The study aimed to determine the factors influencing radiotherapy interruptions and provide solutions to decrease treatment dropouts. Of 1200 patients receiving radiation therapy, 100 (8.3%) experienced interruptions of over 5 days. The most common causes were radiation toxicity (20%), patient death (15%), financial issues (15%), and social issues (12%). After telephone counseling, treatment could restart in 25% of interrupted patients. To reduce interruptions, adequate counseling is needed before and during treatment, and financial support may help address the social determinants of treatment compliance.
Chair and Presenter, Sumanta Kumar Pal, MD, FASCO, Pedro C. Barata, MD, MSc, Toni K. Choueiri, MD, and Cristina Suarez, MD, PhD, prepared useful Practice Aids pertaining to renal cell carcinoma for this CME/MOC/NCPD/AAPA activity titled “Fine-Tuning the Wave of Innovation in RCC: Personalized Management Across the Disease Spectrum.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at https://bit.ly/3yGnLnD. CME/MOC/NCPD/AAPA credit will be available until July 2, 2024.
- The median delay from first consultation to radiation simulation for cervical cancer patients was 55 days. Longer delays did not correlate with increased tumor progression. However, one in four patients received blood transfusions or were hospitalized while waiting, and some required emergency brachytherapy due to bleeding. Though delays did not definitively increase progression in this study, the long wait times highlighted issues in access to timely radiation treatment for cervical cancer patients.
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
- The document discusses treatments and costs for recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) in the Netherlands.
- 125 patients received palliative, non-trial first-line systemic treatment for R/M SCCHN between 2006-2013, with the most common treatments being platinum + 5FU + cetuximab (32%), methotrexate monotherapy (27%), and capecitabine monotherapy (14%).
- Median progression-free survival was 3.4 months and median overall survival was 6.0 months. 27% of patients experienced severe adverse events. Mean total hospital costs ranged from €10,075 to €
This document summarizes updates made in Version 2.2013 of the NCCN Clinical Practice Guidelines for Thyroid Carcinoma. Key updates include: revising pathways for follicular and Hürthle cell neoplasms to include molecular diagnostics; adding recommendations to consider observation for follicular lesions of undetermined significance; and modifying recommendations regarding use of radioactive iodine therapy and surveillance.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
CANDIDATES FOR HIPPOCAMPAL SPARING14MethodologyTo evaluate .docxhumphrieskalyn
CANDIDATES FOR HIPPOCAMPAL SPARING 14
Methodology
To evaluate which patients would be higher priority candidates for hippocampal sparing, 3,000 participant treatment plans were evaluated via a cross-sectional differential research method. The method of research used in this study is considered differential and cross-sectional because groups of participants are different ages are compared on a set of variables and because participates of this study were assigned to groups based on preexisting factors.
Patients over the age of 18 and parents of participants under the age of 18 were asked to take part in the research. The aim of research was explained to them and informed consent was obtained by all participants prior to participating in the study. It was explained to participants, or parents of the participants, that data was going to be collected based on the treatment they received and that no additional experimentation with radiation was to be added to their treatment for the benefit of the research study, therefore, there was no additional risk to their treatment plan implemented by this differential research study. The study was subject to external review several credible institutions including the American Society for Therapeutic Radiology and Oncology (ASTRO).
Participants. Participants of this study were subjects who required WBRT and were evaluated in two categories. The two categories were based on treatment intent and will be separated into preexisting palliative and prophylactic categories. With age thought to be the most influential variable, participants in each category were further categorized into two subcategories based on age. Subjects of this study included subcategory A participates who were required to be 25 years of age and younger and subcategory B participants who were required to be 26 years old age and older based on prior research on brain development studies done by Giedd & Rapoport.
The cumulative sample size for the research study was 2,000 participants. 500 subcategory A and 500 subcategory B participants were included in each intent category. Subject exclusions included patients who were on hospice care, those on a concurrent chemotherapy regimen during their radiation therapy treatment and patients who had a treatment plan change after beginning their initially recommended treatment.
Treatment Intent
Total Number of Participants
A: Under 25
B: Over 25
Prophylactic
500
500
Palliative
500
500
Table 1. Visual representation of participants.
Data Collection Method. Data was collected from 20 Radiation Oncologist between 21 different cancer centers over a course of 18 months between January 2014 and June 2015. Two Oncologists at each cancer center participated in the study by collecting research and all had an average of 3 new WBRT patients per month. Each cancer center then treated an average of 6 new WBRT patients per month, 2,000 of which agreed to participate in the study. Data was collected from each ph ...
Chair and Presenter, Sumanta Kumar Pal, MD, FASCO, Pedro C. Barata, MD, MSc, Toni K. Choueiri, MD, and Cristina Suarez, MD, PhD, prepared useful Practice Aids pertaining to renal cell carcinoma for this CME/MOC/NCPD/AAPA activity titled “Fine-Tuning the Wave of Innovation in RCC: Personalized Management Across the Disease Spectrum.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at https://bit.ly/3yGnLnD. CME/MOC/NCPD/AAPA credit will be available until July 2, 2024.
- The median delay from first consultation to radiation simulation for cervical cancer patients was 55 days. Longer delays did not correlate with increased tumor progression. However, one in four patients received blood transfusions or were hospitalized while waiting, and some required emergency brachytherapy due to bleeding. Though delays did not definitively increase progression in this study, the long wait times highlighted issues in access to timely radiation treatment for cervical cancer patients.
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
This document discusses the approach towards re-irradiation of common cancers. It begins by noting that local recurrence after radiation therapy and second primary tumors in irradiated areas are challenges, though re-irradiation can provide durable disease control in some cases. It then discusses key considerations for re-irradiation of head and neck cancers, gliomas, gynecological cancers, bone metastases, and brain metastases. Important factors include the initial radiation dose, interval since prior radiation, intent of re-irradiation, cumulative organ doses, and risk versus benefit. Advanced radiation techniques like IMRT can help minimize toxicity risks from re-irradiation. Careful patient selection and multidisciplinary evaluation are emphasized for meaningful survival benefits from re-
- The document discusses treatments and costs for recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) in the Netherlands.
- 125 patients received palliative, non-trial first-line systemic treatment for R/M SCCHN between 2006-2013, with the most common treatments being platinum + 5FU + cetuximab (32%), methotrexate monotherapy (27%), and capecitabine monotherapy (14%).
- Median progression-free survival was 3.4 months and median overall survival was 6.0 months. 27% of patients experienced severe adverse events. Mean total hospital costs ranged from €10,075 to €
This document summarizes updates made in Version 2.2013 of the NCCN Clinical Practice Guidelines for Thyroid Carcinoma. Key updates include: revising pathways for follicular and Hürthle cell neoplasms to include molecular diagnostics; adding recommendations to consider observation for follicular lesions of undetermined significance; and modifying recommendations regarding use of radioactive iodine therapy and surveillance.
