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Hong DS, Caissie A, Hurkmans CW, Krauze AV, Kudner R, Purdie TG, Xiao Y. Operational Ontology for Oncology: A Framework for Improved Communication and Understanding in Cancer Care. Int J Radiat Oncol Biol Phys 2023; 117:551-553. [PMID: 37739606 DOI: 10.1016/j.ijrobp.2023.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 09/24/2023]
Affiliation(s)
- David S Hong
- Department of Radiation Oncology, University of Southern California, Los Angeles, California.
| | | | - Coen W Hurkmans
- Department of Radiation Therapy, Catharina Hospital, Eindhoven, The Netherlands
| | - Andra V Krauze
- Radiation Oncology Branch, National Cancer Institute/National Institutes of Health, Bethesda, Maryland
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | - Thomas G Purdie
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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2
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Mayo CS, Feng MU, Brock KK, Kudner R, Balter P, Buchsbaum JC, Caissie A, Covington E, Daugherty EC, Dekker AL, Fuller CD, Hallstrom AL, Hong DS, Hong JC, Kamran SC, Katsoulakis E, Kildea J, Krauze AV, Kruse JJ, McNutt T, Mierzwa M, Moreno A, Palta JR, Popple R, Purdie TG, Richardson S, Sharp GC, Satomi S, Tarbox LR, Venkatesan AM, Witztum A, Woods KE, Yao Y, Farahani K, Aneja S, Gabriel PE, Hadjiiski L, Ruan D, Siewerdsen JH, Bratt S, Casagni M, Chen S, Christodouleas JC, DiDonato A, Hayman J, Kapoor R, Kravitz S, Sebastian S, Von Siebenthal M, Bosch W, Hurkmans C, Yom SS, Xiao Y. Operational Ontology for Oncology (O3): A Professional Society-Based, Multistakeholder, Consensus-Driven Informatics Standard Supporting Clinical and Research Use of Real-World Data From Patients Treated for Cancer. Int J Radiat Oncol Biol Phys 2023; 117:533-550. [PMID: 37244628 PMCID: PMC10741247 DOI: 10.1016/j.ijrobp.2023.05.033] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The ongoing lack of data standardization severely undermines the potential for automated learning from the vast amount of information routinely archived in electronic health records (EHRs), radiation oncology information systems, treatment planning systems, and other cancer care and outcomes databases. We sought to create a standardized ontology for clinical data, social determinants of health, and other radiation oncology concepts and interrelationships. METHODS AND MATERIALS The American Association of Physicists in Medicine's Big Data Science Committee was initiated in July 2019 to explore common ground from the stakeholders' collective experience of issues that typically compromise the formation of large inter- and intra-institutional databases from EHRs. The Big Data Science Committee adopted an iterative, cyclical approach to engaging stakeholders beyond its membership to optimize the integration of diverse perspectives from the community. RESULTS We developed the Operational Ontology for Oncology (O3), which identified 42 key elements, 359 attributes, 144 value sets, and 155 relationships ranked in relative importance of clinical significance, likelihood of availability in EHRs, and the ability to modify routine clinical processes to permit aggregation. Recommendations are provided for best use and development of the O3 to 4 constituencies: device manufacturers, centers of clinical care, researchers, and professional societies. CONCLUSIONS O3 is designed to extend and interoperate with existing global infrastructure and data science standards. The implementation of these recommendations will lower the barriers for aggregation of information that could be used to create large, representative, findable, accessible, interoperable, and reusable data sets to support the scientific objectives of grant programs. The construction of comprehensive "real-world" data sets and application of advanced analytical techniques, including artificial intelligence, holds the potential to revolutionize patient management and improve outcomes by leveraging increased access to information derived from larger, more representative data sets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dan Ruan
- University of California, Los Angeles
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- University of California, San Francisco
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3
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Kim MS, Sheridan M, Rajaraman M, Hollenhorst H, Caissie A, Mahmoud-Ahmed A, Lamond N, Snow S, Corsten M, Mark Taylor S, Trites JR, Rigby MH, Bullock M, Wilke D. The impact of national holidays on postoperative radiotherapy of squamous cell carcinoma of the head and neck. Clin Transl Radiat Oncol 2023; 42:100668. [PMID: 37608964 PMCID: PMC10440354 DOI: 10.1016/j.ctro.2023.100668] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/25/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023] Open
Abstract
Background Delays in starting postoperative radiotherapy (PORT) have been established as negative predictors for clinical outcomes in head and neck squamous cell carcinomas (HNSCC). Our study aimed to examine the effect of delays during PORT, and the impact of national holidays in Canada, a publicly funded system, on oncologic outcomes such as Overall Survival (OS) and Local Recurrence (LR). Methods The provincial cancer registry was queried to obtain demographic, pathologic, and outcomes data from cancer patients treated for all squamous cell carcinomas of the head and neck region treated between January 1, 2007 and November 30, 2019. All extracted information was cross-referenced and supplemented by chart review of patient electronic medical records. Extracted data were analyzed for OS and LR, in the context of Canadian national holidays causing delays during PORT. Results 1433 patients treated for HNSCCs were identified, of whom 338 were treated curatively with surgery followed by PORT. 68.6% of patients experienced at least one day of interruption during treatments due to holidays. LR was 15.4% and OS was 59.6% at 5 years. Treatment interruptions by holidays were predictive of local recurrence (HR, 2.38; 95% CI 1.17-4.83; p = 0.017). Patients that developed early recurrence prior to PORT had very poor oncologic outcomes. Conclusion Our findings were consistent with previously published studies in limiting the interval between surgery and PORT. We identified the novel finding of paired holidays as a significant predictor in determining LR, suggesting the importance of modifying RT delivery schedules and timing.
