging this separation. Individuals developed different ways of knowing about the patient as the basis for providing help. Two different types of help were identified in this study: the behind the scenes, largely invisible work that helpers undertook to help the patient without their knowledge and the explicit visible help that was much more commonly negotiated and discussed between helpers and patients. CONCLUSIONS The study provides the basis for a greater understanding on the part of professionals into the impact of diagnosis and radiotherapy treatment on family and friends. In doing so, the study identifies opportunities for the experience of helpers to be recognised and supported by professionals.
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Affiliation(s)
- Lynda Appleton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Elizabeth Perkins
- Institute of Psychology, Health and Society, William Rathbone VI Chair of Community Nursing Research, University of Liverpool, Liverpool, UK
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Lilliehorn S, Salander P. Living at a residency away from home during radiotherapy as narrated by 52 patients with breast cancer: a cage of safety and discomfort. Disabil Rehabil 2016; 40:450-456. [DOI: 10.1080/09638288.2016.1261412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Sara Lilliehorn
- Department of Social Work, Umeå University, Umeå, Sweden
- Department of Radiation Sciences – Oncology, Umeå University, Umeå, Sweden
| | - Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden
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Sundaresan P, Stockler MR, Milross CG. What is access to radiation therapy? A conceptual framework and review of influencing factors. AUST HEALTH REV 2016; 40:11-18. [PMID: 26072910 DOI: 10.1071/ah14262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/22/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in 'RT access'. We aimed to develop a conceptual framework for the consideration of 'RT access' by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing 'RT access'. METHODS Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for 'RT access'. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFO via OvidSP,1806 to October 2014. RESULTS The framework developed demonstrates that 'RT access' encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. CONCLUSION 'Access' is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of 'RT access' so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects.
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Affiliation(s)
- Puma Sundaresan
- The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email
| | - Martin R Stockler
- The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email
| | - Christopher G Milross
- The Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia. Email
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Stevens B, McKeever P, Law MP, Booth M, Greenberg M, Daub S, Gafni A, Gammon J, Yamada J, Epstein I. Children Receiving Chemotherapy at Home: Perceptions of Children and Parents. J Pediatr Oncol Nurs 2016; 23:276-85. [PMID: 16902083 DOI: 10.1177/1043454206291349] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this descriptive exploratory study was to determine the perspectives of parents and children with cancer on a home chemotherapy program. Qualitative analyses were used to organize data from 24 parents and 14 children into emerging themes. Themes included (1) financial and time costs, (2) disruption to daily routines, (3) psychological and physical effects, (4) recommendations and caveats, and (5) preference for home chemotherapy. When home chemotherapy was compared with hospital clinic-based chemotherapy, parents reported fewer financial and time costs and less disruption to their work and family schedules, and children reported more time to play/study, improved school attendance, and engagement in normal activities. Although some parents felt more secure with hospital chemotherapy, most found it more exhausting and stressful. At home, children selected places for their treatment and some experienced fewer side effects. Although some coordination/communication problems existed, the majority of parents and children preferred home chemo-therapy. Home chemotherapy treatment is a viable, acceptable, and positive health care delivery alternative from the perspective of parents and children with cancer.
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Affiliation(s)
- Bonnie Stevens
- Faculty of Nursing and Medicine, University of Toronto, Toronto, Ontario, Canada.
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Cockle SG, Ogden J. The 'radiation vacation': Parents' experiences of travelling to have their children's brain tumours treated with proton beam therapy. Health Psychol Open 2016; 3:2055102916649767. [PMID: 28070403 PMCID: PMC5193290 DOI: 10.1177/2055102916649767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Proton beam therapy is a new form of radiotherapy. Little is known about patients' experiences of proton beam therapy and less about parents' experiences of children receiving treatment. Semi-structured interviews explored 10 parents' experiences of travelling from the United Kingdom to the United States to have their children's brain tumours treated with proton beam therapy. Thematic analysis uncovered themes of 'adjusting to the PBT routine', 'finding benefit in the situation' and 'readjusting upon returning home'. Parents' initial worries were elevated by travel, but they found benefit in their experiences, describing them positively. The periods before and after treatment were most difficult, illustrating a cycle from upset to calm, back to upset upon their return home.