Daily waiting time management for modern radiation oncology department in Ind...Kanhu Charan
This document discusses strategies for managing patient waiting times in radiation oncology departments. It notes that waiting times can impact patient satisfaction and treatment compliance. Various clinical factors can influence waiting times, such as individualized treatment protocols, patient performance status, use of immobilization devices or motion management techniques, organ site, and protocols for bladder and rectal filling. The conclusion recommends meticulous management of waiting times through clear communication and provisions to engage patients while waiting for treatment.
CANDIDATES FOR HIPPOCAMPAL SPARING14MethodologyTo evaluate .docxhumphrieskalyn
CANDIDATES FOR HIPPOCAMPAL SPARING 14
Methodology
To evaluate which patients would be higher priority candidates for hippocampal sparing, 3,000 participant treatment plans were evaluated via a cross-sectional differential research method. The method of research used in this study is considered differential and cross-sectional because groups of participants are different ages are compared on a set of variables and because participates of this study were assigned to groups based on preexisting factors.
Patients over the age of 18 and parents of participants under the age of 18 were asked to take part in the research. The aim of research was explained to them and informed consent was obtained by all participants prior to participating in the study. It was explained to participants, or parents of the participants, that data was going to be collected based on the treatment they received and that no additional experimentation with radiation was to be added to their treatment for the benefit of the research study, therefore, there was no additional risk to their treatment plan implemented by this differential research study. The study was subject to external review several credible institutions including the American Society for Therapeutic Radiology and Oncology (ASTRO).
Participants. Participants of this study were subjects who required WBRT and were evaluated in two categories. The two categories were based on treatment intent and will be separated into preexisting palliative and prophylactic categories. With age thought to be the most influential variable, participants in each category were further categorized into two subcategories based on age. Subjects of this study included subcategory A participates who were required to be 25 years of age and younger and subcategory B participants who were required to be 26 years old age and older based on prior research on brain development studies done by Giedd & Rapoport.
The cumulative sample size for the research study was 2,000 participants. 500 subcategory A and 500 subcategory B participants were included in each intent category. Subject exclusions included patients who were on hospice care, those on a concurrent chemotherapy regimen during their radiation therapy treatment and patients who had a treatment plan change after beginning their initially recommended treatment.
Treatment Intent
Total Number of Participants
A: Under 25
B: Over 25
Prophylactic
500
500
Palliative
500
500
Table 1. Visual representation of participants.
Data Collection Method. Data was collected from 20 Radiation Oncologist between 21 different cancer centers over a course of 18 months between January 2014 and June 2015. Two Oncologists at each cancer center participated in the study by collecting research and all had an average of 3 new WBRT patients per month. Each cancer center then treated an average of 6 new WBRT patients per month, 2,000 of which agreed to participate in the study. Data was collected from each ph ...
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
This document discusses factors that contribute to readmissions of stroke patients and interventions to reduce readmissions. It notes that readmissions account for 20.5% of hospital admissions and reviews reasons for readmissions like medication issues, lack of follow-up care, and unhealthy lifestyles. The document outlines programs like TRACS, COMPASS and MISTT that provide post-discharge support through nurse coaching, medication management support and lifestyle counseling to reduce readmissions.
Effect of Behavioral Intervention on Reducing Symptom Severity during First C...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Establishment of a Rehabilitation Clinic for Colorectal Cancer. Will it End P...daranisaha
Colorectal cancer (CRC) is the third most common diagnosis and the second most lethal malignancy in both men and women.
To establish a rehabilitation clinic in the oncology department in hospitals and address its positive effect on colorectal cancer patients’ need.
This document reviews the evidence for managing locally advanced rectal cancers. It discusses how treatment has evolved from surgery alone to incorporating neoadjuvant radiation and chemotherapy. Neoadjuvant treatment has been shown to improve local control and survival compared to postoperative or adjuvant treatment. Achieving a pathological complete response after neoadjuvant therapy is associated with better long-term outcomes. Researchers have explored intensifying neoadjuvant treatment and increasing the interval before surgery to improve response rates. Accurately identifying patients who could avoid surgery through a "watch and wait" strategy depends on improved radiological assessment of tumor response.
Chair and Presenters, Sumanta Kumar Pal, MD, FASCO, Pedro C. Barata, MD, MSc, FACP, David F. McDermott, MD, and Tian Zhang, MD, MHS, prepared useful Practice Aids pertaining to renal cell carcinoma for this CME/MOC/NCPD/AAPA/IPCE activity titled “Advancing Personalized Care in RCC: Navigating Rapid Therapeutic Expansion and Sequencing Strategies.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/3uvvd5X. CME/MOC/NCPD/AAPA/IPCE credit will be available until February 25, 2025.
Only a small percentage of cancer patients are good candidates for proton therapy. Yet, for the right patients, proton therapy can reduce radiation exposure to healthy tissue. To help you make the best care decisions, this slide deck offers information to help you identify those of cancer patients best treated with proton therapy.
Cancer and the General Internist discusses how general internists can participate in cancer care. Key points include:
1. Cancer is a leading cause of death in the Philippines and costs of treatment are high, often leading to financial catastrophe for patients.
2. General internists can play roles in cancer screening, prevention through lifestyle counseling, and multidisciplinary care throughout the cancer continuum.
3. Filipinos actively search online for information about cancer signs, symptoms, and treatments. General internists are well-positioned to provide guidance and education to the public.
This survey aimed to assess clinicians' use of stereotactic radiotherapy and targeted therapies for metastatic renal cell carcinoma and determine support for future clinical trials. The primary objective was to evaluate the proportion of clinicians using radiotherapy for metastatic renal cell carcinoma. Secondary objectives included evaluating the proportion using targeted therapies and radiotherapy simultaneously, stopping targeted therapies for radiotherapy, and supporting further research. The online survey was distributed to members of urology and oncology groups in Australia and New Zealand to collect data on current practices. Results and conclusions will be presented at an upcoming conference.
This document provides guidelines for the treatment of hepatobiliary cancers from the National Comprehensive Cancer Network (NCCN). It was last updated on October 14, 2022. The guidelines include the latest recommendations for screening, diagnosing, and treating hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. New recommendations include durvalumab plus chemotherapy as a preferred regimen for unresectable biliary tract cancer, and selpercatinib for RET fusion-positive hepatobiliary tumors.
Surgical Risk Assessment is an Important Factor in any Surgical TreatmentJohnJulie1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
Surgical Risk Assessment is an Important Factor in any Surgical Treatmentsuppubs1pubs1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
This document discusses the need for geriatric assessments (GAs) in older cancer patients undergoing treatment. GAs evaluate patients' functional status, medical conditions, cognition, nutrition, social support and medications. The document aims to analyze evidence on how GAs impact treatment decisions and patient outcomes. It describes how GAs may alter treatments in up to 49% of patients by identifying age-related vulnerabilities. Studies show GAs correlate with survival rates, quality of life and toxicity risks. While GAs provide useful information, more research is still needed on their optimal use in oncology.