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Affiliation(s)
- Michael S. Kim
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada
| | - Margaret Sheridan
- Division of Medical Oncology – Department of Medicine, Dalhousie University, Halifax, Canada
| | - Murali Rajaraman
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada
| | - Helmut Hollenhorst
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada
| | - Amanda Caissie
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada
| | - Ashraf Mahmoud-Ahmed
- Department of Radiation Oncology, Cape Breton Cancer Centre, Dalhousie University, Halifax, Canada
| | - Nathan Lamond
- Division of Medical Oncology – Department of Medicine, Dalhousie University, Halifax, Canada
| | - Stephanie Snow
- Division of Medical Oncology – Department of Medicine, Dalhousie University, Halifax, Canada
| | - Martin Corsten
- Division of Otolaryngology – Head and Neck Surgery, Dalhousie University, Halifax, Canada
| | - S. Mark Taylor
- Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jonathan R.B. Trites
- Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Matthew H. Rigby
- Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Martin Bullock
- Department of Pathology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Derek Wilke
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada
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Caissie A, Mierzwa M, Fuller CD, Rajaraman M, Lin A, MacDonald A, Popple R, Xiao Y, VanDijk L, Balter P, Fong H, Xu H, Kovoor M, Lee J, Rao A, Martel M, Thompson R, Merz B, Yao J, Mayo C. Head and Neck Radiation Therapy Patterns of Practice Variability Identified as a Challenge to Real-World Big Data: Results From the Learning from Analysis of Multicentre Big Data Aggregation (LAMBDA) Consortium. Adv Radiat Oncol 2023; 8:100925. [PMID: 36711064 PMCID: PMC9873496 DOI: 10.1016/j.adro.2022.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/24/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose Outside of randomized clinical trials, it is difficult to develop clinically relevant evidence-based recommendations for radiation therapy (RT) practice guidelines owing to lack of comprehensive real-world data. To address this knowledge gap, we formed the Learning from Analysis of Multicenter Big Data Aggregation consortium to cooperatively implement RT data standardization, develop software solutions for data analysis, and recommend clinical practice change based on real-world data analyzed. The first phase of this "Big Data" study aimed at characterizing variability in clinical practice patterns of dosimetric data for organs at risk (OARs) that would undermine subsequent use of large-scale, electronically aggregated data to characterize associations with outcomes. Evidence from this study was used as the basis for practical recommendations to improve data quality. Methods and Materials Dosimetric details of patients with head and neck cancer treated with radiation therapy between 2014 and 2019 were analyzed. Institutional patterns of practice were characterized, including structure nomenclature, volumes, and frequency of contouring. Dose volume histogram (DVH) distributions were characterized and compared with institutional constraints and literature values. Results Plans for 4664 patients treated to a mean plan dose of 64.4 ± 13.2 Gy in 32 ± 4 fractions were aggregated. Before implementation of TG-263 guidelines in each institution, there was variability in OAR nomenclature across institutions and structures. With evidence from this study, we identified a targeted and practical set of recommendations aimed at improving the quality of real-world data. Conclusions Quantifying similarities and differences among institutions for OAR structures and DVH metrics is the launching point for next steps to investigate potential relationships between DVH parameters and patient outcomes.
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Affiliation(s)
| | | | | | | | - Alex Lin
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Helen Fong
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heping Xu
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Arvind Rao
- University of Michigan, Ann Arbor, Michigan
| | | | - Reid Thompson
- University of Oregon Health Sciences Center, Portland, Oregon
| | - Brandon Merz
- University of Oregon Health Sciences Center, Portland, Oregon
| | - John Yao
- University of Michigan, Ann Arbor, Michigan
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Robin G, Brown E, Davis CA, Bird L, Wilson L, Halperin R, Brundage M, Croke J, Harper C, Giuliani M, Caissie A. Patient Engagement: an Assessment of Canadian Radiotherapy Programs' Current Practices, Perceived Barriers, and Facilitators. J Cancer Educ 2022; 37:1834-1841. [PMID: 34518991 DOI: 10.1007/s13187-021-02049-4] [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] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Abstract
Patient engagement and education have been mandated across Canadian radiation oncology programs (ROP). Guidance documents include the 2014 Canadian Association of Radiation Oncology (CARO) Radiation Therapy Patient Charter, the 2016 Canadian Partnership for Quality Radiotherapy (CPQR) Patient Engagement Guidelines (PEG) for Canadian Radiation Treatment Programs, and Accreditation Canada's 2017 refresh of Cancer Care Standards. Since little is known regarding uptake of these guidance statements, Canadian ROP were surveyed to assess current patient engagement and education practices. An e-survey was sent to Canadian ROP (n = 44). The survey focused on awareness and uptake of the CARO Patient Charter, CPQR PEG, and patient education practices. Survey development was guided by these documents and expert consensus, including CARO's Quality and Standards Patient Education/Engagement working group. Many (71%) responding ROP were familiar with the CARO Patient Charter, while 24% reported use. More than half (53%) of ROP were aware of the CPQR PEG, but approximately third (37%) had previously completed a self-audit. Most (88%) ROP view a pan-Canadian, evidence-based approach to educational materials beneficial and feasible (80%), with the majority (89%) willing to share their best practices across the radiotherapy community. Patient engagement and education are nationally mandated and supported by guidance documents. However, gaps have been identified across ROP for awareness and use of available tools, as well as uptake of their processes critical to quality of care. Understanding current practices will inform CPQR/CARO-supported pan-Canadian initiatives to optimize uptake, including development of CPQR Patient Education Guidance for Canadian Radiation Treatment Programs.
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Affiliation(s)
- Gabrielle Robin
- Dalhousie University, Halifax, NB & NS, Canada.