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Coombs NJ, Coombs JM, Vaidya UJ, Singer J, Bulsara M, Tobias JS, Wenz F, Joseph DJ, Brown DA, Rainsbury R, Davidson T, Adamson DJA, Massarut S, Morgan D, Potyka I, Corica T, Falzon M, Williams N, Baum M, Vaidya JS. Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open 2016; 6:e010703. [PMID: 27160842 PMCID: PMC4890331 DOI: 10.1136/bmjopen-2015-010703] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole breast radiotherapy (EBRT) treatment. SETTING (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT. PARTICIPANTS 485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres. OUTCOME MEASURES The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy. METHODS Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test. RESULTS TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient). CONCLUSIONS The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK. TRIAL REGISTRATION NUMBER ISRCTN34086741; Post-results.
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Affiliation(s)
| | | | - Uma J Vaidya
- Nonsuch High School for Girls, UK
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Julian Singer
- Department of Radiotherapy, Princess Alexandra Hospital, Harlow, UK
| | - Max Bulsara
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
- University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jeffrey S Tobias
- Department of Radiation Oncology(JST), University College London, London, UK
| | - Frederik Wenz
- Department of Radiation Oncology, University of Heidelberg, Germany
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | | | | | | | | | | | - David Morgan
- Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
| | - Ingrid Potyka
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Tammy Corica
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mary Falzon
- Department of Pathology, University College London, London, UK
| | - Norman Williams
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Michael Baum
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
| | - Jayant S Vaidya
- Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK
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Geographic variation in the intended choice of adjuvant treatments for women diagnosed with screen-detected breast cancer in Queensland. BMC Public Health 2015; 15:1204. [PMID: 26630881 PMCID: PMC4668608 DOI: 10.1186/s12889-015-2527-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although early diagnosis and improved treatment can reduce breast cancer mortality, there still appears to be a geographic differential in patient outcomes. This study aims to determine and quantify spatial inequalities in intended adjuvant (radio-, chemo- and hormonal) therapy usage among women with screen-detected breast cancer in Queensland, Australia. Methods Linked population-based datasets from BreastScreen Queensland and the Queensland Cancer Registry during 1997−2008 for women aged 40−89 years were used. We adopted a Bayesian shared spatial component model to evaluate the relative intended use of each adjuvant therapy across 478 areas as well as common spatial patterns between treatments. Results Women living closer to a cancer treatment facility were more likely to intend to use adjuvant therapy. This was particularly marked for radiotherapy when travel time to the closest radiation facility was 4 + h (OR =0.41, 95 % CrI: [0.23, 0.74]) compared to <1 h. The shared spatial effect increased towards the centres with concentrations of radiotherapy facilities, in north-east (Townsville) and south-east (Brisbane) regions of Queensland. Moreover, the presence of residual shared spatial effects indicates that there are other unmeasured geographical barriers influencing women’s treatment choices. Conclusions This highlights the need to identify the additional barriers that impact on treatment intentions among women diagnosed with screen-detected breast cancer, particularly for those women living further away from cancer treatment centers. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2527-2) contains supplementary material, which is available to authorized users.