This document discusses barriers to the development and approval of targeted cancer therapies and companion diagnostics. It identifies key challenges such as identifying meaningful molecular targets, developing diagnostic tests, evaluating tests and therapies together, and administrative coordination between companies and regulatory agencies. The document proposes a "targeted development and approval" policy to facilitate accelerated development and approval of targeted therapies used with companion diagnostics. It outlines criteria for this policy, including that the diagnostic assay must demonstrate analytical validity and the therapy shows evidence the target population clinically benefits.
Rapid review of current service provision following cancer treatmentNHS Improvement
NHS Improvement carried out a rapid review of current provision of services for breast, prostate and colorectal cancer patients following treatment during the summer of 2009 at the request of the National Cancer Survivorship Initiative (NCSI). This publication shares the findings from this review.
(Published September 2010)
MicroGuide app, pop up uni, 1pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
This document discusses factors that contribute to readmissions of stroke patients and interventions to reduce readmissions. It notes that readmissions account for 20.5% of hospital admissions and reviews reasons for readmissions like medication issues, lack of follow-up care, and unhealthy lifestyles. The document outlines programs like TRACS, COMPASS and MISTT that provide post-discharge support through nurse coaching, medication management support and lifestyle counseling to reduce readmissions.
Effect of Behavioral Intervention on Reducing Symptom Severity during First C...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Establishment of a Rehabilitation Clinic for Colorectal Cancer. Will it End P...daranisaha
Colorectal cancer (CRC) is the third most common diagnosis and the second most lethal malignancy in both men and women.
To establish a rehabilitation clinic in the oncology department in hospitals and address its positive effect on colorectal cancer patients’ need.
This document reviews the evidence for managing locally advanced rectal cancers. It discusses how treatment has evolved from surgery alone to incorporating neoadjuvant radiation and chemotherapy. Neoadjuvant treatment has been shown to improve local control and survival compared to postoperative or adjuvant treatment. Achieving a pathological complete response after neoadjuvant therapy is associated with better long-term outcomes. Researchers have explored intensifying neoadjuvant treatment and increasing the interval before surgery to improve response rates. Accurately identifying patients who could avoid surgery through a "watch and wait" strategy depends on improved radiological assessment of tumor response.
Chair and Presenters, Sumanta Kumar Pal, MD, FASCO, Pedro C. Barata, MD, MSc, FACP, David F. McDermott, MD, and Tian Zhang, MD, MHS, prepared useful Practice Aids pertaining to renal cell carcinoma for this CME/MOC/NCPD/AAPA/IPCE activity titled “Advancing Personalized Care in RCC: Navigating Rapid Therapeutic Expansion and Sequencing Strategies.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/3uvvd5X. CME/MOC/NCPD/AAPA/IPCE credit will be available until February 25, 2025.
Only a small percentage of cancer patients are good candidates for proton therapy. Yet, for the right patients, proton therapy can reduce radiation exposure to healthy tissue. To help you make the best care decisions, this slide deck offers information to help you identify those of cancer patients best treated with proton therapy.
Cancer and the General Internist discusses how general internists can participate in cancer care. Key points include:
1. Cancer is a leading cause of death in the Philippines and costs of treatment are high, often leading to financial catastrophe for patients.
2. General internists can play roles in cancer screening, prevention through lifestyle counseling, and multidisciplinary care throughout the cancer continuum.
3. Filipinos actively search online for information about cancer signs, symptoms, and treatments. General internists are well-positioned to provide guidance and education to the public.
This survey aimed to assess clinicians' use of stereotactic radiotherapy and targeted therapies for metastatic renal cell carcinoma and determine support for future clinical trials. The primary objective was to evaluate the proportion of clinicians using radiotherapy for metastatic renal cell carcinoma. Secondary objectives included evaluating the proportion using targeted therapies and radiotherapy simultaneously, stopping targeted therapies for radiotherapy, and supporting further research. The online survey was distributed to members of urology and oncology groups in Australia and New Zealand to collect data on current practices. Results and conclusions will be presented at an upcoming conference.
This document provides guidelines for the treatment of hepatobiliary cancers from the National Comprehensive Cancer Network (NCCN). It was last updated on October 14, 2022. The guidelines include the latest recommendations for screening, diagnosing, and treating hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. New recommendations include durvalumab plus chemotherapy as a preferred regimen for unresectable biliary tract cancer, and selpercatinib for RET fusion-positive hepatobiliary tumors.
Surgical Risk Assessment is an Important Factor in any Surgical TreatmentJohnJulie1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
Surgical Risk Assessment is an Important Factor in any Surgical Treatmentsuppubs1pubs1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
This document discusses the need for geriatric assessments (GAs) in older cancer patients undergoing treatment. GAs evaluate patients' functional status, medical conditions, cognition, nutrition, social support and medications. The document aims to analyze evidence on how GAs impact treatment decisions and patient outcomes. It describes how GAs may alter treatments in up to 49% of patients by identifying age-related vulnerabilities. Studies show GAs correlate with survival rates, quality of life and toxicity risks. While GAs provide useful information, more research is still needed on their optimal use in oncology.
This document discusses barriers to the development and approval of targeted cancer therapies and companion diagnostics. It identifies key challenges such as identifying meaningful molecular targets, developing diagnostic tests, evaluating tests and therapies together, and administrative coordination between companies and regulatory agencies. The document proposes a "targeted development and approval" policy to facilitate accelerated development and approval of targeted therapies used with companion diagnostics. It outlines criteria for this policy, including that the diagnostic assay must demonstrate analytical validity and the therapy shows evidence the target population clinically benefits.
Rapid review of current service provision following cancer treatmentNHS Improvement
NHS Improvement carried out a rapid review of current provision of services for breast, prostate and colorectal cancer patients following treatment during the summer of 2009 at the request of the National Cancer Survivorship Initiative (NCSI). This publication shares the findings from this review.
(Published September 2010)
MicroGuide app, pop up uni, 1pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
Similar to Radiation treatment dropouts-Pitfalls and solutions: A retrospective observational study (20)
April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATROKanhu Charan
This document appears to be a newsletter or e-book with summaries of oncology research articles and case studies from March 2024 to mid-April 2024. It includes summaries on topics like radiotherapy dosing in head and neck cancer, genetic factors in breast cancer treatment, algorithms for surveillance of colorectal polyps, emerging tracers in neuro-oncology, target delineation workflows for various cancer sites, radiation therapy options for pituitary adenoma, comparisons of APBI guidelines for breast cancer, and associations between Chlamydia psittaci and orbital MALT lymphoma. The document also notes that April is National Oral Cancer Awareness Month.