- CARO Quality and Standards Working Group, Markham, ON, Canada.
| | - Erika Brown
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Carol-Anne Davis
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Louise Bird
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Lianne Wilson
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
| | - Ross Halperin
- CARO Quality and Standards Working Group, Markham, ON, Canada
- BC Cancer Agency, Vancouver, BC, Canada
| | - Michael Brundage
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
- Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Jennifer Croke
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Cody Harper
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
| | - Meredith Giuliani
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Amanda Caissie
- Dalhousie University, Halifax, NB & NS, Canada
- CARO Quality and Standards Working Group, Markham, ON, Canada
- Canadian Partnership for Quality Radiotherapy, Halifax, Canada
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McMaster N, Arab M, Ashford T, Chisholm S, Davis CA, Ha M, McKnight R, Rajaraman M, Rodriguez C, Rutledge R, Wilke D, Caissie A. Virtually, Anything is Possible: Implementation of an Electronic Patient Reported Outcome Platform Across A Multi-Center Radiation Oncology Department. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Malik NH, Li GJ, Giuliani M, Brundage M, Caissie A, Cao JQ, Halperin R, Ingledew PA, Vigneault E, Bezjak A. Mapping the Current State of Canadian Medical School Oncology Interest Groups. J Cancer Educ 2022; 37:203-209. [PMID: 32594313 DOI: 10.1007/s13187-020-01803-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/13/2023]
Abstract
Cancer is the leading cause of mortality in Canada. Undergraduate medical education therefore must ensure adequate oncology education for all physicians and inspire some to make oncology their career specialty, in an effort to ensure public care needs are met in the future. Medical student-led oncology interest groups (OIGs) are a subset of specialty interest groups that supplement formal didactic and clinical learning to increase exposure to oncology and access to mentors. We conducted a survey of OIG leaders to ascertain their goals, activities, barriers, future directions, and perceptions about employment prospects. OIG leaders from 12/17 Canadian medical schools responded. Medical oncology was the most represented specialty in OIGs. Half of OIGs had faculty mentors. Self-reported goals were to increase exposure to oncology disciplines (n = 12), assist students with career selection (n = 11) and finding mentors (n = 7), and enhance oncology education (n = 10). OIGs held on average 5 events per year (range 1-12). Reported barriers were finding time to plan events, declining student interest over academic year, and limited funding. Many OIGs showed interest in more standardized resources about oncology disciplines (n = 9), access to presentations (n = 10), more funding (n = 7), and collaboration (n = 7). Employment in many oncology specialties was perceived poorly, and the most important career selection considerations were ease of employment, practice location, and partner/family preference. Our survey highlights common goals, barriers, and perceptions in OIG medical student leaders across Canada and provides guidance for future interventions.
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Affiliation(s)
- Nauman H Malik
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - George J Li
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Brundage
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, NB, Canada
| | - Jeffrey Q Cao
- Department of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Ross Halperin
- BC Cancer - Centre for the Southern Interior, Kelowna, BC, Canada
| | - Paris-Ann Ingledew
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, BC, Canada
| | - Eric Vigneault
- Cancer Research Centre, University of Laval, QC, Québec, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Sherwood M, Rioux D, Knight R, LeBlanc M, Betsch T, Giuliani M, Caissie A. Increasing Undergraduate Exposure to Oncology: the Role of Oncology Interest Groups. J Cancer Educ 2020; 35:997-1001. [PMID: 31165422 DOI: 10.1007/s13187-019-01554-x] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study describes a medical school oncology interest group (OIG) and assesses its influence on student perceptions of oncology, interest in pursuing oncology as a career, and comfort levels with oncology topics such as breaking bad news. From 2015 to 2017, the OIG annual event took place at a satellite campus of a larger Canadian undergraduate medical school. The event provided a question and answer period with a panel of physicians from multiple oncology specialties-discussions focused around lifestyle, training, clinical work, lifestyle, and career focus. Small physician-led groups taught breaking bad news using the SPIKES framework. The interest group also provided a mentoring and networking opportunity to interested students. Pre- and post-event surveys were distributed to students and physicians. For three consecutive years, the student-run, and physician-mentored OIG successfully recruited student and physician participants, providing a clinical skill teaching session as well as mentorship opportunities to students. Pre-event surveys found that only 20% of students believed their current curriculum was adequate as it relates to oncology education. In pre-session, 13% (6/45) of students indicated comfort with the skill of breaking bad news, compared with that in post-session with 81% (34/42) of students feeling comfortable. When asked "How likely are you to pursue a future elective opportunity in oncology?" 49% (20/41) of students indicated "likely" as their response in the pre-session. This response increased post-session to 70% (28/40). The event highlighted the potential for OIGs to increase student interest in pursuing oncology electives and student-perceived comfort with breaking bad news. OIGs are important in promoting interest in the field of oncology and in improving confidence in breaking bad news. This medical student-created, run and maintained oncology interest group supplemented standard curriculum by providing relevant educational and mentorship opportunities to students. This study highlights the feasibility of implementing a self-sustaining medical school oncology interest group and its potential to positively impact student learning and interest in oncology.