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“Undressing” distress among cancer patients living in urban, regional, and remote locations in Western Australia. Support Care Cancer 2015; 24:1963-1973. [DOI: 10.1007/s00520-015-2982-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023]
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Sundaresan P, Milross CG, Smith A, Evans A, Stockler MR, King MT. Factors influencing the use of RT in NSW: a qualitative study exploring consumer and health professional perspectives. J Med Imaging Radiat Oncol 2014; 58:625-32. [PMID: 24945988 DOI: 10.1111/1754-9485.12198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/24/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radiotherapy (RT) is an essential and cost-effective cancer treatment. It is underutilised in Australia. Bridging the gap between actual and optimal RT utilisation requires not only provision of adequate RT infrastructure but also an understanding of the factors that influence the extent to which this opportunity for RT is utilised. This study explored factors perceived to affect RT-related decision making by consumers and health professionals (HPs). METHODS Six semi-structured focus groups (FGs) and 13 interviews were conducted at three geographical locations in NSW, Australia (n = 26 consumers and 30 HPs). Audio recordings of FGs and interviews were transcribed verbatim and analysed thematically. RESULTS An exhaustive list of issues perceived to affect consumer and HP RT decisions was identified. There were common themes across participant groups and locations. Perceptions of RT and its benefits, as well as accurate communication of the expected benefits and risks of RT, were highlighted as important to decision making. Perceived factors relating to 'inconvenience' of RT were multifaceted and included travel, relocation, accommodation, time away from work and financial challenges. Perceived potential barriers to RT referral included knowledge of RT and RT services, availability of a local or visiting RT service, referrer bias, and the low profile of RT. CONCLUSIONS Important drivers during RT decisions appear to include the perceived benefit, risks and inconvenience of RT. Underutilisation of RT may also result from multiple barriers at the referrer level. Further research into whether these factors influence actual RT decisions is needed.
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Affiliation(s)
- Puma Sundaresan
- The Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Central Coast Cancer Centre, Gosford Hospital, Sydney, New South Wales, Australia
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Tools to expedite the development of treatment plans. Qual Manag Health Care 2014; 23:70-5. [PMID: 24710182 DOI: 10.1097/qmh.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Quality improvement strategies can be used to modify existing health care processes to reduce patient wait times. We undertook a quality improvement project to reduce the time between new patients' initial visits and the finalization of their treatment plans. Initiation of treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 2 weeks from their initial consultation. Treatment delays result in increased costs and anxiety for the patient, adversely affecting the quality of care provided. We performed detailed process mapping and a cause-and-effect analysis to identify and prioritize opportunities for improvement. Process improvements addressed 2 key causes of delay to develop a finalized treatment plan: (1) insufficient data for decision making at the time of new patient visit and (2) delays in obtaining diagnostic imaging. After implementing our process improvements, the median time to develop a treatment plan decreased by 89% from 70.5 to 7.6 hours. Our process changes involved minimal additional work and had the secondary outcome of resulting in time savings for the clinic team.
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Breen L, O'Connor M. Rural health professionals’ perspectives on providing grief and loss support in cancer care. Eur J Cancer Care (Engl) 2013; 22:765-72. [DOI: 10.1111/ecc.12091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Affiliation(s)
- L.J. Breen
- School of Psychology and Speech Pathology; Curtin University; Perth Australia
- School of Psychology and Social Science; Edith Cowan University; Perth Australia
| | - M. O'Connor
- School of Psychology and Speech Pathology; Curtin University; Perth Australia
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Ganeva Z. Comparative Analysis of the Current Status, Own Body Perception and Positive Experience From Diagnosed Breast Cancer. PSYCHOLOGICAL THOUGHT 2013. [DOI: 10.5964/psyct.v6i1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Paul CL, Hall AE, Carey ML, Cameron EC, Clinton-McHarg T. Access to care and impacts of cancer on daily life: do they differ for metropolitan versus regional hematological cancer survivors? J Rural Health 2013; 29 Suppl 1:s43-50. [PMID: 23944279 DOI: 10.1111/jrh.12020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Little is known about access to care for hematological cancer patients. This study explored patient experiences of barriers to accessing care and associated financial and social impacts of the disease. Metropolitan versus nonmetropolitan experiences were compared. METHODS A state-based Australian cancer registry identified adult survivors of hematological cancers (including lymphoma, leukemia and myeloma) diagnosed in the previous 3 years. Survivors were mailed a self-report pen and paper survey. FINDINGS Of the 732 eligible survivors, 268 (37%) completed a survey. Forty percent of participants reported at least one locational barrier which limited access to care. Only 2% reported cancer-related expenses had restricted their treatment choices. Almost two-thirds (64%) reported at least one financial or social impact on their daily lives related to cancer. The most frequently reported impacts were the need to take time off work (44%) and difficulty paying bills (21%). Survivors living in a nonmetropolitan location had 17 times the odds of reporting locational or financial barriers compared with those in metropolitan areas. Preferred potential solutions to alleviate the financial and social impacts of the disease were: free parking for tests or treatment (37%), free medications or treatments (29%), and being able to get treatment in their local region (20%). CONCLUSIONS Providing more equitable access to care for hematological cancer patients in Australia requires addressing distances traveled to attend treatment and their associated financial and social impacts on nonmetropolitan patients. Greater flexibility in service delivery is also needed for patients still in the workforce.
