Search

Purpose: Lung cancer remains one of the most diagnosed cancers in Canada and continues to be the leading cause of cancer deaths in Canada, responsible for 25% of all cancer deaths. Prior studies consistently report poor experiences of people with lung cancers. The study purpose was to explore the reasons for consistently poorer reported experience of people with lung cancer compared to people with gastrointestinal cancers, who previously have reported positive cancer care experiences within the same context, and to better understand key differences that influence patient experience. Methods: This qualitative study used semi-structured interviews of people living with lung cancer (LC) and gastrointestinal cancers (GIC) undergoing radiotherapy at a tertiary cancer centre. Thematic content analysis was conducted to analyse interview transcripts. A person-centred care framework was used to guide the development of the interview guide and data analysis. Results: We interviewed 16 participants (10 LC and 6 GIC). Participants with LC reported poor experience leading to and at the time of their cancer diagnosis, including delays in their diagnosis and anxiety related to their diagnosis. Most participants in both groups reported severe symptoms prior to their radiotherapy. However, the symptoms of people living with LC further worsened during the radiation therapy with the addition of treatment side effects, while the symptoms of people living with GIC were better controlled during treatment. Participants living with LC noted poor communication, gaps in coordination and uncertainty. They acknowledged awareness of support services and other resources, but they reported no interest in accessing them. Conclusion: This study identified gaps in patient experience of people living with LC compared to GIC and proposed ideas for quality improvement projects, including expediting the diagnosis process, enhancing communication with patients around their lung cancer diagnosis, improved symptom management, and timing of supportive care services. [ABSTRACT FROM AUTHOR]

Purpose: Longitudinal collection of patient experience data promotes continual high-quality care and guides quality improvement (QI) work. The purpose of this study was to investigate patient experience in the radiation department during COVID-19 and compare results to previous data collected in 2019. Methods: Patient experience data was collected using the Your Voice Matters (YVM) survey. Recruitment occurred between April and June 2022. Consecutive patients were approached to complete the YVM regarding their consultation or radiation treatment appointment. The proportion of patients with positive experience scores was calculated for 2022 results. Unadjusted results were compared between 2019 and 2022. The adjusted analysis included logistic regression modelling to evaluate factors associated with an overall positive experience. Content analysis was completed for current qualitative data. Results: Overall, 400 patients completed the YVM regarding their consultation or radiation treatment. The most favorable experiences included polite reception staff and feeling respected and listened to. Compared to 2019, there was no significant difference in overall experience scores. Results showed improvements in wait times for consultations (p < 0.01) and treatments (p < 0.01). Despite improvements, wait times and contacting the clinic remain areas with the lowest scores. In 2022, patients with breast cancer had greater odds of a positive experience compared to lung. Conclusions: Patients at our institution continued to have positive experiences over time, despite the pandemic. Improvements were most evident with wait times. Other items including contacting the clinic remain areas for improvement. These results guided various QI work in our department to improve communication, clinic flow, and other aspects of patient experience. [ABSTRACT FROM AUTHOR]

Patient report outcomes are commonly collected during oncology visits to elicit symptom burden and guide management. We aimed to determine the frequency of intervention for patients undergoing radiotherapy with high symptom complexity scores and identify which factors are associated with being offered an intervention. A retrospective chart audit was completed of adult patients with cancer who had at least one radiotherapy appointment and were assigned a high symptom complexity. A total of 200 patients were included; 150 (75.0%) patients were offered an intervention for the main symptom. The most offered intervention was medications. Multivariable logistic regression showed factors associated with being offered an intervention were the following: symptom score of 9 (OR = 9.56, 95% CI 1.64–62.8) and 10 (OR = 7.90, 95% CI 1.69–38.2); palliative intent radiation (OR 3.87, 96% CI 1.46–11.1); and last review appointment (OR 6.22, 95% CI 1.84–23.3). Symptoms associated with being offered an intervention included pain (OR 22.6, 95% CI 6.47–91.1), nausea (OR 15.7, 95% CI 1.51–412), shortness of breath (OR 7.97, 95% CI 1.20–63.7), and anxiety (OR 6.69, 95% CI 1.58–31.6). This knowledge will help guide clinical practice to understand symptom burden and how we can improve our management of patients' symptoms. [ABSTRACT FROM AUTHOR]