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Affiliation(s)
| | - Danielle Rioux
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | | | - Max LeBlanc
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Taylor Betsch
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, NB, Canada
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Li GJ, Malik NH, Giuliani M, Brundage M, Caissie A, Cao JQ, Halperin R, Ingledew PA, Vigneault E, Bezjak A. 163: Mapping The Current State of Canadian Oncology Interest Groups. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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McGuffin M, Liszewski B, Caissie A, Brown E, Wilson L, Bird L, Milosevic M. 186: A Pan-Canadian Approach to Patient-Centered Quality Improvement Initiatives: Development and Promotion of Patient Education, Engagement and Patient Reported Outcome Guidance Documents. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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O’Donnell J, Barbera L, Olson R, Brown E, Bird L, Caissie A, Croke J, Davis CA, Milosevic M, Brundage M. 144: A Pan-Canadian Approach to Supporting The Collection and Utilization of Patient Reported Outcomes in Radiation Oncology: An Initiative of the Canadian Partnership for Quality Radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Caissie A, Mierzwa M, Fuller C, Rajaraman M, Lin A, MacDonald A, Popple R, Xiao Y, VanDijk L, Balter P, Fong H, Ping H, Lee J, Rao A, Martel M, Thompson R, Yao J, Mayo C. 183: Head and Neck Radiotherapy (RT) Patterns of Practice Variability Identified as a Challenge to Real-World Big Data: Recommendations from the Learning from Analysis of Multicentre Big Data Aggregation (Lambda) Consortium. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Dosani M, Giuliani M, Golden DW, Jimenez R, Hirsch AE, Caissie A, Malik N, Kong T, Nguyen TK, Ingledew PA. 42: Factors That Promote Medical Student Interest in Radiation Oncology: A Survey of Canadian Radiation Oncology Residents. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30934-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Reiman TJ, Thompson R, Naz F, Michael JCR, Scheme E, Phinyomark A, Galvis L, Daigle-Maloney T, Caissie A, Ojah J, Salem M, Campbell HA, Brooks E, Graham S, Purves C, Beydaghyan G, Abdelsalam M. Analysis of exhaled breath of lung cancer patients using infrared spectroscopy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21037] [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: 11/20/2022] Open
Abstract
e21037 Background: Currently low-dose computed tomography is used for lung cancer (LC) screening, but is limited by radiation exposure, cost, and a high false detection rate (1,2). An accurate, accessible and affordable screening technology is needed to improve detection of LC in high risk individuals. Methods: We conducted an unblinded, prospective cohort study on the effectiveness of a novel technology utilizing infrared absorption measurements via cavity ringdown spectroscopy (IR-CRDS) to differentiate the expired breath of treatment-naïve LC patients from controls without known cancer. Breath samples were taken from 100 LC patients and 98 control subjects but, only 62 non-small cell lung cancer (NSCLC) and 96 control samples were analyzed. Patients on treatment were eligible but, the protocol was amended to exclude these due to signal ambiguities. Samples were also excluded due to missing data, unclear histologic subtypes, or if they were classified as small cell LC samples to prevent obscuring the NSCLC signal. A piecewise cubic spline interpolation was used for the spectra with missing values (3). After first- and second-derivative spectra were computed to increase the information density, a one-dimensional local binary pattern extracted features from the spectra (4). Meaningful spectra-based features were selected using a minimum redundancy maximum relevance algorithm (5). Finally, a classification model was built using a support vector machine classifier (3). Results: The table below characterizes each cohort. The discriminant analysis differentiated between NSCLC and control cases with a cross validation accuracy of 86.1% (89.6% sensitivity and 80.7% specificity) using 20 selected spectra-based features. Conclusions: IR absorption measurements can be used to accurately discriminate between NSCLC and control participants. We continue to build our database to support more robust machine learning models. To our knowledge, this is the first time IR-CRDS has been used to differentiate between NSCLC and control cases. [Table: see text]
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Affiliation(s)
| | | | - Farah Naz
- Horizon Health Network–Saint John Regional Hospital, Saint John, NB, Canada
| | | | - Erik Scheme
- University of New Brunswick, Fredericton, NB, Canada
| | | | | | | | | | | | | | | | - Erin Brooks
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
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Kang S, Caissie A, Kassam Z, Ingledew PA, Alfieri J, Parliament M, Bezjak A, Giuliani M. Promoting Career Selection Through a Comprehensive Enrichment Experience: A Review of the Canadian Radiation Oncology Summer Studentship. Int J Radiat Oncol Biol Phys 2020; 107:27-32. [PMID: 31987964 DOI: 10.1016/j.ijrobp.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE The impact that early clinical exposure to radiation oncology has on medical students' understanding of oncology and career choice is understudied. This study aims to review the experience and outcomes of medical students who participated in the Canadian Association of Radiation Oncology-Canadian Radiation Oncology Foundation 6-week summer studentship. METHODS AND MATERIALS Medical students who participated in the nationally funded studentship from 2014 to 2018 were asked to fill out a survey after completing the program. The survey asked about student experience related to radiation oncology before the studentship, student satisfaction with the studentship (scale of 1-5; 5 = outstanding, 3 = meets expectations, 1 = unsatisfactory), and student willingness to recommend it to other students (scale of 1-10; 1 = strongly disagree, 5 = neutral, 10 = strongly agree). The effect of studentship on interest in the specialty was assessed (scale of 1-10; 1 = strongly disagree, 5 = neutral, 10 = strongly agree), including intent to direct their career toward radiation oncology. Match rates to radiation oncology residency are reported for students who participated in the studentship from 2013 to 2016. RESULTS All 31 students responded to the survey. Overall, the program was highly rated: inclusion of a broad range of clinical problems (mean = 4.6/5); opportunity to learn assessment, investigation, and management (mean = 4.2/5); and overall educational value (mean = 4.8/5). Poststudentship, most students reported an increased interest in oncology (76%, n = 22/29), and specifically radiation oncology (83%, n = 24/29). They would highly recommend this program to another medical student (mean = 9.8/10). The average percentage of these students entering a radiation oncology career (30.5%) each year was higher than national residency match rates in radiation oncology (0.7%). CONCLUSIONS Clinical exposure to radiation oncology through a nationally funded Canadian Association of Radiation Oncology-Canadian Radiation Oncology Foundation summer studentship positively affected medical student interest in oncology. This study suggests a potential effect of the studentship program on career selection of radiation oncology.