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Affiliation(s)
- Christine L Paul
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia.
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Nissim R, Wong R, Fyles A, Moddel D, Zimmermann C, Rodin G. Can trained volunteers provide psychosocial support to patients undergoing radiotherapy? The perspective of patients and volunteers. Pract Radiat Oncol 2012; 2:e23-e29. [PMID: 24674181 DOI: 10.1016/j.prro.2011.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Clinic-based psychosocial interventions, including volunteer-based ones, may be a cost-efficient and acceptable means of integrating psychosocial support into cancer care during radiotherapy. The present study evaluated a new psychosocial volunteer support program in a large radiotherapy clinic. METHODS AND MATERIALS Patients were asked to complete a demographic and satisfaction with care questionnaire. Clinic volunteers were asked to report their interactions with patients on shift logs. RESULTS Of the 182 participating patients, 93 (51%) recalled meeting a volunteer in the clinic, with the 2 most common support types provided being the following: "listening and caring," and "information on services." Analysis of 224 volunteers' shift logs indicated that almost all interactions (94%) were initiated by the volunteers, and almost half (47%) involved the patients' companions in the clinic. The most common support type documented was "information and navigation" (71%), followed by "emotional" (47%), "diversional" (21%), and "physical/practical" (17%) support. CONCLUSIONS Trained volunteers can effectively provide clinic-based psychosocial support and information to a high proportion of radiotherapy patients. These findings demonstrate that volunteer support is a feasible means of meeting the psychosocial needs of patients with cancer attending outpatient radiotherapy clinics, who may not require or want professional psychosocial support.
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Affiliation(s)
- Rinat Nissim
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Rebecca Wong
- Department of Radiation Oncology, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Anthony Fyles
- Department of Radiation Oncology, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dhara Moddel
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Paul C, Carey M, Anderson A, Mackenzie L, Sanson-Fisher R, Courtney R, Clinton-McHarg T. Cancer patients' concerns regarding access to cancer care: perceived impact of waiting times along the diagnosis and treatment journey. Eur J Cancer Care (Engl) 2012; 21:321-9. [PMID: 22111696 PMCID: PMC3410528 DOI: 10.1111/j.1365-2354.2011.01311.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2011] [Indexed: 01/07/2023]
Abstract
Waiting times can raise significant concern for cancer patients. This study examined cancer patients' concern levels at each phase of waiting. Demographic, disease and psychosocial characteristics associated with concern at each phase were also assessed. 146 consenting outpatients (n= 146) were recruited from two hospitals in Sydney, Australia. Each completed a touch-screen computer survey, asking them to recall concern experienced regarding waiting times at each treatment phase. Approximately half (52%) reported experiencing concern during at least one treatment phase, while 8.9% reported experiencing concern at every phase. Higher proportions of patients reported concern about waiting times from: deciding to have radiotherapy to commencement of radiotherapy (31%); the first specialist appointment to receiving a cancer diagnosis (28%); and deciding to have chemotherapy to commencement of chemotherapy (28%). Patient groups more likely to report concern were those of lower socio-economic status, born outside Australia, or of younger age. Although a small proportion of patients reported very high levels of concern regarding waiting times, the experience of some concern was prevalent. Opportunities for reducing this concern are discussed. Vulnerable groups, such as younger and socio-economically disadvantaged patients, should be the focus of efforts to reduce waiting times and patient concern levels.
