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Thijssen SV, Boersma LJ, Heising L, Swart RR, X J Ou C, Roumen C, J G Jacobs M. Clues to address barriers for access to proton therapy in the Netherlands. Radiother Oncol 2023; 178:109432. [PMID: 36464178 DOI: 10.1016/j.radonc.2022.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND PURPOSE The Netherlands has National Indication Protocols on proton therapy (PT) to select patients who benefit most from PT. However, referrals to proton therapy centres (PTCs) are lagging. The objective of this research is to identify the barriers for access to PT and to design interventions to address these barriers. MATERIAL AND METHODS We conducted a nationwide survey among radiation oncologists (ROs), and semi- structured in-depth interviews with ROs and patients. Subsequently, four workshops were held, in which ROs from one PTC and ROs from referring hospitals participated. The workshops were based on design-thinking research, where ideas were co-created on a multidisciplinary basis to encourage joint problem ownership. Kruskal Wallis and X2 tests were used to analyze data. RESULTS The most prominent barriers mentioned by ROs were patient selection, poor logistics, and logistical worries about the combination of radiation treatment with chemotherapy. Patients pointed out the inefficient coordination between organisations, poor communication, travel issues and discomfort during treatment. Clues to increase referrals revealed the need for additional tools for patient selection and innovative ways to improve logistics. A case manager was identified as beneficial to the patients' journey as part of a multidisciplinary approach. Such an approach should include the active involvement of medical oncologists, surgeons and pulmonologists. CONCLUSION Barriers for access to PT were identified and prioritized in the inter-organisational care- pathway of proton therapy patients in The Netherlands. Innovative solutions were co- designed to solve the barriers.
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Affiliation(s)
- Salina V Thijssen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Luca Heising
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands; Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands
| | - Rachelle R Swart
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Carol X J Ou
- Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands
| | - Cheryl Roumen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Maria J G Jacobs
- Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands; Maastro, Maastricht, the Netherlands.
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Chen E, Deshane A, Damico N, Kharouta M, Kim U, Kemmann M, Kyasaram R, Wu AK, Biswas T, Dorth J, Mansur D, Choi S, Bhatt A. An Analysis of Cancer Center-Provided Rideshare Utilization for Radiation Therapy. J Am Coll Radiol 2023; 20:40-50. [PMID: 36581084 DOI: 10.1016/j.jacr.2022.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The potential of rideshare services to facilitate timely radiation therapy (RT), especially for resource-limited patients, is understudied. METHODS Patients (n = 63) who received 73 courses of RT (1,513 fractions) and utilized free hospital-provided rideshare service (537 rides) were included in this retrospective study. A multidimensional analysis was conducted including a comparison of demographic, disease characteristics, and treatment completion data; a revenue analysis to evaluate the financial impact of rideshare services; and a geospatial analysis to evaluate community-level characteristics of patients. RESULTS Median age was 59; most were female (56%) and self-identified as Black or African American (56%), not working (91%), not partnered (83%), high school educated or less (78%), and insured with Medicaid (51%). Geospatial analysis revealed that patients lived in communities with significantly higher rates of resource deprivation. Median rideshare distance was 6.4 miles (interquartile range 3.4-11.2) with a median cost of $13.04 per rideshare (interquartile range 9-19). Of the rideshare-facilitated treatments, 100% were completed, with an overall course completion rate of 97.3% compared with 85.4% for those who did not use rideshare (P = .001); two patients discontinued RT for reasons unrelated to transportation. High rideshare utilization (n = 32), defined as utilization ≥ 45% of the treatment course, was associated with significantly shorter treatment courses and lower radiation doses compared with low rideshare utilization (P = .04). Total rideshare cost for high utilizers and whole cohort was $11,589 and $16,895, facilitating an estimated revenue of $401,952 and $1,175,119, respectively. CONCLUSIONS Free hospital-provided rideshare service is economically feasible and associated with high RT completion rates. It may help enhance quality radiation care for those who come from resource-limited communities.