TARGET DELINEATION OF THORACIC NODAL. STATIONKanhu Charan
The document discusses the different thoracic nodal stations that are relevant for staging lung cancer. It lists 24 different nodal station groups in the thoracic region, including supraclavicular, upper paratracheal, prevertebral, lower paratracheal, subaortic, para aortic, carinal, paraesophageal, and hilar nodal stations. Accurate identification of involved nodal stations is important for determining the stage and treatment planning for lung cancer patients.
TARGET DELINEATION IN RECTUM CANCER BY DR KANHUKanhu Charan
This document outlines the workflow for target delineation in radiation oncology for carcinoma of the rectum. It defines the gross tumor volume for the primary tumor (GTVp) and involved nodes (GTVn), as well as the clinical target volumes (CTVs) which add margins around the GTVs to cover microscopic disease. It describes the borders of the mesorectum and lists the lymph node regions included in the CTV for involved nodes. It concludes by specifying the planning target volumes (PTVs) which expand the CTVs and listing the dose schedules.
TARGET DELINEATION IN ANAL CANAL CANCER BY DR KANHUKanhu Charan
1. The document discusses target delineation and radiation therapy workflow for anal cancer, including definitions of gross tumor volume (GTV) and clinical target volumes (CTVs) based on anatomical locations.
2. It provides guidelines for determining margins around the GTV and nearby anatomical structures to create the CTVs for the primary tumor (CTVp), involved nodes (CTVn), and elective nodal regions (CTVnLR) to cover possible microscopic disease.
3. Treatment planning volumes (PTVs) are created by adding margins to the CTVs, with the PTV-HR receiving the full prescription dose and the PTV-LR receiving a lower dose.
TARGET DELINEATION IN VULVAL CANCER BY DR KANHUKanhu Charan
The document outlines the steps and guidelines for target delineation in vulval cancer radiation therapy planning. It discusses delineating the gross tumor volume (GTV), clinical target volume (CTV), organs at risk (OAR), and planning target volume (PTV). Specific guidelines are provided for contouring depending on the location and extent of the primary tumor, including the vulva, mons pubis, vagina, anorectum, urethra, and clitoris. Radiation dose parameters and OAR constraints are also reviewed. The target delineation workflow aims to adequately cover suspected disease while minimizing dose to surrounding healthy tissues.
TARGET DELINEATION IN CERVIX CANCER BY DR KANHUKanhu Charan
This document outlines the 10 step workflow for target delineation in cervical cancer radiotherapy treatment planning. It describes the clinical target volumes that should be contoured for the primary gross tumor (GTVp), primary clinical target (CTVp), nodal gross tumor (GTVn), nodal clinical targets (CTVn) and elective nodal volumes. It provides explanations and guidelines for delineating each target volume, including the parametrium and nodal regions. Diagrams and images are included to illustrate the anatomical locations and boundaries of the target volumes.
Oncology cartoons by Dr Kanhu Charan PatroKanhu Charan
This document provides guidance on target volume delineation for vulval cancer from the Royal College of Radiologists. It outlines the clinical target volume (CTV) for different disease sites, including the vulva, mons pubis, vagina, anorectum, urethra and pelvic nodes. Contouring workflows and organ-at-risk constraints are also discussed. Recommendations are given for radiation dose and treatment of resectable and unresectable head and neck cancer. The final item notes that smoking increases the risk of kidney cancer.
RADIATION THERAPY IN BILIARY TRACT CANCERKanhu Charan
This document provides information on biliary tract cancers and the role of chemoradiotherapy in their treatment. It discusses the anatomy and types of biliary cancers, risk factors, presentation, diagnosis, staging, and standard treatment approaches including surgery. It then focuses on the evidence and guidelines for use of radiation therapy, including as adjuvant therapy after surgery for positive margins or nodes, as radical/definitive therapy for unresectable disease, and for palliation of symptoms from local or metastatic disease. Key findings are that chemoradiation improves local control and survival as adjuvant or radical therapy, and brachytherapy and external beam radiation are effective for palliation. Optimal regimens involve fluorouracil or capec
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUMEKanhu Charan
Dr Kanhu Charan Patro provides summaries of statistical concepts in 3 sentences or less, beginning each summary with the date. Summaries from January 19th to February 15th are presented, covering topics such as p-values, censoring in survival analysis, hazard ratios, and ISRS guidelines for stereotactic radiosurgery. On February 15th, a 3 sentence summary of World Cancer Day is provided, noting the date it is held, the organization that leads it, and the 2024 slogan of "Close the care gap".
Molecular Profile of Endometrial cancer.Kanhu Charan
The document discusses molecular analysis and classification of endometrial cancer, which impacts staging and treatment decisions. It describes aggressive histological subtypes and how molecular markers like POLE mutations, MMRd, and p53 abnormalities determine low, intermediate, or high risk stratification. Ongoing PORTEC trials are exploring the impact of molecular profiling on adjuvant treatment, with POLE mutations potentially downstaging while p53 mutations upstage disease. Molecular analysis provides predictive significance for personalized adjuvant therapies in endometrial cancer.
ONCOLOGY CARTOONS JANUARY 2024 BY DR KANHU CHARAN PATROKanhu Charan
This document discusses cervical cancer awareness month in January and provides 3 recommendations: 1) Be loyal to your partner to reduce risk of HPV infection, 2) Maintain genital hygiene, 3) Get vaccinated against HPV to prevent cervical cancer, and 4) Get screened regularly to detect cervical cancer early.
TYPES OF STATISTICAL DATA BY DR KANHU CHARAN PATROKanhu Charan
This document discusses types of data in statistics. It defines qualitative and quantitative data, and describes different types of quantitative data like discrete, continuous, ordinal, and nominal. Examples of love and fight data are provided to illustrate these concepts. The document concludes with a short poem about not fighting in marriage.
WHY STEREOTATXY IN CRANIAL AVM / DR KANHU CHARAN PATROKanhu Charan
This document discusses stereotactic radiosurgery (SRS) for the treatment of cerebral arteriovenous malformations (AVMs). It begins by explaining what an AVM is and the risks they pose if untreated, such as bleeding in the brain. It then covers treatment options for AVMs and why SRS is often preferred for certain cases, such as when the AVM is in an eloquent or deep brain area. The document provides details on patient selection, imaging and planning for SRS, anticipated outcomes, and risks of treatment complications. It emphasizes the importance of multidisciplinary discussion and informed consent when determining if SRS is appropriate for a patient's individual AVM.
1) SBRT is an effective treatment for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT). In a study of 70 HCC patients with PVTT treated with SBRT, median survival was 10 months and 6-month and 12-month survival rates were 67.3% and 40% respectively.