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Affiliation(s)
- C Paul
- The University of Newcastle, Health Behaviour Research Group and Priority Research Centre for Health Behaviour, Hunter Medical Research Institute Callaghan, NSW 2308, Australia. )
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Zucca A, Boyes A, Newling G, Hall A, Girgis A. Travelling all over the countryside: Travel-related burden and financial difficulties reported by cancer patients in New South Wales and Victoria. Aust J Rural Health 2011; 19:298-305. [DOI: 10.1111/j.1440-1584.2011.01232.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
BACKGROUND People living in rural areas who have a diagnosis of cancer have poorer outcomes than people living in urban centers. The reasons for this are unclear. Little is known about the impact that living in a rural area has on the diagnosis and treatment decisions of these people and how these may in turn impact on care outcomes. OBJECTIVES This study explored the reasons why people living in rural areas may delay diagnosis and what issues affected the decisions they made regarding their cancer treatment. METHODS In depth, semistructured interviews were conducted with 18 participants from 3 rural Western Australian health regions. Content analysis was used to develop themes. RESULTS Four themes were identified to describe the rural cancer experience. The first 3 themes, Experiences of Diagnosis and Referral, The Treatment Journey, and Managing your own Care, relate to the experiences of rural cancer patients during their journey through the health care system. The final overarching theme, Implicit Faith, described the level of confidence that rural cancer patients had in the health system, often despite delays and inconveniences. CONCLUSIONS There is a need to improve primary health care and care coordination for rural cancer patients living in Australia and to promote self-advocacy and consumer empowerment for rural cancer patients. IMPLICATIONS FOR PRACTICE Rural patients need help and support throughout their cancer journey, including through the process of diagnosis.
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Butow PN, Phillips F, Schweder J, White K, Underhill C, Goldstein D. Psychosocial well-being and supportive care needs of cancer patients living in urban and rural/regional areas: a systematic review. Support Care Cancer 2011; 20:1-22. [PMID: 21956760 DOI: 10.1007/s00520-011-1270-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 09/06/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to describe what is known about levels of morbidity and the experience and needs of people with cancer, and their informal caregivers, living in rural areas. METHODS A search of online databases for English language papers describing or assessing the prevalence of psychosocial morbidity or needs in a population of rural or regional cancer patients was employed. The following were excluded: intervention studies, discussion of service delivery, effectiveness of support groups or support via videoconferencing, concentrated on medical outcomes or survival rates, reported differences in the uptake of cancer screening or concentrated on health attitudes or treatment decision making. RESULTS There were 37 studies in the review, including 25 quantitative studies (all surveys), 11 of which included a control group of urban patients and 12 qualitative studies. Until recently, most studies had methodological shortcomings. Only two prospective studies were identified, most studies focused on breast cancer and few addressed psychological morbidity. The majority of controlled studies reported worse outcomes for rural patients, who appear to have higher needs in the domains of physical/daily living. This may reflect more limited access to resources, a more self-sufficient lifestyle and personal characteristics, for example, being more stoical and less likely to ask for help. The need to travel for treatment caused many practical, emotional and financial problems for patients and burdened them with additional worry concerning family and work commitments. Some patients reported benefits in sharing experiences with others also forced to stay away from home, but most agreed that staying at home was preferable. CONCLUSION This review highlights that whilst we are beginning to get some insight into the needs of people with cancer in rural areas, much is still unknown. Population-based, prospective studies including people with heterogeneous cancers from rural and urban settings are needed.
