scholarly journals Do sustainable palliative single fraction radiotherapy practices proliferate or perish 2 years after a knowledge translation campaign?

2021 ◽  
Author(s):  
Shaheer Shahhat ◽  
Nikesh Hanumanthappa ◽  
Youn Tae Chung ◽  
James Beck ◽  
Rashmi Koul ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Bone Metastases ◽  
Palliative Radiotherapy ◽  
Population Based ◽  
Time Dependent ◽  
Short Term ◽  
Single Fraction ◽  
Factors Associated ◽  
Fractionation Schedule ◽  
Baseline Characteristics

Abstract BACKGROUND There is a paucity of data regarding the time-dependent effects of knowledge translation (KT) campaign derived Radiation Oncologist (RO) prescription behaviour. In early 2017, the XXXX and XXXX undertook a comprehensive KT campaign to improve utilization of single fraction radiotherapy (SFRT) over multiple fraction radiotherapy (MFRT) in accordance with clinical guidelines for palliative management of bone metastases. The campaign significantly increased short-term SFRT utilization. We assess the time-dependent effects of KT-derived SFRT utilization 12-24 months removed from the KT campaign in a Canadian Provincial Cancer Program. METHODS This retrospective, population-based cohort study identified all patients receiving palliative radiotherapy for bone metastases in XXXX from 1 Jan 2018 to 31 Dec 2018 using provincial radiotherapy databases. Baseline characteristics were tabulated by fractionation schedule. The proportion of patients treated with SFRT in 2018 was compared to 2017 levels overall and by prescribing RO. Logistic regression analyses identified risk factors associated with MFRT receipt. RESULTS In 2018, 1,008 patients received palliative radiotherapy for bone metastasis, of which 63.3% received SFRT, a small overall increase in SFRT use over 2017 (59.1%). However, 41.1% of ROs demonstrated year-over-year decreases in SFRT utilization, indicative of a time-dependent loss of SFRT prescription habits derived from KT. CONCLUSION Although SFRT use increased slightly overall in 2018, evidence of compliance fatigue was observed suggestive of a time-perishing property of RO prescription behaviours derived from KT methodologies. These findings highlight the need for additional longitudinal KT reinforcement practices in the years following KT campaigns.

scholarly journals Does Dissemination of Guidelines Alone Increase the Use of Palliative Single-Fraction Radiotherapy? Initial Report of a Longitudinal Change Management Campaign at a Provincial Cancer Program

2020 ◽  
Vol 27 (4) ◽  
pp. 190-197 ◽  
Author(s):  
J.O. Kim ◽  
N. Hanumanthappa ◽  
Y.T. Chung ◽  
J. Beck ◽  
R. Koul ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Multivariable Analysis ◽  
Sustainable Use ◽  
Palliative Radiotherapy ◽  
Longitudinal Change ◽  
Patient Treatment ◽  
Initial Report ◽  
Single Fraction ◽  
Factors Associated ◽  
Fractionation Schedule

Background: Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (SFRT) and multiple-fraction radiotherapy (MFRT) for the palliation of painful bone metastases, SFRT remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (CWC) that recommend SFRT. We assessed whether dissemination of the guidelines influenced SFRT use in Manitoba in 2016, and we identified factors associated with MFRT. Methods: All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with MFRT. Results: In 2016, 807 patients (mean age: 70 years; range: 35–96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, MFRT was used—a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (OR): 5.3] or lung primary (OR: 3.3), complicated bone metastasis (OR: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of MFRT use. Conclusions: Dissemination of cwc recommendations alone did not increase SFRT use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of SFRT in Manitoba.

Palliative radiotherapy for bone metastases: Population-based utilization near end of life in a Canadian province.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. 9523-9523
Author(s):  
Manpreet Singh Tiwana ◽  
Mark Barnes ◽  
Andrew Kiraly ◽  
Stacy Miller ◽  
David Hoegler ◽  
...  
Keyword(s):  
Bone Metastases ◽  
End Of Life ◽  
Palliative Radiotherapy ◽  
Population Based ◽  
Canadian Province

Randomized clinical trial with two palliative radiotherapy regimens in painful bone metastases: 30Gy in 10 fractions compared with 8Gy in single fraction

2008 ◽  
Vol 89 (2) ◽  
pp. 150-155 ◽  
Author(s):  
Palmira Foro Arnalot ◽  
Agustí Valls Fontanals ◽  
Joan Carles Galcerán ◽  
Frances Lynd ◽  
Xavier Sanz Latiesas ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Bone Metastases ◽  
Randomized Clinical Trial ◽  
Palliative Radiotherapy ◽  
Single Fraction ◽  
Painful Bone Metastases