2) Patients who received SBRT combined with transarterial chemoembolization (TACE) had significantly longer survival compared to those who did not receive TACE after SBRT.
3) SBRT is a promising bridging therapy prior to liver transplantation or hepatectomy by downstaging PVTT to make these curative procedures possible.
DR KANHU CHARTAN PATRO/ FOR ENT SURGEONSKanhu Charan
1. Radiotherapy plays a crucial role in the treatment of head and neck cancers, both as a primary treatment and in combination with surgery. It is used for cancers of the nasopharynx, larynx, hypopharynx, and as postoperative treatment for most oral cancers.
2. Advances in radiotherapy technology such as IMRT have allowed for better tumor targeting while minimizing doses to surrounding healthy tissues, reducing treatment toxicities. Imaging techniques such as PET-CT provide improved visualization of tumors and affected lymph nodes, helping determine accurate target volumes.
3. Organ preservation approaches using radiotherapy and chemotherapy are increasingly used to treat head and neck cancers, avoiding disfiguring surgeries while achieving high
DECEMBER 2023 ONCOLOGY CARTOONS DRKANHU CHARAN PATROKanhu Charan
Here are the key points about the hepatitis B vaccine and liver cancer:
- Hepatitis B virus (HBV) infection can lead to chronic hepatitis B and significantly increase the risk of developing liver cancer later in life.
- The hepatitis B vaccine is effective at preventing HBV infection and therefore helps prevent liver cancers caused by the virus. It was the first vaccine referred to as an "anti-cancer" vaccine by the FDA.
- Around 25% of people with chronic HBV infection may develop liver cancer according to the CDC. Getting vaccinated helps avoid this risk.
- The hepatitis B vaccine is available and affordable in India, ranging from around 45 rupees per pediatric dose to 250 rupees for the
DEBATE IN CA BLADDER TMT VS CYSTECTOMYKanhu Charan
1) Dr. KanhuCharanPatro is a radiation oncologist who specializes in stereotactic radiation oncology for treating cancers like urinary bladder cancer.
2) The document discusses trimodal therapy (TMT) versus radical cystectomy (surgery to remove the bladder) for treating urinary bladder cancer, citing evidence from studies that TMT may provide comparable survival outcomes to cystectomy with fewer side effects and better quality of life.
3) A meta-analysis of over 50,000 patients found that TMT had non-inferior overall survival rates to cystectomy at over 10 years and may be a reasonable alternative for patients who cannot undergo or do not want surgery.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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the treatment is delivered, that is, the overall treatment
time (OTT).[2]
Radiation is usually delivered on a five‑days‑a‑week schedule
completed within a certain predetermined number of
weeks.[1]
However, unplanned interruptions may occur during
the predefined treatment schedule that are termed treatment
dropouts. This is a common phenomenon, particularly in
busy radiation centers and in large academic institutions.
Interruptions or dropouts in radiotherapy have a deleterious
effect in the form of decreased locoregional control due to
tumor repopulation.[3,4]
A treatment break of even a single
day in head-and-neck cancers can result in a decrease in local
control by 1.4%.[4]
McCloskey et al., in their study on patients
with head-and-neck cancers treated with definitive concurrent
chemoradiotherapy, showed that locoregional failure was more
in patients who had an interruption of radiation treatment of
more than a week as compared to those who had no treatment
breaks.[5]
According to the American Brachytherapy Society, the
total treatment duration for cervical cancer (including external
beam radiotherapy and brachytherapy) should be limited to
eightweeks.[6]
Prolongationof theOTTforcervical cancerleads
to a daily decrease of 0.6–1% in local control.[6]
It therefore becomes important to quantify treatment
interruptions in practice, to characterize the reasons for
the interruptions, and to provide solutions. We therefore
conducted this study to understand the reasons for radiation
treatment interruptions at our center, and to formulate
possible solutions that could help in decreasing the
occurrence of treatment dropouts.
MATERIALS AND METHODS
General study details
This was a retrospective observational study conducted at
the Mahatma Gandhi Cancer Hospital and Research Institute,
a tertiary cancer center in Vishakhapatnam, Andhra Pradesh,
India; analysis was performed in November 2022 for the
study conducted between May 2009 and July 2010. As it was
a retrospective analysis, ethical committee clearance was not
required as per our institutional guidelines. Additionally, as it
was a retrospective study, written informed consent could not
be obtained, and this was not necessary as per the institutional
guidelines. The study was conducted according to the ethical
guidelines established by the Declaration of Helsinki and Good
Clinical Practice Guidelines. The study was not registered with
a public clinical trials registry, as it was not an interventional
clinical trial. No funding was received for this study.
Participants
We included patients with biopsy‑proven cancer who received
radiation treatment as radical concurrent chemoradiotherapy,
adjuvant, or palliative therapy depending upon the indications
and site of tumor, and had been treated at our center during
the study period. We excluded patients whose medical records
did not contain complete biopsy and treatment reports.
Aims/objectives
Our primary objective was to determine the frequency
of radiation treatment interruptions and the factors that
predisposed to these interruptions and to propose solutions.
PUTTING IN PERSPECTIVE
Central question
• What are the causes of radiotherapy treatment interruptions?
Key findings
• 100 of 1200 (8.3%) patients had radiation treatment interruptions or dropouts.
• The main causes of radiation treatment interruptions were radiation reactions or toxicity (20 [20%]), death (15 [15%]),
progressive disease (10 [10%]), financial constraints (15 [15%]), social issues (12 [12%]), referral misguidance (9 [9%]),
mistaken satisfaction due to treatment response and impression by the patient or caregiver that the disease had been
cured early (6 [6%]), non-compliance (7 [7%]), and change in radiation plan (6 [6%]).
• There were no radiation interruptions due to machine breakdown during the study.
• Counseling at three different levels, that is, by the radiation oncologist (level I), radiation counselor (level II), and radiation
therapy technologist (level III), was implemented in an attempt to increase the treatment compliance of patients.
• Treatment could be restarted in 25 (25%) patients of a total of 100 dropouts, after counseling.
Impact
• Apart from counseling, various other issues such as financial support, motivating patients to continue despite radiation
reactions, educating non‑oncology physicians regarding treatment compliance, and resolving machine breakdown need
to be addressed to further decrease these dropouts.
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Study methodology
Eligible patients were identified from the medical records
section of our institute. The complete demographic data of
the eligible patients including clinical details, sex, primary
site, treatment interruption, and duration were collected
from the clinical case records. The data were carefully
checked for quality to ensure completeness and accuracy. We
did not collect or record any personal identification data of
the patients. As part of routine care, patients were discussed
in the multidisciplinary tumor board and were then planned
for radiation therapy. The radiation dose and fractionation
used at various tumor sites are depicted in Table 1.