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Affiliation(s)
- Phyllis N Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, NSW, Australia.
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Stevens C, Bondy SJ, Loblaw DA. Wait times in prostate cancer diagnosis and radiation treatment. Can Urol Assoc J 2010; 4:243-8. [PMID: 20694099 PMCID: PMC2910767 DOI: 10.5489/cuaj.09122] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Wait times for cancer diagnosis and treatment are a significant concern for Canadians. Men with prostate cancer experience longer waiting times for diagnosis and treatment than those observed for other cancers. Longer waits are associated with both patient and family psychosocial distress and may be associated with worse prognosis. METHODS Men referred for treatment of prostate cancer at a single Canadian cancer centre were interviewed. The intervals from suspicion to definitive therapy were calculated, factors associated with delays along this pathway were identified, and common causes of delay identified by patients were described. RESULTS A total of 41 consecutive patients participated. The median interval from suspicion to the first fraction of radiotherapy for all patients was 247 days (interquartile range [IQR] 168-367 d). The median diagnostic interval was 53 days (IQR 28-166 d). The median treatment interval was 127 days (IQR 100-180 d). Patients under 70 years old and patients with INTERPRETATION In this study, 12% and 0% of patients met Canadian Strategy for Cancer Control and Canadian Association of Radiation Oncologists wait time recommendations, respectively. A large component of wait time is patient driven. Alternate strategies should be developed and measured to shorten the intervals between the suspicion and treatment of prostate cancer.
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Affiliation(s)
- Christiaan Stevens
- Fellow, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, ON
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Abstract
OBJECTIVE The aim of this research project was to gain an understanding of the experiences of rural cancer patients who commute to an urban cancer center for palliative care. METHOD The study utilized a mixed method design. Fifteen individuals with a palliative designation participated in semi-structured interviews and filled out the Problems and Needs in Palliative Care Questionnaire. RESULTS Qualitative findings included three major themes: cultures of rural life and care, strategies for commuting, and the effects of commuting. Participants valued their rural lifestyles and gained significant support from their communities. Strategies included preparing for the trip with particular attention to pain management, making the most of time, and maintaining significant relationships. Establishing a routine helped to offset the anxiety of commuting. Commuting was costly but the quality of life and supportive relationships obtained through treatment were significant benefits. Questionnaire data suggested that participants were experiencing a number of problems but few indicated they desired more professional attention to those problems. SIGNIFICANCE OF RESULTS Rural lifestyles are often an important part of overall well-being and commuting for care is both costly and complex. Health care providers should assist individuals to weigh the relative contributions of staying in their rural locale versus commuting for care to their overall quality of life. Palliative-care individuals in this study indicated a number of ongoing problems but were not inclined to seek further assistance from health care providers in addressing those problems. Clinicians should actively inquire about problems and further research is needed to understand why patients are reluctant to seek help.
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Matthews EE, Cook PF. Relationships among optimism, well-being, self-transcendence, coping, and social support in women during treatment for breast cancer. Psychooncology 2009; 18:716-26. [PMID: 19034884 DOI: 10.1002/pon.1461] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The impact of diagnosis and treatment for breast cancer, stressors that affect emotional well-being, is influenced by several psychosocial factors and the relationships among them. The purpose of this study was to investigate the relationship between optimism and emotional well-being (EWB) and the individual and combined mediation of this relationship by perceived social support (SS), problem focused coping (PFC), and self-transcendence in women with breast cancer during radiation therapy. METHODS Ninety-three women receiving radiation treatment for breast cancer completed questionnaires that measured EWB, optimism, SS, PFC, and self-transcendence. RESULTS Correlational and multiple regression analysis revealed that optimism was positively related to EWB. Of the three mediators, self-transcendence alone was found to partially mediate the relationship between optimism and EWB. The relationship between optimism and PFC was not significant. Optimism was related to SS, but its indirect effect on EWB through SS did not reach significance. CONCLUSIONS AND IMPLICATIONS During breast cancer treatment, the positive effects of optimism on EWB are partially mediated by a woman's level of self-transcendence. Brief screening of women's optimism may help identify women at risk for psychological distress. Early detection and interventions to promote psychological adjustment throughout the cancer trajectory (e.g. enhancing self-transcendence) should receive attention in future research.