Background: Microwave imaging has been proposed for medical applications, creating maps related to water content of tissues. Breast imaging has emerged as a key application because the signals can be coupled directly into the breast and experience limited attenuation in fatty tissues. While the literature contains reports of tumor detection with microwave approaches, there is limited exploration of treatment monitoring. Purpose: This study aims to detect treatment‐related changes in breast tissue with a low‐resolution microwave scanner. Methods: Microwave scans of 15 patients undergoing treatment for early‐stage breast cancer are collected at up to 4 time points: after surgery (baseline), 6 weeks after accelerated partial breast radiation, as well as 1 and 2 years post‐treatment. Both the treated and untreated breast are scanned at each time point. The microwave scanner consists of planar transmit and receive arrays and uses signals from 0.1 to 10 GHz. The average microwave frequency properties (permittivity) are calculated for each scan to enable quantitative comparison. Baseline and 6‐week results are analyzed with a two‐way ANOVA with blocking. Results: Consistent properties are observed for the untreated breast over time, similar to a previous study. Comparison of the scans of the treated and untreated breast suggests increased properties related to treatment, particularly at baseline and 6‐weeks following radiotherapy. Analysis of the average properties of the scans with ANOVA indicates statistically significant differences (p<0.05$p < 0.05$) in the treated and untreated breast at these time points. Conclusions: Microwave imaging has the potential to track treatment‐related changes in breast tissues. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this analysis is to predict worsening post‐treatment normal tissue toxicity in patients undergoing accelerated partial breast irradiation (APBI) therapy and to quantitatively identify which diagnostic, anatomical, and dosimetric features are contributing to these outcomes. Methods: A retrospective study of APBI treatments was performed using 32 features pertaining to various stages of the patient's treatment journey. These features were used to inform and construct a Bayesian network (BN) based on both statistical analysis of feature distributions and relative clinical importance. The target feature for prediction was defined as a measurable worsening of telangiectasia, subcutaneous tissue induration, or fibrosis when compared against the observed baseline. Parameter learning for the network was performed using data from the 299 patients included in the ACCEL trial and predictive performance was measured. Feature importance for the BN was quantified using a novel information‐theoretic approach. Results: Cross‐validated performance of the BN for predicting toxicity was consistently higher when compared against conventional machine learning (ML) techniques. The measured BN receiver operating characteristic area under the curve was 0.960±$\,{\pm}\,$0.013 against the best ML result of 0.942±$\,{\pm}\,$0.021 using five‐fold cross‐validation with separate test data across 100 trials. The volume of the clinical target volume, gross target volume, and baseline toxicity measurements were found to have the highest feature importance and mutual dependence with normal tissue toxicity in the network, representing the strongest contribution to patient outcomes. Conclusions: The BN outperformed conventional ML techniques in predicting tissue toxicity outcomes and provided deeper insight into which features are contributing to these outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a knowledge‐based (KB) planning model for RapidPlan, generated using a five‐field intensity‐modulated radiotherapy (IMRT) class solution beam strategy and rigorous dosimetric constraints for accelerated partial breast irradiation (APBI). Materials and methods: The RapidPlan model was configured using 64 APBI treatment plans and validated for 120 APBI patients who were not included in the training dataset. KB plan dosimetry was compared to clinical plan dosimetry, the clinical planning constraints, and the constraints used in phase III APBI trials. Dosimetric differences between clinical and KB plans were evaluated using paired two‐tailed Wilcoxon signed‐rank tests. Results: KB