Counseling of patients was performed at three levels during
various stages of radiation delivery—level I by the radiation
oncologist, level II by the radiation coordinator or counselor,
and level III by the radiation therapy technologist. During
the initial visit, the radiation oncologist (level I) counseled
the patients and their attendants regarding all aspects of
radiation—starting from the simulation process, treatment
initiation and continuation, probable side-effects and their
management, and prognosis of the disease. Thereafter,
patients and their attendants were again counseled by the
radiation coordinator or counselor (level II) regarding the
various steps of the radiation process, that is, simulation,
treatment start, and possible side-effects. On the day of
the start of radiation treatment, the radiation therapy
technologist (level III) counseled the patients and their
attendants regarding the treatment process. A specific time
slot was allotted to each patient to avoid unnecessary waiting
for radiation delivery.
During the radiation treatment, patients were reviewed once
a week by the radiation oncologist to evaluate and treat the
side-effects of radiation. Counseling was done regarding
the importance of treatment continuation and the possible
consequences of discontinuation, that is, recurrence of
disease.
Missing treatment for more than five consecutive
days (excluding weekends and public holidays) during
radiation therapy was labeled as radiation treatment
interruption or dropout. Patients who had treatment
interruptions were called on the telephone and efforts were
made to determine the cause, followed by counseling to solve
the problem and resume treatment. The causes of treatment
interruption were recorded under the following headings:
death, misguidance by non‑oncology physicians (sometimes
patients were referred to non‑oncology doctors for
management of comorbidities, and these physicians, due
to lack of knowledge, occasionally misguided the patients,
telling them that the radiation treatment was completed),
financial problems, false sense of patient satisfaction (rapid
tumor regression during radiation treatment, which
sometimes led patients to assume that the disease was cured
early), old age, comorbidity, or social issues, progressive
disease, change in treatment, toxicity, patient frustration due
to machine breakdown (occasionally leading to permanent
discontinuation of radiation), or non-compliance with the
radiation treatment schedule.
Statistics
As this was a retrospective study, we did not calculate
the sample size a priori. We included all eligible patients
during the study period. Statistical analysis was performed
in the Statistical Package for the Social Sciences (SPSS)
software (IBM Corp. Released 2012. IBM SPSS Statistics
for Windows, Version 21.0. Armonk, NY: IBM Corp.). We
performed simple descriptive statistics and represented the
data in the form of numbers and percentages. We did not
perform any tests for statistical significance.
RESULTS
Of 1378 patients screened over the 15 months period, that
is, from May 2009 to July 2010, 1200 were included as the
final study population [Figure 1].
Among the 1200 patients who started radiation, there
were 724 (60.4%) male patients; 379 (31.6%) patients
had head-and-neck malignancies. The vast majority of
patients were receiving therapy with curative intent (1142,
95.2%) [Table 2]. Of the 1200 patients who started radiation,
100 patients (8.3%) stopped radiation in the midst of
treatment (termed as dropouts), as shown in Table 3. The
top three causes for dropouts included radiation toxicity (20,
20%), death due to various causes such as toxicity, disease
progression, or other reasons like infections (15, 15%), and
financial issues (15, 15%). After counseling all the 100 patients
who had treatment interruptions, treatment was restarted
Table 1: Fractionation sizes for various sites of radiation
treatment received by patients enrolled in the study on
radiation interruptions
Tumor site Fractionation
size
Radiotherapy only or
concurrent chemoradiotherapy
Head-and-neck 1.8–2 Gy/fraction Concurrent chemoradiotherapy
Brain 1.8–2 Gy/fraction Concurrent chemoradiotherapy
Breast 1.8–2 Gy/fraction Radiotherapy
Gynecological 1.8–2 Gy/fraction Concurrent chemoradiotherapy
Gastrointestinal 1.8–2 Gy/fraction Concurrent chemoradiotherapy
Genitourinary 1.8–2 Gy/fraction Concurrent chemoradiotherapy
Palliative radiation
(various sites)
3 Gy/fraction Radiotherapy
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in 25 (25%) patients, that is, one‑quarter of the total number
of dropouts. The other 75 (75%) patients did not resume
radiation after interruption, despite counseling.
DISCUSSION
In the present study conducted on 1200 patients receiving
radiation over a 15‑month period, 100 (8.3%) patients
discontinued radiation treatment, which is lower than what
has been reported in most other studies in the literature.
The retrospective study on treatment interruption in patients
with cancer treated between 2012 and 2013 by Razmjoo et al.
showed that of a total of 1476 cases, there were 432 (29.3%)
treatment breaks.[1]
Giddings analyzed 471 patients with
head-and-neck cancer from 2006 to 2008 and found that
there were 74% treatment interruptions during radiation.[3]
Lee et al., in their study on treatment interruptions during
radiation therapy, found 220 (13.4%) radiation treatment
interruptions in a total of 1500 patients.[7]
Our low level of
treatment interruptions or dropouts may have been due to
the counseling system put in place at multiple levels as a
part of routine care.