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Affiliation(s)
- Eric Chen
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Alok Deshane
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nicholas Damico
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Michael Kharouta
- Resident, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Uriel Kim
- Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Matthew Kemmann
- Director, Strategic Planning and Analytics, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ravi Kyasaram
- Cancer Informatics Senior Data Architect, Cancer Informatics, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Anna K Wu
- Medical Student, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Tithi Biswas
- Thoracic Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer Dorth
- Head and Neck Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Mansur
- Pediatric Section Leader, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Serah Choi
- CNS Section Leader, and Vice Chair of Laboratory Research, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Assistant Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Aashish Bhatt
- Professor, Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio; and Associate Professor, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Scirocco E, Cellini F, Donati CM, Capuccini J, Rossi R, Buwenge M, Montanari L, Maltoni M, Morganti AG. Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review. Curr Oncol 2022; 29:7932-7942. [PMID: 36290904 PMCID: PMC9601168 DOI: 10.3390/curroncol29100627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Palliative radiotherapy (PRT) is known to be effective in relieving cancer related symptoms. However, many studies and clinical practice show several barriers hindering its use and worsening the quality of patient support during PRT. Various solutions were proposed to overcome these barriers: training on PRT for supportive and palliative care specialists and training on palliative care for radiation oncologists, and introduction of pathways and organizational models specifically dedicated to PRT. Evidence on innovative organizational models and mutual training experiences is few and sparse. Therefore, the aim of this literature review is to present a quick summary of the information available on improving the PRT quality through training, new pathways, and innovative organizational models. The majority of studies on the integration of PRT with other palliative and supportive therapies present low levels of evidence being mostly retrospective analyses. However, it should be emphasized that all reports uniformly showed advantages coming from the integration of PRT with supportive therapies. To actively participate in the integration of PRT and palliative care, providing comprehensive support to the needs of patients with advanced cancer, radiation oncologists should not only plan PRT but also: (i) assess and manage symptoms and stress, (ii) rapidly refer patients to specialists in management of more complex symptoms, and (iii) participate in multidisciplinary palliative care teams. To this end, improved education in palliative care both in residency schools and during professional life through continuous medical education is clearly needed. In particular, effective training is needed for radiotherapy residents to enable them to provide patients with comprehensive palliative care. Therefore, formal teaching of adequate duration, interactive teaching methods, attendance in palliative care services, and education in advanced palliative care should be planned in post-graduated schools of radiotherapy.
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Affiliation(s)
- Erica Scirocco
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2143564
| | - Francesco Cellini
- UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00185 Roma, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00185 Roma, Italy
| | - Costanza Maria Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Jenny Capuccini
- Palliative Care Unit, AUSL Romagna (Local Health Authority), 48022 Lugo, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Luigi Montanari
- Palliative Care Unit, AUSL Romagna (Local Health Authority), 48022 Lugo, Italy
| | - Marco Maltoni
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
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Mushonga M, Nyakabau AM, Ndlovu N, Iyer HS, Bellon JR, Kanda C, Ndarukwa-Jambwa S, Chipidza F, Makunike-Mutasa R, Muchuweti D, Muguti EG, Cluff Elmore SN. Patterns of Palliative Radiotherapy Utilization for Patients With Metastatic Breast Cancer in Harare, Zimbabwe. JCO Glob Oncol 2021; 7:1212-1219. [PMID: 34343013 PMCID: PMC8457791 DOI: 10.1200/go.20.00656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In sub-Saharan Africa, radiotherapy (RT) utilization and delivery patterns have not been extensively studied in patients with metastatic breast cancer. METHODS A retrospective cohort study of female patients with metastatic breast cancer seen at Parirenyatwa Radiotherapy Centre in Zimbabwe from 2014 to 2018 was conducted. Demographics, pathology, staging, and treatment data were abstracted through chart review. Fisher's exact test and chi-squared test of independence were used to compare proportions, and independent two-sample t-tests were used to compare means. RESULTS Of 351 patients with breast cancer, 152 (43%) had metastatic disease, median age 51 years (interquartile range: 43-61 years). Of those with metastatic disease, 30 patients (20%) received radiation to various metastatic sites: 16 spine; three nonspine bone metastases; six whole brain; and five chest wall or supraclavicular. Patients who received radiation were younger (46 v 52 years; P = .019), but did not differ significantly by performance status than those who did not. The most common dose prescription was 30 Gy in 10 fractions (33%). Five (17%) patients had treatment interruption and two (7%) had treatment noncompletion. Province of origin and clinical tumor stage were significant predictors of RT receipt (P = .002; and P = .018, respectively). CONCLUSION A minority of patients with metastatic breast cancer received RT (20%), and these were likely to be younger, with advanced tumor stage, and resided in provinces where RT is available. Conventional courses were generally prescribed. There is a need to strongly consider palliative RT as an option for patients with metastatic breast cancer and use of hypofractionated courses (e.g. 8 Gy in one fraction) may support this goal.
