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Barnes M.,Cancer Agency Center for the North | Tiwana M.S.,Cancer Agency Center for the North | Tiwana M.S.,University of Northern | Kiraly A.,University of Northern | And 4 more authors.
Journal of Bone Oncology | Year: 2015

Purpose This study assesses the incidence of distal bone metastases in palliative radiotherapy (RT) patients. Material and methods All courses of RT for bone metastases from 2007-2011 for patient living in British Columbia (BC) were identified in a provincial RT programme. Treated bone metastases (BoM) were categorized as distal if the BoM was located within or distal to the elbow or knee. Patients were grouped by primary tumour site as breast, lung, prostate gastrointestinal, haematological, melanoma, and other. The incidence of distal bone metastases and associations with primary tumour types were determined. Results From 2007 to 2011, 8008 patients were treated with 16,277 courses of RT, of which 425 (3%) were courses of RT for distal BoM. The incidence of distal BoM in decreasing order by primary tumour type was melanoma (5%), haematological (3%), lung (2%), other (2%), prostate (2%), breast (1%) and gastrointestinal (1%). Distal BoM where more commonly identified in the lower extremity (87%, p<0.001). Single fraction RT was used more commonly for distal vs non-distal BoM (66% vs. 49%; p<0.001). Conclusion The incidence of distal BoM among patients treated with palliative RT was 3% and most commonly identified in patients with melanoma and haematological malignancies. © 2015 The Authors. Published by Elsevier GmbH.


Tiwana M.S.,Cancer Agency Center for the North | Tiwana M.S.,University of Northern British Columbia | Barnes M.,Cancer Agency Center for the North | Kiraly A.,University of Northern British Columbia | And 3 more authors.
BMC Palliative Care | Year: 2016

Background: Palliative radiotherapy (PRT) can significantly improve quality of life for patients dying of cancer with bone metastases. However, an aggressive cancer treatment near end of life is an indicator of poor-quality care. But the optimal rate of overall palliative RT use near the end of life is still unknown. We sought to determine the patterns of palliative radiation therapy (RT) utilization in patients with bone metastases towards their end of life in a population-based, publicly funded health care system. Methods: All consecutive patients with bone metastases treated with RT between 2007 and 2011 were identified in a provincial Canadian cancer registry database. Patients were categorized as receiving RT in the last 2 weeks, 2-4 weeks, or >4 weeks before their death. Associations between RT fractionation utilization by these categories, and patient and provider characteristics were assessed through logistic regression. Results: Of the 16,898 courses 1734 (10.3) and 709 (4.2 %) were prescribed to patients in the last 2-4 weeks and <2 weeks of their life, respectively. Primary lung (8 %) and gastrointestinal (6.9 %) cancers received palliative RT more commonly in the last 2 weeks of life (OR 3.72 [2.86-4.84] & 3.33 [2.42-4.58] respectively, p <0.001). Among the 709 patients who received RT in the last 2 weeks of life, 350 (49), 167 (24), and 127 (18 %) were for spine, pelvis, and extremity metastases, respectively. RT was prescribed most frequently to spine (5 %) and extremity (4 %) metastases p <0.001 in the last two weeks of life, though only varied between 1 % (sternum) and 5 % (spine) by site of metastases. Single fraction RT was prescribed more commonly in the last 2 weeks of life (64.2 %), compared to individuals who received RT 2-4 weeks (54.5), and >4 weeks (47.9 %) before death (p <0.001). Conclusions: This population-based analysis found that only 4 % of patients with bone metastases received radiation therapy during the last 2 weeks of their life in our population-based, publicly funded program, though it was significantly higher in patients with lung cancer and those with metastases to the spine or extremity. Appropriately, use of multiple fractions palliative RT was less common in patients closer to death. © 2016 Tiwana et al.


Pope D.J.,University of Wollongong | Cutajar D.L.,University of Wollongong | George S.P.,University of Wollongong | Guatelli S.,University of Wollongong | And 5 more authors.
Physics in Medicine and Biology | Year: 2015