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Affiliation(s)
- Stella Kang
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, New Brunswick, Canada
| | - Zahra Kassam
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Stronach Regional Cancer Centre, Newmarket, Ontario, Canada
| | - Paris-Ann Ingledew
- Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Alfieri
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Matthew Parliament
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Ontario and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Ontario and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Caissie A, Rajaraman M, Popple R, Martel M, Fuller CD, Balter P, Mierzwa M, Lin A, Xiao Y, McDonald A, Fong H, Xu H, Mayo C, Cherpak A, Yao J. 38 Early Dosimetric Findings from the Learning from Analysis of Multicentre Big Data Aggregation (LAMBDA) Consortium. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Robin G, Brown E, Davis CA, Bird L, Wilson L, Halperin R, Brundage M, Croke J, Caissie A. 67 Patient Engagement: A Pan-Canadian Survey of Radiotherapy Centres’ Current Practices. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Grady S, Hudson A, Mitera G, McLeod K, Caissie A. 222 A Single Centre’s Review of Emergent and Urgent Palliative Radiotherapy: Are We Compliant with Provincial Policy? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brown E, O’Donnell J, Barbera L, Bird L, Caissie A, Davis CA, Kildea J, Milosevic M, Olson R, Brundage M. 212 Patient Reported Outcomes Used in Radiation Programs Across Canada. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33274-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Liszewski B, Brown E, Caissie A. 43 Using Community Consultation to Maintain Relevance and Promote Uptake of the Quality Assurance Guidelines for Canadian Radiation Treatment Programs: A Quality Improvement Process. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)33330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Matuszak MM, Fuller CD, Yock TI, Hess CB, McNutt T, Jolly S, Gabriel P, Mayo CS, Thor M, Caissie A, Rao A, Owen D, Smith W, Palta J, Kapoor R, Hayman J, Waddle M, Rosenstein B, Miller R, Choi S, Moreno A, Herman J, Feng M. Performance/outcomes data and physician process challenges for practical big data efforts in radiation oncology. Med Phys 2018; 45:e811-e819. [PMID: 30229946 DOI: 10.1002/mp.13136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/09/2018] [Revised: 07/20/2018] [Accepted: 08/08/2018] [Indexed: 11/11/2022] Open
Abstract
It is an exciting time for big data efforts in radiation oncology. The use of big data to help aid both outcomes and decision-making research is becoming a reality. However, there are true challenges that exist in the space of gathering and utilizing performance and outcomes data. Here, we summarize the current state of big data in radiation oncology with respect to outcomes and discuss some of the efforts and challenges in radiation oncology big data.
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Affiliation(s)
| | | | | | | | - Todd McNutt
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Maria Thor
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Arvind Rao
- University of Michigan, Ann Arbor, MI, USA
| | - Dawn Owen
- University of Michigan, Ann Arbor, MI, USA
| | - Wade Smith
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Amy Moreno
- MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mary Feng
- University of California at San Francisco, San Francisco, CA, USA
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Caissie A, Brown E, Olson R, Barbera L, Davis CA, Brundage M, Milosevic M. Improving patient outcomes and radiotherapy systems: A pan-Canadian approach to patient-reported outcome use. Med Phys 2018; 45:e841-e844. [DOI: 10.1002/mp.12878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Amanda Caissie
- Department of Radiation Oncology; Dalhousie University; Saint John New Brunswick E2L-4L4 Canada
| | - Erika Brown
- Canadian Partnership for Quality Radiotherapy; Red Deer Alberta T4R0C1 Canada
| | - Rob Olson
- Department of Radiation Oncology; University of British Columbia; Prince George British Columbia V2M-7E9 Canada
| | - Lisa Barbera
- Department of Radiation Oncology; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario M4N-3M5 Canada
| | - Carol-Anne Davis
- Department of Radiation Oncology; Dalhousie University; Halifax Nova Scotia B3H-4R2 Canada
| | - Michael Brundage
- Department of Radiation Oncology; Queen's University; Kingston Ontario K7L-5P9 Canada
| | - Michael Milosevic
- Department of Radiation Oncology; Princess Margaret Cancer Centre; University of Toronto; Toronto Ontario M5G-2M9 Canada
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Rouette J, Gutierrez E, O'Donnell J, Reddeman L, Hart M, Foxcroft S, Mitera G, Warde P, Brundage MD, Czarnota G, El-Mallah M, Falkson C, Liu FF, Gulavita S, McMillan W, Pantarotto J, Rachakonda R, Read N, Schneider K, Shehata S, Stevens C, Tsao J, Waldron J, Wells W, Wright J, Warde P, Sharpe M, Lockhart E, Brundage M, Hart M, Caissie A, Hollenhorst H, Wilson L, Parliament M, Milosevic M, Warde P, Halperin R, Foxcroft S, Ebacher A, McGowan T. Directly Improving the Quality of Radiation Treatment Through Peer Review: A Cross-sectional Analysis of Cancer Centers Across a Provincial Cancer Program. Int J Radiat Oncol Biol Phys 2017; 98:521-529. [DOI: 10.1016/j.ijrobp.2016.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
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Adleman J, Gillan C, Caissie A, Davis CA, Liszewski B, McNiven A, Giuliani M. Development of a Quality and Safety Competency Curriculum for Radiation Oncology Residency: An International Delphi Study. Int J Radiat Oncol Biol Phys 2017; 98:428-437. [DOI: 10.1016/j.ijrobp.2016.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/13/2016] [Accepted: 11/19/2016] [Indexed: 12/20/2022]
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Adleman J, Gillan C, Caissie A, Davis CA, Liszewski B, McNiven A, Giuliani M. 56: Development of a Quality and Safety Competency Curriculum for Radiation Oncology Residency: An International Delphi Study. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Caissie A, Brown E, Bissonnette JP, Tyldesley S, Brundage M, Milosevic M. 176: Measuring Uptake of the Canadian Partnership for Quality Radiotherapy (CPQR) Programmatic Key Quality Indicators (KQI): A Pan-Canadian Audit of Compliance. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Caissie A, Rouette J, Jugpal P, Davis CA, Hollenhorst H, O'Donnell J, Mitera G, Brundage MD. A pan-Canadian survey of peer review practices in radiation oncology. Pract Radiat Oncol 2016; 6:342-351. [PMID: 27025163 DOI: 10.1016/j.prro.2016.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Peer review (PR) of treatment plans has been recognized internationally as a key component of quality care in radiation oncology programs (ROPs). We conducted a survey of Canadian ROPs to describe current PR practices and identify barriers/facilitators to PR optimization. METHODS AND MATERIALS A 42-item e-survey was sent to all Canadian ROPs (n = 44). Survey development was guided by expert consensus, literature review, and existing guidelines. One multidisciplinary response per ROP was requested. RESULTS Response rate was 100.0% (44/44). All ROPs (100.0%) reported conducting some PR and rated its importance as 7/10 or higher (10 = extremely important). One-half of ROPs (52.3%) peer-reviewed >80% of curative treatment plans. ROPs reported performing PR "always/almost always" pretreatment (38.6%) or before 25% of radiation therapy delivery (52.3%). The majority of ROPs reported recommending major plan changes in <5% of plans (88.6%) and documenting findings in the medical record (58.1%). Barriers to PR were radiation oncologist availability (34.1%) and time constraints (27.3%). Facilitators included development of PR standards (97.7%) and education/support (90.9%). CONCLUSIONS The ROPs perceive PR as highly important, but substantial variation in the extent, timing, and documentation of PR exists. The understanding of current PR activities, barriers, and facilitators will inform the development of initiatives to optimize PR in radiation oncology.