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Affiliation(s)
| | - Anna Mary Nyakabau
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Cancerserve Trust, Harare, Zimbabwe
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Hari Subramaniam Iyer
- Harvard T.H. Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | | | - Caroline Kanda
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Sandra Ndarukwa-Jambwa
- Sally Mugabe Central Hospital, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Fallon Chipidza
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Radiation Oncology Program, Boston, MA
| | - Rudo Makunike-Mutasa
- Department of Pathology, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - David Muchuweti
- Department of Surgery, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Edwin G Muguti
- Department of Surgery, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
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Abstract
BACKGROUND Previous research unambiguously establishes the importance of knowledge and education about opioids and pain management in medical care. This article aimed at describing the perception of the general public on the uses and the risks of morphine in palliative care in an Ecuadorian sample, where training and access to those services is limited. METHODS We used an online recruited sample of 257 participants for this cross-sectional descriptive study. Participants responded to an online self-report survey regarding morphine's effects and its relationship with addiction and death in a palliative care context. RESULTS Analyses indicate that there is a lack of understanding about the effectiveness of morphine and that, overall, participants did not associate morphine with death and dying. Results also show that people in health-related occupations did not differ from the general public in beliefs about the addiction and the effectiveness of morphine. However, occupation and education effects were noted for several other items, as well as whether the participants had direct experiences with palliative care as either a patient or a caregiver. CONCLUSIONS There is still misinformation about opioids such as morphine in the general public and health professionals in Ecuador. Although personal experiences with pain control and palliative care are linked to better knowledge about opioids, education is still necessary to overcome the myths around them. Future research could address the found misconceptions to increase health literacy through education policies and interventions.
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Affiliation(s)
| | - Guido Mascialino
- School of Psychology, Universidad de Las Américas, Quito, Ecuador
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6
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Abstract
Introduction: Pancreatic adenocarcinoma is now the third-leading cause of cancer-related deaths in the US which can be attributed to rising incidence, diagnosis at advanced stages and early development of metastasis. Systemic therapy remains palliative with early development of resistance possibly related to the constitutive activation of 'undruggable' KRAS, immunosuppressive microenvironment, and intense desmoplasia. The advancements in molecular biology has led to the development and investigation of targeted and immune therapeutics.Areas covered: This study provides a comprehensive review of the literature to further the understanding of molecular targets with their respective antibody-based therapies in clinical development in pancreatic cancer. PubMed was systematically searched for English-language articles discussing antibody-based therapies under phase 2 clinical trial investigation in pancreatic adenocarcinoma.Expert opinion: PDAC remains highly resistant to chemotherapy with no significant improvement in survival for patients with advanced or metastatic cancer. Unfortunately, the majority of the antibody-based targeted and immune therapeutics have failed to meet their primary efficacy endpoints in early phase trials. However, there are a few promising antibody-based drugs with intriguing preliminary data that merit further investigation, while many more continue to be developed and investigated preclinically, and in early phase trials.
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Affiliation(s)
- Jasmeet Kaur
- Department of Internal Medicine, Saint Joseph Mercy Oakland Hospital, Pontiac, MI, USA
| | - Paramveer Singh
- Division of Hematology and Oncology, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Thomas Enzler
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vaibhav Sahai
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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7
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Gutt R, Malhotra S, Hagan MP, Lee SP, Faricy-Anderson K, Kelly MD, Hoffman-Hogg L, Solanki AA, Shapiro RH, Fosmire H, Moses E, Dawson GA. Palliative Radiotherapy Within the Veterans Health Administration: Barriers to Referral and Timeliness of Treatment. JCO Oncol Pract 2021; 17:e1913-e1922. [PMID: 33734865 DOI: 10.1200/op.20.00981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Most Veterans Health Administration hospitals do not have radiation oncology (RO) departments on-site. The purpose of this study is to determine the impact of on-site RO on referral patterns and timeliness of palliative radiation therapy (PRT). MATERIALS AND METHODS A survey was sent to medical directors at 149 Veterans Health Administration centers. Questions evaluated frequency of referral for PRT, timeliness of RO consults and treatment, and barriers to referral for PRT. Chi-square analysis was used to evaluate differences between centers that have on-site RO and centers that refer to outside facilities. RESULTS Of 108 respondents, 33 (31%) have on-site RO. Chi-square analysis revealed that RO consult within 1 week is more likely at centers with on-site RO (68% v 31%; P = .01). Centers with on-site RO more frequently deliver PRT for spinal cord compression within 24 hours (94% v 70%; P = .01). Those without on-site RO were more likely to want increased radiation oncologist involvement (64% v 26%; P < .001). Barriers to referral for PRT included patient ability to travel (81%), patient noncompliance (31%), delays in consult and/or treatment (31%), difficulty contacting a radiation oncologist (14%), and concern regarding excessive number of treatments (13%). Respondents with on-site RO less frequently reported delays in consult and/or treatment (6% v 41%; P < .0001) and difficulty contacting a radiation oncologist (0% v 20%; P = .0056) as barriers. CONCLUSION Respondents with on-site RO reported improved communication with radiation oncologists and more timely consultation and treatment initiation. Methods to improve timeliness of PRT for veterans at centers without on-site RO should be considered.