Low dose rate brachytherapy is a widely used modality for the treatment of prostate cancer. Most clinical treatment planning systems currently in use approximate all tissue to water, neglecting the existence of inhomogeneities, such as calcifications. The presence of prostatic calcifications may perturb the dose due to the higher photoelectric effect cross section in comparison to water. This study quantitatively evaluates the effect of prostatic calcifications on the dosimetric outcome of brachytherapy treatments by means of Monte Carlo simulations and its potential clinical consequences. Four pathological calcification samples were characterised with micro-particle induced x-ray emission (μ-PIXE) to determine their heavy elemental composition. Calcium, phosphorus and zinc were found to be the predominant heavy elements in the calcification composition. Four clinical patient brachytherapy treatments were modelled using Geant4 based Monte Carlo simulations, in terms of the distribution of brachytherapy seeds and calcifications in the prostate. Dose reductions were observed to be up to 30% locally to the calcification boundary, calcification size dependent. Single large calcifications and closely placed calculi caused local dose reductions of between 30-60%. Individual calculi smaller than 0.5 mm in diameter showed minimal dosimetric impact, however, the effects of small or diffuse calcifications within the prostatic tissue could not be determined using the methods employed in the study. The simulation study showed a varying reduction on common dosimetric parameters. D90 showed a reduction of 2-5%, regardless of calcification surface area and volume. The parameters V100, V150 and V200 were also reduced by as much as 3% and on average by 1%. These reductions were also found to relate to the surface area and volume of calcifications, which may have a significant dosimetric impact on brachytherapy treatment, however, such impacts depend strongly on specific factors in the patient's individual treatment. These factors include the number, size, composition and spatial distribution of calcifications in the prostate as well as the distribution of brachytherapy seeds. © 2015 Institute of Physics and Engineering in Medicine.


Howard A.F.,University of British Columbia | Howard A.F.,Cancer Agency Vancouver Center | Hasan H.,Cancer Agency Vancouver Center | Bobinski M.A.,University of British Columbia | And 6 more authors.
Journal of Cancer Survivorship | Year: 2014

Background: Paediatric brain tumour survivors (PBTS) are at high risk for medical, neurocognitive and psychological sequelea during adulthood. Details illustrating the types and breadth of these chronic sequelae are essential to fully comprehend their impact on daily living. Purpose: This study describes Canadian parents of PBTS perspectives of life challenges experienced by their now adult son or daughter related to work and finances, daily and social functioning, and legal difficulties. Method: Parents of PBTS completed an anonymous online exploratory survey. Findings: Forty-six of 60 invited parents completed the survey. Parents reported that PBTS experienced difficulty gaining or sustaining employment (65 %) because of their health and/or a disability and employers reticence to hire and adequately support PBTS. Independent living was considered unaffordable for PBTS who received a disability allowance (82 %) and those who were employed (50 %). Thirty percent indicated their family experienced hardship because of PBTS medical expenses, which were usually paid for out of pocket (76 %). Although the majority of PBTS were independent with daily tasks and social functioning, a subgroup required continuous support. Forty percent of employed PBTS received limited assistance to accommodate their special needs. Parents indicated their son or daughter had been the victim of theft, fraud or assault (37 %), and commonly considered them vulnerable, in need of protection and feared for their future safety. Conclusion: Research that further illuminates the hardships facing PBTS and informs the development of support and resources to address PBTS vulnerabilities is warranted. Implications for Cancer Survivors: PBTS are at risk for unemployment, financial challenges and legal difficulties, which appear to be poorly addressed by health and social programs. © 2014 Springer Science+Business Media New York.


Olson R.A.,Cancer Agency Center for the North | Olson R.A.,University of Northern British Columbia | Olson R.A.,University of British Columbia | Tiwana M.,Cancer Agency Center for the North | And 13 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2016

Purpose To assess the impact of a population-based intervention to increase the consistency and use of single-fraction radiation therapy (SFRT) for bone metastases. Methods and Materials In 2012, an audit of radiation therapy prescriptions for bone metastases in British Columbia identified significant interphysician and -center (26%-73%) variation in the use of SFRT. Anonymous physician-level and identifiable regional cancer center SFRT use data were presented to all radiation oncologists, together with published guidelines, meta-analyses, and recommendations from practice leaders. The use of SFRT for bone metastases from 2007 through 2011 was compared with use of SFRT in 2013, to assess the impact of the audit and educational intervention. Multilevel logistic regression was used to assess the relationship between the usage of SFRT and the timing of the radiation while controlling for potentially confounding variables. Physician and center were included as group effects to account for the clustered structure of the data. Results A total of 16,898 courses of RT were delivered from 2007 through 2011, and 3200 courses were delivered in 2013. The rates of SFRT use in 2007, 2008, 2009, 2010, 2011, and 2013 were 50.5%, 50.9%, 48.3%, 48.5%, 48.0%, and 59.7%, respectively (P<.001). Use of SFRT increased in each of 5 regional centers: A: 26% to 32%; B: 36% to 56%; C: 39% to 57%; D: 49% to 56%; and E: 73% to 85.0%. Use of SFRT was more consistent; 3 of 5 centers used SFRT for 56% to 57% of bone metastases RT courses. The regression analysis showed strong evidence that the usage of SFRT increased after the 2012 intervention (odds ratio 2.27, 95% confidence interval 2.06-2.50, P<.0001). Conclusion Assessed on a population basis, an audit-based intervention increased utilization of SFRT for bone metastases. The intervention reversed a trend to decreasing SFRT use, reduced costs, and improved patient convenience. This suggests that dissemination of programmatic quality indicators in oncology can lead to increased utilization of evidence-based practice. © 2016 Elsevier Inc.

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