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Affiliation(s)
- Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, NB, Canada
| | - Julie Rouette
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Paul Jugpal
- Radiation Therapy Services, Nova Scotia Cancer Center, Halifax, NS, Canada; Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Carol-Anne Davis
- Radiation Therapy Services, Nova Scotia Cancer Center, Halifax, NS, Canada; Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Helmut Hollenhorst
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Jennifer O'Donnell
- Radiation Therapy Services, Nova Scotia Cancer Center, Halifax, NS, Canada
| | - Gunita Mitera
- Canadian Partnership Against Cancer, Toronto, Canada; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Michael D Brundage
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada.
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Leung A, Lien K, Zeng L, Nguyen J, Caissie A, Culleton S, Holden L, Chow E. The EORTC QLQ-BN20 for assessment of quality of life in patients receiving treatment or prophylaxis for brain metastases: a literature review. Expert Rev Pharmacoecon Outcomes Res 2014; 11:693-700. [DOI: 10.1586/erp.11.66] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lien K, Zeng L, Nguyen J, Cramarossa G, Culleton S, Caissie A, Lutz S, Chow E. Comparison of the EORTC QLQ-C15-PAL and the FACIT-Pal for assessment of quality of life in patients with advanced cancer. Expert Rev Pharmacoecon Outcomes Res 2014; 11:541-7. [DOI: 10.1586/erp.11.64] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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31
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Nguyen J, Caissie A, Zhang L, Zeng L, Dennis K, Holden L, Jon F, Tsao M, Danjoux C, Barnes E, Sahgal A, DeAngelis C, Chow E. Dexamethasone toxicity and quality of life in patients with brain metastases following palliative whole-brain radiotherapy. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0019-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lien K, Zeng L, Nguyen J, Cramarossa G, Cella D, Chang E, Caissie A, Holden L, Culleton S, Sahgal A, Chow E. FACT-Br for assessment of quality of life in patients receiving treatment for brain metastases: a literature review. Expert Rev Pharmacoecon Outcomes Res 2012; 11:701-8. [PMID: 22098286 DOI: 10.1586/erp.11.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Brain metastases are a significant cause of morbidity and mortality for patients with advanced cancers, and quality-of-life (QoL) end points are most appropriate for this population. The Functional Assessment of Cancer Therapy (FACT) questionnaires are commonly used to assess cancer-related QoL issues. The FACT-Brain (FACT-Br) provides an additional set of disease-specific questions pertaining to brain neoplasms. We aim to provide a comprehensive review to examine the use of the FACT-Br as a QoL assessment for patients with brain metastases. MATERIALS & METHODS A review of the literature was conducted and all studies utilizing the FACT-Br for QoL assessment of patients with brain metastases were included. Study information and relevant information regarding the FACT-Br were extracted. RESULTS A total of 14 studies were identified representing various treatment options (radiation, chemotherapy and surgery) for patients with brain metastases. All studies utilized at least part of the FACT-Br as the main QoL assessment. In addition, neurocognitive and performance status assessments were performed in nine and 12 out of 14 studies, respectively. Issues of poor accrual, compliance and attrition were common and posed problems in reaching statistically significant changes in QoL despite changes in raw QoL scores. CONCLUSION Studies involving patients with brain metastases should continue to utilize QoL tools such as the FACT-Br; however, this tool still requires validation for use in this patient population. Additional studies should observe the relationship between neurocognitive function and QoL, and attempt to minimize poor accrual and compliance issues through modifications of trial design and reduction of patient burden.
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Affiliation(s)
- Karen Lien
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Caissie A, Nguyen J, Chen E, Zhang L, Sahgal A, Clemons M, Kerba M, Arnalot PF, Danjoux C, Tsao M, Barnes E, Holden L, Danielson B, Chow E. Quality of life in patients with brain metastases using the EORTC QLQ-BN20+2 and QLQ-C15-PAL. Int J Radiat Oncol Biol Phys 2011; 83:1238-45. [PMID: 22172909 DOI: 10.1016/j.ijrobp.2011.09.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/19/2011] [Accepted: 09/12/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The 20-item European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm (QLQ-BN20) is a validated quality-of-life (QOL) questionnaire for patients with primary brain tumors. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15 Palliative (QLQ-C15-PAL) core palliative questionnaire is a 15-item version of the core 30-item QLQ-C30 and was developed to decrease the burden on patients with advanced cancer. The combination of the QLQ-BN20 and QLQ-C30 to assess QOL may be too burdensome for patients. The primary aim of this study was to assess QOL in patients before and after treatment for brain metastases using the QLQ-BN20+2 and QLQ-C15-PAL, a version of the QLQ-BN20 questionnaire with 2 additional questions assessing cognitive functioning that were not addressed in the QLQ-C15-PAL. METHODS AND MATERIALS Patients with brain metastases completed the QLQ-C15-PAL and QLQ-BN20+2 questionnaires to assess QOL before and 1 month after radiation. Linear regression analysis was used to assess changes in QOL scores over time, as well as to explore associations between the QLQ-BN20+2 and QLQ-C15-PAL scales, patient demographics, and clinical variables. Spearman correlation assessed associations between the QLQ-BN20+2 and QLQ-C15-PAL scales. RESULTS Among 108 patients, the majority (55%) received whole-brain radiotherapy only, with 65% of patients completing follow-up at 1 month after treatment. The most prominent symptoms at baseline were future uncertainty (QLQ-BN20+2) and fatigue (QLQ-C15-PAL). After treatment, significant improvement was seen for the QLQ-C15-PAL insomnia scale, as well as the QLQ-BN20+2 scales of future uncertainty, visual disorder, and concentration difficulty. Baseline Karnofsky Performance Status was negatively correlated to QLQ-BN20+2 motor dysfunction but positively related to QLQ-C15-PAL physical functioning and QLQ-BN20+2 cognitive functioning at baseline and follow-up. QLQ-BN20+2 scales of future uncertainty and motor dysfunction correlated with the most QLQ-C15-PAL scales, including overall QOL (negative association) at baseline and follow-up. CONCLUSION After radiation, the questionnaires showed maintenance of QOL and improvement of QOL scores such as future uncertainty, which featured prominently in this patient population. It is proposed that the 37-item QLQ-BN20+2 and QLQ-C15-PAL, as opposed to the 50-item QLQ-BN20 and QLQ-C30, may be used together as a universal QOL assessment tool in this setting.