In our study, the maximum number of dropouts (20%) were
due to treatment‑related toxicity, especially mucositis and
dysphagia. Acute radiation reaction, that is, a reaction
Total number of patients’ case sheets
accessed from the institutional medical
records from May 2009 to July 2010
(n = 1378)
Excluded (n = 178)
• Complete demographic data missing (n = 23)
• Complete treatment records missing (n = 155)
Final enrolled population
(n = 1200)
Type of radiation treatment received (n = 1200)
• Curative (n = 1142): 50–70 Gy radiotherapy +/- concurrent chemotherapy
• Palliative (n = 58): 30 Gy, only radiotherapy
Treatment completion (n = 1200)
• Completed full treatment course without interruption (n = 1100)
• Treatment interrupted >5 consecutive days excluding public holidays
(n = 100)
○ Treatment restarted after telephonic counseling (n = 25)
○ Treatment not completed despite telephone counseling (n = 75)
Analysis set (patients with treatment interruptions) (n = 100)
• Patients contacted over telephone (n = 100)
• Patients who provided reasons for interruptions (n = 100)
Figure1:Flowdiagramshowingtheselectionprocessofthestudypopulation
Table 2: Clinicodemographic details and the intent of treatment
of patients enrolled in the study on radiotherapy interruptions
Variable Number of patients (percentage) (n=1200)
Sex
Male 724 (60.4)
Female 476 (39.6)
Tumor site
Head-and-neck 379 (31.6)
Brain 52 (4.3)
Breast 128 (10.7)
Gynecological 301 (25.1)
Gastrointestinal 142 (11.8)
Genitourinary 83 (6.9)
Others* 115 (9.6)
Intent of therapy
Curative 1142 (95.2)
Palliative 58 (4.8)
*Soft tissue sarcoma (15 [1.25%]), Ewing’s sarcoma (15 [1.25%]), acute leukemia
(5 [0.4%]), lung (10 [0.8%]), lymphoma (30 [2.5%]), Wilms’ tumor (5 [0.4%]),
rhabdomyosarcoma (4 [0.3%]), and bone metastasis (31 [2.6%])
Table 3: Details of the patients enrolled in the study, who received radiation treatment, and the dropouts, that is patients who did
not receive radiation for five consecutive days, excluding weekends and public holidays
Event Number of patients (percentage) (n=1200)
Total number of patients started on radiation 1200 (100)
Patients who did not receive radiation for five consecutive treatment days (i.e., dropouts) 100 (8.3)
Reasons for dropouts (n=100)
Death
Social issues
Toxicity*
Progressive disease
Referral misguidance**
Incorrect satisfaction with early tumor response by patient or family
Financial issues
Non-compliance***
Change in treatment
Machine breakdown
15 (15% of total dropouts)
12 (12% of total dropouts)
20 (20% of total dropouts)
10 (10% of total dropouts)
9 (9% of total dropouts)
6 (6% of total dropouts)
15 (15% of total dropouts)
7 (7% of total dropouts)
6 (6% of total dropouts)
0 (0% of total dropouts)
Number of patients who resumed treatment after counseling 25 (25% of total dropouts)
*Toxicities included mucositis (11 [55%] patients), dysphagia (9 [45%] patients), and vomiting (3 [15%] patients) **Sometimes patients who had been referred to non‑oncology
doctors for the management of comorbid conditions were misguided by them regarding treatment completion due to a lack of knowledge about the course and regimen of the
radiotherapy. ***Patients did not complete the scheduled treatment due to various reasons, for example, a family problem that necessitated the patient to return home (locally, far
away from the treatment center) midway through the treatment
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that occurs during radiation treatment and up to 6 weeks
after treatment completion, was the most common cause
of treatment interruption in the study on radiotherapy in
nasopharyngeal cancers by Chen et al.[8]
Acute radiation
reactions are inevitable and are the most common reasons
for non-compliance of patients. The management of these
toxicities would include early detection during weekly
reviews by the radiation oncologist and adequate use of
supportive medications.
Muzumder et al. in their study found that of 148 patients with
head-and-neck cancers treated with radiotherapy, 46 (31%)
had treatment interruptions, which was higher than what
we noted in our study (20%).[9]
The Grade 3 acute toxicities
in the study by Muzumder et al. included dysphagia (46.1%),
mucositis (28.5%), and nausea and vomiting (0%), while in
our study, the most common acute toxicity was Grade 3
mucositis (55%) followed by dysphagia (45%) and nausea and
vomiting (15%). Radiation mucositis leads to pain, dysphagia,
dependency on nasogastric tube feeding, weight loss, and
possibly even death due to aspiration. This depends on the
tumor site, volume of tissue irradiated, treatment dose,
and fractionation. Concurrent chemotherapy further adds
compounds mucositis. These effects can be mitigated by
the use of midline blocks or conformal radiation technique,
benzydamine mouthwash, nasogastric tube for feeding,
and nutritional supplementation during the entire course
of radiotherapy.[10‑13]
Acute gastrointestinal toxicity results
from radiation‑induced death of intestinal stem cells in the
intestinal crypts that are unable to replace the damaged
surface epithelium. Radiation also leads to damage to the
underlying blood vessels.[14]
Gastrointestinal toxicity can be
in the form of nausea, vomiting, loss of appetite, bleeding,
and diarrhea. It depends on many factors such as site of
the primary tumor, treatment volume, total dose, and
fractionation.[15]
Strategies for preventing gastrointestinal
toxicity include following full bladder protocol for treatment
as this will displace the small bowel out of the radiation
portals, treating in the prone position with a belly board that
will allow the bowel to fall off with gravity to outside the
radiation field, and using intensity‑modulated radiotherapy,
image‑guided radiotherapy, proton therapy, or brachytherapy
that will target the tumor while sparing the normal tissues.
Gastrointestinal toxicity can be well managed by nutritional
support and diet.[15‑18]
These acute toxicities can be mitigated
by proper counseling before the start and throughout the
radiation treatment regarding possible side-effects and
advising necessary medications during a regular review of
patients every week during the treatment. Additionally, the
patients need to be educated that these acute side-effects are
temporary and will resolve after the completion of treatment.
The second most common cause of treatment interruption in
our study was death, which accounted for 15% of dropouts.
A retrospective analysis of 56 patients was conducted by
Domschikowski et al., to find the cause of death in patients
treated with radiotherapy. The most common cause of death
was multi‑organ failure related to cancer (26 patients),
followed by combined causes of tumor and infection, cardiac
complications, and embolism (16 patients) and causes
unrelated to cancer (cardiac infarction, infection, respiratory
failure, etc.) (14 patients).[19]
Thus, the death of patients
during radiotherapy could be due to coexisting infection,
hematologic toxicities in patients receiving concurrent
chemotherapy, comorbid conditions, mismanaged toxicities,
nutrition problems, electrolyte imbalance, etc. Dropouts
due to death are cause‑specific and can be decreased by
performing a thorough complete initial evaluation and review
of all the comorbidities at regular reviews and timely referrals.
Patients with high‑risk comorbidities should strive to consult
with their non‑oncology physicians during radiation for the
management of their comorbidities.[20]
We found that 15% of the patients interrupted radiation
treatment due to financial issues. Radiation treatment is
costly and patients had to travel daily during the course of
treatment, which added to the financial burden on the family.
Many families were unable to bear such huge expenses unless
helped by non-governmental organizations or societies. Some
of the patients had to rent an apartment for 1–2 months near
the hospital to enable them to complete the treatment. . Some
patients and their relatives were unable to resume radiation
after interruption, due to ongoing financial problems.
Unfortunately, details regarding the income of the patients
were not available. Razmjoo et al. showed that 1.9% of the
patients had to interrupt their treatment due to monetary
problems.[1]
Health Minister’s Cancer Patient Fund helps in
providing financial assistance to patients with cancer below
the poverty line.[21]
Financial issues can be solved by taking
the help of various non-governmental organizations and trust
societies and referring needy patients to government hospitals
for treatment.[22,23]
The most common cause of treatment breaks in the study
by Lee et al. was tumor progression including death, which
was seen in 30% of patients.[7]
Dropouts due to progressive
disease accounted for 10% of the total dropouts in our study.