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Minstrell M, Winzenberg T, Rankin N, Hughes C, Walker J. Supportive care of rural women with breast cancer in Tasmania, Australia: changing needs over time. Psychooncology 2008; 17:58-65. [PMID: 17410518 DOI: 10.1002/pon.1174] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Providing for patients' psychosocial needs is a potential means of minimising cancer morbidity. Needs assessments can guide responsive patient-centred care. A longitudinal survey of women with early breast cancer consulting a breast nurse in a primarily rural state of Australia was undertaken to measure unmet supportive care needs, identify changes in unmet needs across time and compare results with previous studies. Needs assessments were completed with the Supportive Care Needs Survey (SCNS) at 1 month (n = 74) and 3 months (n = 83) post-diagnosis. Access to services was also examined. High levels of psychological and health system and information needs were identified at 1 month post-diagnosis, but these decreased significantly at 3 months post-diagnosis. Sexuality domain needs increased significantly during the same time. Compared to a previous SCNS study of rural women with breast cancer, unmet supportive care needs in this study were significantly lower than previously reported, although assistance with energy levels (i.e. fatigue) continues to be an unmet need for women with breast cancer. Results suggest there have been positive cultural changes within healthcare systems, specifically in better informing patients and providing support. Although services appear to be more responsive to breast cancer patients, significant unmet needs still exist.
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Affiliation(s)
- Melinda Minstrell
- University Department of Rural Health, Faculty of Health Science, University of Tasmania, Hobart, Australia.
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Faria SL, Mahmud S, Wakil G, Negrete S, Souhami L, David M, Duclos M, Shenouda G, Freeman CR. Is There a Detrimental Effect of Waiting for Radiotherapy for Patients With Localized Prostate Cancer? Am J Clin Oncol 2006; 29:463-7. [PMID: 17023780 DOI: 10.1097/01.coc.0000225919.35003.88] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate a possible deleterious effect of waiting time to radiotherapy on the biochemical relapse (BR) of patients with localized prostate cancer. PATIENTS AND METHODS Patients included in this retrospective study had localized prostate adenocarcinoma treated with external-beam irradiation alone. Waiting time was defined as the interval between the first consultation and the first radiation treatment. BR was defined as 3 consecutive rises of prostatic specific antigen (PSA). Patients were split into 3 groups of waiting time: group A were treated within 40 days; group B waited 41 to 80 days; group C waited >80 days to receive radiotherapy. The effect of waiting on BR was estimated by the Kaplan-Meier method. Multivariate Cox proportional hazards modeling was adjusted for known prognostic factors. RESULTS There were 289 patients who participated in the analysis. Median follow-up time was 6.1 year. Overall BR rate was 44% at 5 years. The median waiting time increased over the study period from 26 days in 1992 to 123 days in 2000. In adjusted multivariate analysis there was a nonsignificant higher risk of BR with waiting for 41 to 80 days (hazard ratio [HR] = 0.8; 95% confidence interval [CI] = 0.3-1.6) and for >80 days (HR = 0.6; 95% CI = 0.2-1.5) when compared with patients treated within 40 days after consultation. CONCLUSION Delaying the start of radiotherapy showed little effect on the rate of BR in the group of 288 prostate cancer patients analyzed in this study.
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Affiliation(s)
- Sergio L Faria
- Department of Oncology, Division of Radiation Oncology, McGill University Montreal, QC, Canada.
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