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Affiliation(s)
- Amanda Caissie
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Koo K, Zeng L, Chen E, Zhang L, Culleton S, Dennis K, Caissie A, Nguyen J, Holden L, Jon F, Tsao M, Barnes E, Danjoux C, Sahgal A, Chow E. Do elderly patients with metastatic cancer have worse quality of life scores? Support Care Cancer 2011; 20:2121-7. [PMID: 22081058 DOI: 10.1007/s00520-011-1322-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/01/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to compare self-reported quality of life (QOL) scores in old and young patients with metastatic cancer using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire. MATERIALS AND METHODS Patients receiving palliative radiotherapy (RT) for bone metastases and brain metastases completed the QLQ-C15-PAL questionnaire prior to treatment. Using multiple linear regression analysis, a parametric test, the QLQ-C15-PAL scores were compared using 65 and 70 years as cutoff ages. RESULTS A total of 340 patients were referred for palliative RT for bone metastases (n = 190) or brain metastases (n = 150). Physical functioning and appetite were worse in the older group using either 65 or 70 years as the cutoff age. Age-related differences in the QLQ-C15-PAL scores varied as a function of age cutoff used and location of metastatic site irradiated. CONCLUSION Based on the (EORTC) QLQ-C15-PAL, elderly advanced cancer patients have a different QOL profile. Similar observations have been reported with the (EORTC) QLQ-C30 questionnaire.
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Affiliation(s)
- Kaitlin Koo
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Caissie A, Zeng L, Nguyen J, Zhang L, Jon F, Dennis K, Holden L, Culleton S, Koo K, Tsao M, Barnes E, Danjoux C, Sahgal A, Simmons C, Chow E. Assessment of health-related quality of life with the European Organization for Research and Treatment of Cancer QLQ-C15-PAL after palliative radiotherapy of bone metastases. Clin Oncol (R Coll Radiol) 2011; 24:125-33. [PMID: 21917431 DOI: 10.1016/j.clon.2011.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 07/08/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
Abstract
AIMS To assess health-related quality of life (HRQOL) after palliative radiotherapy for painful bone metastases using a palliative questionnaire (European Organization for Research and Treatment of Cancer QLQ-C15-PAL). MATERIALS AND METHODS Patients scheduled to receive palliative radiotherapy for painful bone metastases (n=178) completed the QLQ-C15-PAL questionnaire before treatment and at week 1, week 2, month 1 and month 2 after the first day of radiotherapy. A partial response (PR) or a complete response (CR) to radiotherapy was defined according to the International Consensus criteria. General linear regression was used to analyse changes in QOL in the entire cohort and within responders and non-responders to radiotherapy at all follow-up periods. RESULTS The overall radiotherapy response was 45% at week 1 (n=21) (41% PR, 4% CR), 62% at week 2 (n=28) (58% PR, 4% CR), 62% at month 1 (n=58) (60% PR, 2% CR) and 65% at month 2 (n=38) (60% PR, 5% CR). In general, a significant decrease in pain (P<0.0001), insomnia (P<0.0001) and constipation (P=0.004) was seen by month 1 after radiotherapy. In patients who responded to radiotherapy, overall QOL significantly improved by month 2 after radiotherapy (P=0.002). Radiotherapy responders also reported an improvement in emotional functioning together with a decrease in symptoms such as insomnia and constipation at month 1. No improvements were seen in any of the QLQ-C15-PAL scores for patients whose pain did not respond to radiotherapy. CONCLUSION Radiotherapy responders showed not only an improvement in pain, but also in HRQOL as assessed by QLQ-C15-PAL. As early as 1 week after radiotherapy for bone metastases, a pain relief response was reported by patients.
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Affiliation(s)
- A Caissie
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Ontario, Canada
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Caissie A, Culleton S, Nguyen J, Zhang L, Zeng L, Holden L, Dennis K, Chan E, Jon F, Tsao M, Danjoux C, Sahgal A, Barnes E, Koo K, Chow E. What QLQ-C15-PAL Symptoms Matter Most for Overall Quality of Life in Patients With Advanced Cancer? World J Oncol 2011; 2:166-174. [PMID: 29147243 PMCID: PMC5649654 DOI: 10.4021/wjon330w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2011] [Indexed: 11/29/2022] Open
Abstract
Background Few studies have evaluated the QLQ-C15-PAL health-related quality of life (QOL) questionnaire, an abbreviated version of the QLQ-C30 questionnaire that was designed specifically for patients with advanced cancer. The present study assessed whether certain symptoms or functional domains from the QLQ-C15-PAL predicted overall QOL when rated prior to palliative radiation treatment (RT). Patients and Methods Patients attending an outpatient palliative radiotherapy clinic completed QLQ-C15-PAL questionnaires prior to palliative RT for bone, brain or lung disease. Pearson correlations were computed between the QLQ-C15-PAL functional/symptom scores and overall QOL scores. Multiple linear regressions were used to evaluate the relative importance of functional/symptom scales in association with overall QOL. Results Data from 369 patients were analyzed. The QLQ-C15-PAL domains of physical and emotional functioning, pain, and appetite loss were significant predictors of overall QOL in these patients with advanced cancer. Appetite loss was the only significant independent predictor of overall QOL in the subgroup of patients with advanced lung cancer (n = 29). Both appetite loss and emotional functioning were independently predictive of overall QOL in patients with bone metastases (n = 190). In patients with brain metastases (n = 150), independent predictors of overall QOL included physical and emotional functioning as well as fatigue. Conclusion The QLQ-C15-PAL domains of physical and emotional functioning, pain and appetite loss were significant predictors of overall QOL in this cohort of patients with advanced cancer. Different functional and symptom scales predicted overall QOL in patients with bone metastases, brain metastases or advanced lung cancer.