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Affiliation(s)
| | | | | | - Steve P Lee
- VA Long Beach Healthcare System, Long Beach, CA
| | | | | | - Lori Hoffman-Hogg
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC.,Office of Nursing Services, VHACO, Washington, DC
| | | | | | - Helen Fosmire
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
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Siau E, Salazar H, Livergant J, Klein J. Non-oncologist Physician Knowledge of Radiation Therapy at an Urban Community Hospital. J Cancer Educ 2021; 36:199-206. [PMID: 31605283 DOI: 10.1007/s13187-019-01618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Radiation therapy (RT) is a crucial part of cancer care, but previous work suggests that many non-radiation oncologist physicians are uncomfortable referring for RT. To evaluate training and understanding of RT, the authors sent invitations to complete an online questionnaire to all physicians at a community hospital in Bronx, NY, which asked about oncology training and self-rated and objective knowledge of RT. Out of 247 invited participants, 87 responded (35%). Among responders, 19 were attending physicians (22%) and 66 (76%) were residents. Seventy-two percent of respondents reported caring for > 5 cancer patients in the past month, but 54% reported never referring patients for RT. Sixty-nine percent of respondents stated they received no radiation oncology training in medical school, and 36% reported no general oncology training. Approximately half believed themselves to be "somewhat knowledgeable" about RT indications (48%), benefits (53%), and side effects (55%). Objective assessment mean score was 6.2/12 (median 7) for all respondents; Respondents with internal medicine specialization scored higher than others (mean 7.7 vs 3.5; p < 0.01). Scores did not differ between attending and resident physicians, resident post-graduate levels, or receiving oncology training in medical school. The factors most commonly cited as affecting RT referral decisions were type of cancer, patient wishes, family wishes, poor functional status, and life expectancy. Many physicians are unaware of RT effectiveness or indications, which may affect referral patterns. Previous oncology training was not associated with higher knowledge scores.
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Affiliation(s)
- Evan Siau
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, SBH Health System, Bronx, NY, USA
| | | | - Jonathan Livergant
- Division of Radiation Oncology, University of British Columbia and BC Cancer, Victoria, BC, Canada
| | - Jonathan Klein
- Department of Radiation Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA.
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Vargas A, Torres C, Küller-Bosch A, Villena B. Palliative Care Physicians and Palliative Radiotherapy, Knowledge and Barriers for Referring: A Cross-sectional Study. J Pain Symptom Manage 2020; 60:1193-1199.e3. [PMID: 32615300 DOI: 10.1016/j.jpainsymman.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Palliative radiotherapy is effective in the management of symptoms resulting from advanced cancer. However, it remains underutilized. In developed countries, many factors have been linked to this phenomenon but data in developing and low-income countries, particularly in Latin America, are lacking. OBJECTIVES To conduct a cross-sectional survey to explore palliative care physicians' knowledge of palliative radiotherapy and to investigate possible factors that limit patient referral. METHODS This is a cross-sectional survey. An online questionnaire was sent to palliative care physicians (n = 170) registered in the Chilean Medical Society of Palliative Care directory. RESULTS The overall response rate was 58.8%. Nearly all respondents (98%) considered radiotherapy to be a useful treatment. Less than half the respondents (43%) had good knowledge of palliative radiotherapy. Knowledge was correlated with self-reported knowledge (P = 0.015), discussing cases with radiation oncologist (P = 0.001), and having attended educational events on palliative radiotherapy (P = 0.001). Patient reluctance, poor performance status, and family reluctance were identified as major barriers to the use of palliative radiotherapy. Physicians from cities other than the capital were more likely to be concerned about barriers such as distance to radiotherapy facilities (P = 0.01), the duration of the referral process (P = 0.01), and the lack of a radiation oncologist available for discussing cases (P = 0.01). CONCLUSIONS Several barriers affect referral to palliative radiotherapy. Some barriers seem to be more significant for physicians practicing in cities far from cancer centers. Physicians' knowledge is less than optimal and has been identified as a barrier to referral. Educational interventions and broadening the availability of cancer treatment resources are needed to improve the referral process.