This is usually seen in cases with advanced disease, mostly
in patients with head-and-neck cancers. The cause of early
disease progression may have been due to aggressive tumor
biology or an incorrect plan of treatment starting from the
decision to administer radiation, drawing wrong contours,
or a bad radiation plan (any plan by the physicist that was
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not according to the standard or any plan in which further
modification could have resulted in better tumor coverage
and sparing of the normal tissues from radiation exposure,
thus leading to decreased toxicity). These issues need to
be addressed meticulously by ensuring that treatment is
delivered by a multidisciplinary team, following adequate
and appropriate radiation guidelines, and peer review of
radiation contours and plans.[24‑26]
In our study, treatment interruption due to social issues
occurred in 12% of patients. Dropouts due to social
issues were mainly because of old age (poor mobility and
lack of caregivers), social inhibition, lack of adequate
caregiver support, lack of knowledge about the disease,
fearfulness (particularly of the side-effects of radiation),
etc. Dropouts due to social issues can be solved by proper
counseling and increasing awareness about the disease and
the importance of completing the whole course of radiation
treatment to the patient’s outcome and survival.
Radiation treatment is usually delivered over six to eight
weeks depending on the tumor site, and the course is
protracted as compared to other treatments. Dropouts due
to referral misguidance are because doctors without oncology
training lack knowledge about the radiation treatment
duration. Therefore, when sending these patients to other
specialty doctors for the treatment of various comorbid
illnesses, management of toxicity, and other related issues,
they may be misguided and assume that the radiation is
complete, so they may not send the patients back to the
Radiation Oncology Department. Dropouts due to referral
misguidance occurred in around 9% of all dropouts in the
present study. This issue could be mitigated by providing
adequate information to non‑oncology doctors regarding
the radiation treatment schedules and the importance of
adherence to the prognosis and overall survival of patients.
Some patients whose tumors responded rapidly during
treatment, mostly as a result of regression of a large nodal mass
or symptomatic benefit, felt satisfied and wrongly concluded
that the disease was cured, and they therefore discontinued
treatment. In the current study, six (6%) patients interrupted
their treatment due to the false belief that the disease had
been prematurely cured. Such dropouts could be prevented by
proper counseling regarding the fact that cure of the disease
wouldbepossibleonlyoncompletionoftheplannedtreatment
and discussing the likelihood of recurrence of the disease and
incurability in case of incomplete therapy.
Decision change by the radiation oncologist during treatment
occurred in 6% of patients, which led to dropouts. This issue
may be prevented by peer review by radiation oncology
colleagues and tumor board discussion for all cases before
the start of treatment.
In the study by Razmjoo et al., the most common cause of
treatment interruptions in Iran was machine breakdown
or maintenance accounting for 29.5% of interruptions,
followed by side-effects of radiation seen in 16.7% , public
holidays in 8.1%, and death in 5.3% of patients.[1]
Radiation
interruptions due to machine breakdown varied from
country to country—44% in the UK, 45% in Spain, and 2% in
Vancouver.[1]
Dropouts due to machine breakdown occur due
to frustration among the patients who end up having to wait
the whole day for the commencement of treatment. There
were no radiation interruptions due to machine breakdown
in our study. This was possible by instituting an annual
maintenance contract for the machines. An engineer was
deployed for our machines so that machine‑related problems
could be resolved expediently, and patients did not have to
wait long for their treatment. Additionally, our physicists or
technologists were trained to handle small machine problems
on their own.
In our study, dropouts due to non-compliance were seen in
seven (7%) patients. In the overall cohort, 25 (25%) patients
agreedtocontinueradiationaftercounseling.Thiswaspossible
because of proper counseling not just before the start of
radiationbutalsoduringradiationtherapy.Itisvitallyimportant
to discuss the importance of compliance to the planned
radiotherapy regimen with the patient and family members.
Table 4 summarizes the various causes of radiation treatment
dropouts and the suggested methods to solve each issue.
A limitation of our study was the lack of generalizability of the
results as it was a single institutional study, and the sample
size was relatively small. Additional studies with large sample
sizes are necessary to corroborate these results. We only
included patients who received long‑course radiotherapy or
concurrent chemoradiotherapy in the standard fractionation
scheme; short‑course therapy was not included except for
patients who were treated with palliative intent.
CONCLUSION
Inoursetup,8.3%ofourpatientshavetreatmentinterruptions.
The three most common causes of such interruptions are
acute radiation toxicity, financial issues, and death. Proper
counseling at various levels of patient interaction by the
radiation oncologist, radiation counselor, and radiation
therapy technologists throughout the treatment period
can decrease the dropouts in radiation treatment. Apart
from counseling, various other measures such as financial
assistance, motivating patients to continue despite radiation
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reactions, educating non‑oncology physicians regarding the
need for treatment compliance, and resolving the machine
breakdowns will further decrease these dropouts.
Author contributions
Study conception and design: all authors; data collection
and analysis: MA, KK, KLR; statistical analysis and manuscript
preparation: KCP, AA; manuscript editing: PSB, VKRP, MM,
VM; review and critical revision of the manuscript, and
final approval of the version to be published: all authors;
accountability for all aspects of the work: all authors.
Data sharing statement
Individual de‑identified participant data will be made
available on reasonable request, from Dr. Kanhu Charan
Patro drkcpatro@gmail.com), starting from the date of
publication, until 10 years after publication. Requests beyond
this time frame will be considered on a case‑by‑case basis.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Table 4: Causes of radiation treatment interruptions and possible solutions to mitigate individual issues
Causes of treatment dropouts Methods to mitigate the problem
Acute radiation toxicity during radiation •
Conformal radiation technique
•
Midline block
•
Nasogastric tube feeding
•
Mouthwash using benzydamine
•
Nutritional and diet supplementation
Death during radiation •
Comprehensive evaluation of all health‑related comorbidities before the start of
radiation
•
Steps to be taken to address such issues, such as setting up standard operating
procedures for the management of comorbid conditions before the start of radiation
Tumor progression during radiation •
Taking the help of a multidisciplinary tumor board to plan appropriate treatment
strategy before the start of radiation
•
Peer review of radiation contours and plans before treatment approval and delivery
Social issues such as older persons without caregivers, social
inhibition (fears and myths in the minds of patients regarding
treatment‑related side-effects), lack of knowledge of the
disease and radiation treatment, non-compliance by relatives
•
Proper counseling
•
Increasing awareness regarding cancer and the need for compliance with treatment
Financial issues •
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•
Timely referral to government radiation centers
Referral misguidance* •
Educating non‑oncology physicians regarding the importance of radiation treatment
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•
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Changing decision during treatment by the treating physician •
Peer review
•
Tumor board case discussion
Machine breakdown or maintenance •
Annual and regular maintenance during weekends and holidays
•
Having an engineer on‑site for easy handling of machine issues
•
Giving training to the radiation physicist and technologist to handle minor
machine-related problems
*On referral to non‑oncology doctors for the management of comorbid conditions, patients are sometimes misguided by them regarding treatment completion due to ignorance
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VISUAL ABSTRACT
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