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Affiliation(s)
- Amanda Caissie
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shaelyn Culleton
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Janet Nguyen
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lori Holden
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kristopher Dennis
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Esther Chan
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Florencia Jon
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - May Tsao
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Danjoux
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Barnes
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin Koo
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Caissie A, Culleton S, Nguyen J, Zhang L, Zeng L, Holden L, Dennis K, Chan E, Jon F, Tsao M, Danjoux C, Sahgal A, Barnes E, Koo K, Chow E. EORTC QLQ-C15-PAL quality of life scores in patients with advanced cancer referred for palliative radiotherapy. Support Care Cancer 2011; 20:841-8. [DOI: 10.1007/s00520-011-1160-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 04/04/2011] [Indexed: 11/29/2022]
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Koo K, Zeng L, Jon F, Chen E, Dennis K, Holden L, Zhang L, Caissie A, Nguyen J, Tsao M, Barnes E, Danjoux C, Sahgal A, Chow E. Quality of Life in Patients Treated with Palliative Radiotherapy for Advanced Lung Cancer and Lung Metastases. World J Oncol 2011; 2:70-75. [PMID: 29147227 PMCID: PMC5649705 DOI: 10.4021/wjon288w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2011] [Indexed: 12/26/2022] Open
Abstract
Background The purpose of this study was to investigate quality of life (QOL) in patients receiving palliative radiotherapy (RT) for advanced lung cancer/lung metastases using the EORTC QLQ-LC13 and the EORTC QLQ-C15-PAL questionnaires. Methods Patients who received palliative RT for lung metastases or advanced lung cancer between November 2007 and October 2010 completed the EORTC QLQ-LC13 and the QLQ-C15-PAL at baseline prior to RT, 1, 2, 4, 8 and 12 weeks post-treatment. The Wilcoxon Signed Rank test was used to compare QOL scores between baseline and each follow-up period. Results Thirty-one patients with advanced lung disease were included in this study; 61% of participants were male and 39% were female. The median age was 69 years (range 38 - 85), and median KPS and PPS scores at baseline were both 70 (range 30 - 90). All patients received radiotherapy to the lung. None of the QLQ-LC13 scores significantly improved or deteriorated at any follow-up. Of the QLQ-C15-PAL scales, fatigue, pain, insomnia and physical functioning significantly improved at their respective follow-ups. Conclusions This was the first study to use the EORTC QLQ-LC13 in conjunction with the EORTC QLQ-C15-PAL questionnaires. Future studies should continue to incorporate quality of life assessment tools specific to disease characteristics in advanced cancer patients.
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Affiliation(s)
- Kaitlin Koo
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Florencia Jon
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Emily Chen
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kristopher Dennis
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Lori Holden
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Caissie
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Janet Nguyen
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - May Tsao
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Barnes
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Danjoux
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Dennis K, Zhang L, Holden L, Jon F, Barnes E, Tsao M, Danjoux C, Sahgal A, Zeng L, Koo K, Khan L, Caissie A, Chow E. Functional Interference due to Pain Following Palliative Radiotherapy for Bone Metastases Among Patients in Their Last Three Months of Life. World J Oncol 2011; 2:47-52. [PMID: 29147225 PMCID: PMC5649702 DOI: 10.4021/wjon290w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2011] [Indexed: 11/28/2022] Open
Abstract
Background To compare the self-reported ratings of functional interference caused by pain between patients who did and did not respond to palliative radiotherapy for bone metastases during their last three months of life. Methods A prospectively gathered Brief Pain Inventory (BPI) database compiled from patients receiving palliative radiotherapy for painful bone metastases was reviewed. Demographic and clinical data, pain response rates and self-reported ratings of functional interference caused by pain were analyzed for those patients who died within three months of beginning radiotherapy. Results From 400 patients in the database, 83 died within 3 months of beginning radiotherapy. There were 54 male and 29 female patients. Their median age was 69 years and their median KPS was 70. The three most common primary cancers were lung (40%), gastrointestinal (16%) and breast (14%). For patients with available follow-up information the 1-month overall pain response rate was 78% and the 2-month rate was 83%, which include both complete and partial responses as defined by the International Bone Metastases Consensus. At 1 month, patients responding to treatment reported significantly less interference by pain on their general activity, walking ability, normal work, sleeping, and enjoyment of life than did patients not responding to treatment. Conclusions Patients that responded to treatment reported less functional interference due to pain than did patients who did not respond. Despite being very near the end of life, patients responding to palliative radiotherapy for painful bone metastases may benefit from more than pain relief alone.
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Affiliation(s)
- Kristopher Dennis
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Lori Holden
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Florencia Jon
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Barnes
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - May Tsao
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Cyril Danjoux
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Liang Zeng
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin Koo
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Luluel Khan
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Caissie
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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Caissie A, Le LW, Zimmermann C. Timeliness of code status documentation in terminally ill cancer patients admitted to a general oncology ward. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Caissie A, Al-Mahrouki A, Furukawa M, Karshafian R, Giles A, Lee J, Li YQ, Wong S, Czarnota G. 39 IN VITRO AND IN VIVO VASCULAR EFFECTS OF NOVEL RADIOSENSITIZING ULTRASOUND-ACTIVATED MICROBUBBLES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lee J, Karshafian R, Banihashemi B, Caissie A, Giles A, Burns P, Czarnota G. Novel Enhancement of Cancer Responses to Radiation utilizing Ultrasound-activated Microbubbles: Histopathological-treatment Outcomes. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mahmud A, Brundage M, Caissie A, Tonita J, Chalchal H. 218 Prognostic expectations for patients with glioblastoma multiforme in a population-based cohort. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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