planning was able to produce IMRT‐based APBI plans in a single optimization without manual intervention that are comparable or better than the conventionally optimized, clinical plans. Comparing KB plans to clinical plans, differences in PTV, heart, contralateral breast, and ipsilateral lung dose–volume metrics were not clinically significant. The ipsilateral breast volume receiving at least 50% of the prescription dose was statistically and clinically significantly lower in the KB plans. Conclusion: KB planning for IMRT‐based APBI provides equivalent or better dosimetry compared to conventional inverse planning. This model may be reliably applied in clinical practice and could be used to transfer planning expertise to ensure consistency in APBI plan quality. [ABSTRACT FROM AUTHOR]

Background: Previous studies have found that patients with lung cancer report worse patient experience compared to other tumour groups. Reasons that may negatively impact patient experience include delays in diagnosis as well as inadequate symptom management. The purpose of this study was to compare the diagnostic timelines and symptom reports of patients with lung and gastrointestinal (GI) cancers. Methods: This study included patients diagnosed with lung or GI cancers who attended a radiation oncology (RO) consultation and/or received radiation treatment between May and August 2019 at the Tom Baker Cancer Centre, Calgary, Alberta, Canada. Data collected included demographics, dates of diagnostic time points, and self-reported symptom scores across 3 time points. A descriptive analysis was completed, and the median number of days between time points was compared between tumour groups. Results: Patients with lung cancer had longer diagnostic timelines compared to GI patients. The median number of days between the first investigative test and biopsy was 21 days longer for patients with lung cancer (p < 0.05). From RO consultation to the first treatment review appointment, 25% and 4% of lung and GI patients, respectively, reported worsening of symptoms. A greater proportion of lung patients reported worse symptom scores during treatment compared to GI patients. This varied by specific symptom. Conclusions: Patients with lung cancer experienced delays in receiving a diagnosis and worse symptom burden during radiation therapy in this study. We identified potential targets to improve patient experience. [ABSTRACT FROM AUTHOR]

Patient-reported experience is associated with improved patient safety and clinical outcomes. Quality improvement programs rely on validated patient-reported experience measures (PREMs) to design projects. This descriptive study compares the experience of cancer patients treated with radiation as recorded through the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) or as recorded through Your Voice Matters (YVM) between February and August 2019. Six questions were compared (“overall experience with care”, “discussion of worries”, “involvement in decisions”, “trusting providers with confidential information”, “providing family with information”, and “knowing who to contact”). Positive experience scores were calculated by cohort and by tumor groups. Multivariable logistic regression models evaluated factors associated with positive experience. Two cohorts (220 and 200 patients) met the eligibility criteria for the AOPSS and YVM, respectively. Positive experience was reported similarly between the two PREMs for “overall experience with care”, “discussion of worries”, and “trusting providers with confidential information” with a score difference of 1–4% at the cohort level. Positive experience score difference ranged from 5% to 44% across questions at the tumor group level. Different experience gaps were identified with the two measures, mainly at the tumor group level. Programs interested in using these PREMS might consider this when designing projects. [ABSTRACT FROM AUTHOR]

The expansion of cancer services closer to home has become a major focus of publicly funded healthcare, with cancer organizations attempting to invest in smaller centers by integrating radiotherapy into these facilities. In Canada this has resulted in Ontario, British Columbia and Alberta investing in 12 expanded regional centers over the past 20 years. Quebec, Manitoba and Nova Scotia have made similar investments. Alberta's three new centers opened in 2010, 2013 and 2021 (projected). This study examined improvements in wait times and patient throughput between 2010 and 2020, and highlighted strategies that will support the sustainability and growth of clinical activity through to 2030. Significant improvement in ready to treat wait times for radiotherapy have resulted from opening two centers, and the provincial throughput for patients requiring systemic or radiotherapy has gone up by 16%. A patient satisfaction survey demonstrated that rural patients are happy with their care and desire the provision of more of their cancer treatment closer to home. An expert panel provided recommendations on what needs to be done to stabilize recruitment and retention. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To determine the volumetric changes in pharyngeal structures in patients with head and neck squamous cell carcinoma (HNSCC) treated with curative chemoradiation therapy (CRT). Patients treated with CRT for esophageal carcinoma (EC), where pharyngeal structures were not part of the radiation treatment fields, were controlled for dysphagia‐associated weight loss. We hypothesize that tissue volume alteration is a contributing factor of post‐CRT dysphagia. Study Design: Case series. Methods: This study measured pre‐ and 1‐year posttreatment volumes of the base of tongue (BOT), parapharyngeal spaces, posterior pharyngeal constrictors (PCs), and retropharyngeal space (RPS) in patients undergoing CRT for HNSCC or EC treated January 1, 2012 to December 31, 2015. All HNSCC patients were treated to doses of 66 to 70 Gy in 30 to 33 fractions using intensity‐modulated radiotherapy techniques. Results: Our cohort included 49 HNSCC and 11 EC patients. Within the HNSCC cohort, the PCs volume increased 1.55 cm3 (95% confidence interval [CI]: 0.77 to 2.34 cm3, P =.0002), RPS increased 1.22 cm3 (95% CI: 0.67 to 1.77 cm3, P <.0001), and BOT decreased 2.29 cm3 (95% CI: −0.20 to 4.79 cm3, P =.070). The EC cohort showed no significant volumetric changes for any anatomic space, with combined PCs and RPS volume changes statistically less than the HNSCC cohort (P =.031). There was no difference in mean body mass index reduction between groups (P =.10). Conclusions: Volumetric changes following CRT may play a role in posttreatment dysphagia. Our findings support loss of physiologic function from posterior pharynx tissue thickening combined with reduced pharyngeal constriction capacity, and BOT atrophy secondary to radiation effects contribute to dysphagia. Level of Evidence: 4 Laryngoscope, 130:597–602, 2020 [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the performance of structure‐guided deformable image registration (SG‐DIR) relative to rigid registration and DIR using TG‐132 recommendations. This assessment was performed for image registration of treatment planning computed tomography (CT) and magnetic resonance imaging (MRI) scans with Primovist® contrast agent acquired post stereotactic body radiation therapy (SBRT). SBRT treatment planning CT scans and posttreatment Primovist® MRI scans were obtained for 14 patients. The liver was delineated on both sets of images and matching anatomical landmarks were chosen by a radiation oncologist. Rigid registration, DIR, and two types of SG‐DIR (using liver contours only; and using liver structures along with anatomical landmarks) were performed for each set of scans. TG‐132 recommended metrics were estimated which included Dice Similarity Coefficient (DSC), Mean Distance to Agreement (MDA), Target Registration Error (TRE), and Jacobian determinant. Statistical analysis was performed using Wilcoxon Signed Rank test. The median (range) DSC for rigid registration was 0.88 (0.77–0.89), 0.89 (0.81–0.93) for DIR, and 0.90 (0.86–0.94) for both types of SG‐DIR tested in this study. The median MDA was 4.8 mm (3.7–6.8 mm) for rigid registration, 3.4 mm (2.4–8.7 mm) for DIR, 3.2 mm (2.0–5.2 mm) for SG‐DIR where liver structures were used to guide the registration, and 2.8 mm (2.1–4.2 mm) for the SG‐DIR where liver structures and anatomical landmarks were used to guide the registration. The median TRE for rigid registration was 7.2 mm (0.5–23 mm), 6.8 mm (0.7–30.7 mm) for DIR, 6.1 mm (1.1–20.5 mm) for the SG‐DIR guided by only the liver structures, and 4.1 mm (0.8–19.7 mm) for SG‐DIR guided by liver contours and anatomical landmarks. The SG‐DIR shows higher liver conformality as per TG‐132 metrics and lowest TRE compared to rigid registration and DIR in Velocity AI software for the purpose of registering treatment planning CT and post‐SBRT MRI for the liver region. It was found that TRE decreases when liver contours and corresponding anatomical landmarks guide SG‐DIR. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the dosimetric and radiobiological impact of abdominal compression (AC) on nearby gastrointestinal critical structures (GI-CS) and reported toxicities of patients treated with non-hepatic abdominal stereotactic body radiotherapy (SBRT). Methods: Two sets of CT scans, planning scans with AC and pre-treatment diagnostic scans without AC (non-AC) were compared for patients treated with a prescription dose to planning target volume (PTV) =25 Gy/5-fractions at a single institution. Target volumes were delineated on both sets of scans and PTV was expanded isotropically by 2 cm (PTV+2) and 4 cm (PTV+4). All GI-CS were summated to create a composite CS (GI-lumen). Rigid registration of AC and non-AC scans was done using Velocity AI (Varian Medical Systems) to obtain dose distribution information. Lymann-Probit and logit models were used for radiobiological calculations. Toxicity scores were obtained from prospectively collected clinical data. Results: A total of 12 patients were included. Mean PTV volumes were 190.3cc and 196.4cc with AC and non-AC (p=0.95). Significant improvement in V30 of GI-lumen was seen with AC (0.11cc vs. 4.97cc, p=0.04). There were no differences in the normal tissue complication probabilities of the individual GI-CS or the summary indices except a notable trend towards better NTCP for small bowel late effects with AC (0.21% vs. 2.45%; p=0.055). Three patients had acute grade-1 anorexia, one patient had acute grade-2 gastritis. There was no grade =3 GI toxicity. At a median follow-up of 2.6 years, total of 8/12 (66.7%) patients developed local recurrence of whom 4 (33.3%) had isolated local recurrence. Conclusion: Use of AC did not result in any dosimetric or radiobiological inferiority for GI-CS. The current cohort completed their treatment with minimal toxicity. [ABSTRACT FROM AUTHOR]

Background: Aggressive medical management of cancer patients at the end of life (EOL) is an indicator of health services quality. We evaluated the variations in EOL cancer therapy utilization and in acute care hospital deaths across different types of cancer within the setting of a regionalized cancer program.Methods: Intravenous chemotherapy and radiotherapy use within the last 14 and 30 days of life was identified through the Alberta Cancer Registry and then verified by chart review for cancer decedents residing within 50 km of the Tom Baker Cancer Centre between 2003 and 2010. Multivariable logistic regression was used to examine variations in outcomes of interest by cancer, adjusting for age and other factors in prespecified models.Results: Of the 9863 decedents included in the study, 3.0 and 6.3 % received chemotherapy within the final 14 and 30 days of life, respectively. In multivariable model, breast, hematological, and gynecological cancers were at least 2.5 times more likely than other cancers to undergo EOL chemotherapy. Radiotherapy was given to 4.6 % of decedents within 14 days of death, but only 66 % (359/542 courses) were completed as prescribed. Acute care admission within 14 days of death was seen in 44 % of decedents and 34 % died in the hospital.Conclusions: In our regional cancer program, the intensity of cancer therapies near the end of life varied considerably across different cancer types. Such variations may be unwarranted. A substantial proportion of cancer deaths occurred in the acute care setting. Greater efforts to integrate palliative care in outpatient cancer services are needed. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine the volumetric changes in pharyngeal structures in patients with head and neck squamous cell carcinoma (HNSCC) treated with curative chemoradiation therapy (CRT). Patients treated with CRT for esophageal carcinoma (EC), where pharyngeal structures were not part of the radiation treatment fields, were controlled for dysphagia-associated weight loss. We hypothesize that tissue volume alteration is a contributing factor of post-CRT dysphagia.Study Design: Case series.Methods: This study measured pre- and 1-year posttreatment volumes of the base of tongue (BOT), parapharyngeal spaces, posterior pharyngeal constrictors (PCs), and retropharyngeal space (RPS) in patients undergoing CRT for HNSCC or EC treated January 1, 2012 to December 31, 2015. All HNSCC patients were treated to doses of 66 to 70 Gy in 30 to 33 fractions using intensity-modulated radiotherapy techniques.Results: Our cohort included 49 HNSCC and 11 EC patients. Within the HNSCC cohort, the PCs volume increased 1.55 cm3 (95% confidence interval [CI]: 0.77 to 2.34 cm3 , P = .0002), RPS increased 1.22 cm3 (95% CI: 0.67 to 1.77 cm3 , P < .0001), and BOT decreased 2.29 cm3 (95% CI: -0.20 to 4.79 cm3 , P = .070). The EC cohort showed no significant volumetric changes for any anatomic space, with combined PCs and RPS volume changes statistically less than the HNSCC cohort (P = .031). There was no difference in mean body mass index reduction between groups (P = .10).Conclusions: Volumetric changes following CRT may play a role in posttreatment dysphagia. Our findings support loss of physiologic function from posterior pharynx tissue thickening combined with reduced pharyngeal constriction capacity, and BOT atrophy secondary to radiation effects contribute to dysphagia.Level Of Evidence: 4 Laryngoscope, 130:597-602, 2020. [ABSTRACT FROM AUTHOR]