The prognostic significance of bone metastases and skeletal-related events (SREs) in prostate cancer survival: A population-based historical cohort study in Denmark (1999–2007)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5160-5160 ◽  
Author(s):  
J. P. Fryzek ◽  
K. Cetin ◽  
M. Nørgaard ◽  
A. Ø. Jensen ◽  
J. Jacobsen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Large Population ◽  
Prognostic Significance ◽  
Population Based ◽  
Short Term ◽  
Historical Cohort

5160 Background: Common among advanced prostate cancer patients, bone metastases indicate cancer progression and poor prognosis but few studies have quantified their influence on patient survival, particularly in the presence of subsequent skeletal-related complications. We therefore sought to examine this in a large population-based cohort of prostate cancer patients. Methods: Using data from the Danish National Patient Registry (covering all Danish hospitals), we studied 23,087 patients diagnosed with prostate cancer between 1999 and 2007, with follow-up through April 2008 (median follow-up: 2.2 years). We estimated the incidence of bone metastases following cancer diagnosis and the subsequent occurrence of SREs (radiation and surgery to the bone, fracture, spinal cord compression). We then computed and compared survival for three prostate cancer subgroups - no bone metastases, bone metastases, and bone metastases with SREs - using Kaplan-Meier and multivariate Cox proportional hazards models. Results: Across the study period, 14% (n = 3,261) of the prostate cancer patients developed bone metastases: 6.8% (n = 1,570) had bone metastases and no SRE and 7.3% (n = 1,691) had both bone metastases and at least one SRE (radiation to the bone was most frequent). One-year survival was lowest for prostate cancer patients with bone metastases and SREs (40%) compared to the groups with no bone metastases (87%) and with bone metastases but no SREs (47%). Similarly, after adjusting for age and the presence of comorbidities, short-term prognosis was poorest in patients with both bone metastases and SREs: compared to prostate cancer patients with no bone metastases, the 1-year mortality rate was 6.7 times greater for those with bone metastases and SREs (95% confidence interval (CI): 6.0–7.6) versus just 4.7 times higher in those with only bone metastases (95% CI: 4.3–5.2). Less than 1% of prostate cancer patients who developed bone metastases and suffered any SRE survived beyond five years. Conclusions: Although the presence of bone metastases confers a short-term prognosis in prostate cancer patients, survival is even poorer for patients who also experience skeletal-related complications. [Table: see text]

scholarly journals Optimal dose-fractionation schedule of palliative radiotherapy for patients with bone metastases: a protocol for systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033120 ◽  
Author(s):  
Xiaofang Tang ◽  
Qiancheng Hu ◽  
Ye Chen ◽  
Xin Wang ◽  
Xiaofen Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Metastases ◽  
Meta Analysis ◽  
Palliative Radiotherapy ◽  
Optimal Dose ◽  
Dose Fractionation ◽  
Cochrane Library ◽  
Assessment Development ◽  
Fractionation Schedule ◽  
American Society

IntroductionThe optimal dose-fractionation schedule of palliative radiotherapy has been debated in patients with bone metastases. Our objective is to comprehensively compare multiple fraction schedules with single fraction radiotherapy in terms of efficacy and toxicities by performing a systematic review and network meta-analysis.Methods and analysisElectronic searches of titles/abstracts of palliative radiotherapy for bone metastases will be performed, using PubMed, Cochrane Library, Embase,clinical trials, American Society for Therapeutic Radiology and Oncology and European Society of Radiotherapy and Oncology. The primary outcome of interest is the incidence of skeletal-related event following palliative radiotherapy for bone metastases in prospective studies. The risk of bias and quality of evidence will be evaluated based on Cochrane Collaboration’s tool and Grades of Recommendation, Assessment, Development and Evaluation in the network meta-analysis. We will conduct subgroup analysis and sensitivity analysis regardless of heterogeneity estimates.Ethics and disseminationThis study will synthesise the evidence regarding dose-fractionation schedule of palliative radiotherapy in patients with bone metastases. We hope the findings from this study will help clinicians and patients select optimum palliative radiotherapy by identifying the optimal dose-fractionation schedule of palliative radiotherapy with the most value in terms of patient-important outcomes. The evidence obtained from network meta-analysis will help to guide head-to-head research in the future. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics review board is not required for this network meta-analysis.PROSPERO registration numberCRD42019135195.