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Affiliation(s)
- Andrés Vargas
- Department of Radiation Oncology, Instituto de Radiomedicina (IRAM), Santiago de Chile, Chile.
| | - Carolina Torres
- Palliative Care Unit, Hospital San José de Osorno, Osorno, Chile
| | - Anna Küller-Bosch
- Palliative Care Unit, Hospital Barros Luco-Trudeau, Santiago de Chile, Chile
| | - Belén Villena
- Instituto de Literatura y Ciencias del Lenguaje, Pontificia Universidad Católica de Valparaiso, Valparaiso, Chile
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10
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Dennis K, Harris G, Kamel R, Barnes T, Balboni T, Fenton P, Rembielak A. Rapid Access Palliative Radiotherapy Programmes. Clin Oncol (R Coll Radiol) 2020; 32:704-712. [DOI: 10.1016/j.clon.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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Bach-Mortensen AM, Verboom B. Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers. Res Synth Methods 2020; 11:743-759. [PMID: 32845574 DOI: 10.1002/jrsm.1447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews cataloguing the barriers to and facilitators of various outcomes are increasingly popular, despite criticisms of this type of review on philosophical, methodological, and practical grounds. The aims of this review are to appraise, analyze, and discuss the reporting and synthesis practices used in recently published barriers and facilitators reviews in health services research. METHODS All English-language peer-reviewed systematic reviews that synthesized research on barriers and facilitators in a health services context were eligible for inclusion. We searched 11 databases over a 13-month period (1 November 2017-30 November 2018) using an exhaustive list of search terms for "barrier(s)," "facilitator(s)," and "systematic review." RESULTS One hundred reviews were included. We found a high degree of variation in the synthesis practices used in these reviews, with the majority employing aggregative (rather than interpretive) approaches. The findings echo common critiques of this review type, including concerns about the reduction of complex phenomena to simplified, discrete factors. Although several reviews highlighted the "complexity" of barriers and facilitators, this was usually not analyzed systematically. Analysis of the subsample of reviews that explicitly discussed the barriers and facilitators approach revealed some common issues. These tended to be either conceptual/definitional (eg, ideas about interrelationships and overlap between factors) and methodological/practical (eg, challenges related to aggregating heterogeneous research). CONCLUSION Barriers and facilitators reviews should (a) clearly operationally define "barrier" and "facilitator," (b) explicitly describe how factors are extracted and subsequently synthesized, and (c) provide critical reflection on the contextual variability and reliability of identified factors.
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Affiliation(s)
| | - Ben Verboom
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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12
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Soko GF, Burambo AB, Mngoya MM, Abdul BA. Public Awareness and Perceptions of Radiotherapy and Their Influence on the Use of Radiotherapy in Dar es Salaam, Tanzania. J Glob Oncol 2020; 5:1-10. [PMID: 31702947 PMCID: PMC6882515 DOI: 10.1200/jgo.19.00175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Misconceptions associated with radiotherapy (RT) may affect the patient’s choice to undergo or not undergo RT. In this study, the level of awareness and perceptions about radiation and RT, as well as their impact on the use of RT, were assessed. MATERIALS AND METHODS A cross-sectional survey was conducted in the city of Dar es Salaam, Tanzania, between November 2018 and March 2019. Stratified sampling was used to obtain a sample of 629 participants from 4 strata, including 53 patients with cancer, 129 health professionals, 127 medical and nursing students, and 320 respondents from the general public. A questionnaire with 13 items measuring awareness and 8 items measuring perceptions was used for data collection. The Kruskal-Wallis test and χ2 test were used to test association between predictor and outcome variables. Statistical analyses were performed using statistical software. RESULTS The percentage of right responses was < 50% in all 13 awareness items. Only 16.9% of respondents were aware that RT would not reduce their lifespan. Only 34.5% of respondents had positive perceptions of RT. Awareness was higher among medical/nursing students, younger respondents, single or cohabiting respondents, and those who had attained a college or higher education. Overall, 52% would accept receiving RT if recommended as part of their treatment. Those who would accept undergoing RT were more likely to have higher awareness and a positive perception of RT. CONCLUSION Public awareness of RT in Dar es Salaam is low, and negative perceptions prevail. Low levels of awareness and negative perceptions have a negative effect on the use of RT.
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