Palliative radiotherapy for bone metastases: assessment of factors influencing dose-fractionation schedules at a UK cancer centre

2013 ◽  
Vol 12 (3) ◽  
pp. 208-217 ◽  
Author(s):  
N. Bhalla ◽  
H. Wong ◽  
A. Ibrahim ◽  
J. A. Green
Keyword(s):  
Bone Metastases ◽  
Statistical Tests ◽  
Population Analysis ◽  
Metastatic Breast ◽  
Dose Fractionation ◽  
High Morbidity ◽  
Single Fraction ◽  
Factors Influencing ◽  
Fractionation Schedule ◽  
To Receive

AbstractContextMeta-analyses demonstrate single-fraction radiotherapy to be as effective as multi-fraction treatment in palliating painful bone metastases, although surveys suggest reluctance in prescribing single fractions.AimsAssess the factors influencing the choice of dose-fractionation regimen in an unselected population; examine retreatment rates and subsequent skeletal events.MethodsData were extracted from case notes for 120 patients treated in 2000 and 2006 in a single centre serving a defined population; analysis used χ2 and Fisher's exact statistical tests.ResultsAn 8 Gy fraction was the commonest regimen prescribed (single-fraction delivery rate 53·6%). Tumour site was a significant factor in choice of dose-fractionation schedule. Patients with metastatic breast carcinoma were significantly less likely to receive single-fraction treatment compared with those with metastatic lung carcinoma (year 2000: p = 0·038, 2006: p = 0·001). There was a significantly higher retreatment rate following single-fraction compared with multi-fraction treatment (11% versus 3%). There were two subsequent neural axis compressions and four pathological fractures.ConclusionsSingle-fraction treatment is the commonest regimen but multiple fractions are still frequently delivered. Better prognosis groups appear more likely to receive multi-fraction treatment, possibly to avoid the need for retreatment. Subsequent skeletal events are rare but carry high morbidity when they occur.

Predicting toxicities from adjuvant treatment in a population-based cohort of early colon cancer (CC) patients (pts): A strategy to improve use of curative chemotherapy.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 412-412
Author(s):  
Gillian Gresham ◽  
Jasleen Sidhu ◽  
Navraj Malhi ◽  
Winson Y. Cheung
Keyword(s):  
Side Effects ◽  
Population Based ◽  
Advanced Age ◽  
Clinical Factors ◽  
Factors Associated ◽  
Cancer Agency ◽  
Gi Toxicity ◽  
Baseline Characteristics ◽  
Folfox Chemotherapy ◽  
Ecog Ps

412 Background: CC pts treated with chemotherapy are at risk of experiencing a number of toxicities. The identification of pts who may be at a higher risk of developing toxicities allows clinicians to be more vigilant in preventing and managing side effects early, thus enabling more optimal delivery of chemotherapy. Our aim was to determine clinical factors associated with toxicities from adjuvant FOLFOX in early CC. Methods: Pts diagnosed with stage III CC from 2005 to 2008, seen at any 1 of 5 regional cancer centers of the British Columbia Cancer Agency, and treated with adjuvant FOLFOX chemotherapy were reviewed. We evaluated various toxicities, including gastrointestinal, hematologic, cardiovascular, and neurological side effects. Baseline and clinical factors were assessed in univariate and multivariate models to determine potential predictors for each of the different chemotherapy toxicities. Results: In total, 475 pts were included: median age was 62 years (range 26-89), 16.2% were aged >70 years, and 54.5% were men. In terms of function, the majority (90.1%) was ECOG 0/1. Time to adjuvant chemotherapy (TTAC) >8 weeks (OR 1.91, 95% CI 1.8-3.1, p=0.006) and renal dysfunction with a GFR <50 (OR 1.69, 95% CI 1.1-2.6, p=0.0038) were significantly associated with higher odds of any GI toxicity. Likewise, TTAC >8weeks (OR 2.8, 95% CI 1.5-5.2, p=0.002), ECOG PS >1 (OR 2.86, 95% CI 1.2-6.7, p=0.016), and low white blood cell count <6.4 (OR 2.32, 95% CI 1.3-4.0, p=0.0043) were correlated with a greater risk of significant neutropenia. Multiple toxicities were more prevalent among those who waited >8 weeks to initiate adjuvant FOLFOX (OR 1.69, 95%CI 1.1-2.7, p=0.03). Further, advanced age >70 years was an indepenent risk factor for worse nausea and diarrhea. Conclusions: Consideration of important baseline characteristics such as TTAC, advanced age, renal function, and specific laboratory parameters when recommending adjuvant FOLFOX can be useful in identifying patients with increased likelihood of toxicities. This group of patients may benefit from increased monitoring in order to enable optimal doses of curative chemotherapy to be delivered.

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