Petric P.,National Center for Cancer Care and Research |
Petric P.,Oncology and Radiotherapy Institute |
Hudej R.,Oncology and Radiotherapy Institute |
Rogelj P.,University of Primorska |
And 13 more authors.
Radiotherapy and Oncology | Year: 2013
Background and aim: We aimed to quantify target volume delineation uncertainties in cervix cancer image guided adaptive brachytherapy (IGABT). Materials and methods: Ten radiation oncologists delineated gross tumour volume (GTV), high- and intermediate-risk clinical target volume (HR CTV, IR CTV) in six patients. Their contours were compared with two reference delineations (STAPLE-Simultaneous Truth and Performance Level Estimation and EC- expert consensus) by calculating volumetric and planar conformity index (VCI and PCI) and inter-delineation distances (IDD). Results: VCISTAPLE and VCIEC were 0.76 and 0.72 for HR CTV, 0.77 and 0.68 for IR CTV and 0.59 and 0.58 for GTV. Variation was most prominent caudally and cranially in all target volumes and posterolaterally in IR CTV. IDDSTAPLE and IDDEC for HR CTV (3.6 ± 3.5 and 3.8 ± 3.4 mm) were significantly lower than for GTV (4.8 ± 4.2 and 4.2 ± 3.5 mm) and IR CTV (4.7 ± 5.2 and 5.2 ± 5.6 mm) (p < 0.05). Conclusions: Due to lower delineation uncertainties when compared to GTV and IR CTV, HR CTV may be considered most robust volume for dose prescription and optimization in cervix cancer IGABT. Adequate imaging, training and use of contouring recommendations are main strategies to minimize delineation uncertainties. © 2013 Elsevier Ireland Ltd. All rights reserved.
Manifestation pattern of early-late vaginal morbidity after definitive radiation (Chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: An analysis from the embrace study
Kirchheiner K.,Medical University of Vienna |
Kirchheiner K.,Christian Doppler Laboratory |
Nout R.A.,Leiden University |
Tanderup K.,Aarhus University Hospital |
And 10 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014
Background and Purpose Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study (www.embracestudy.dk) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials In total, 588 patients with a median follow-up time of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/ interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity is still pronounced with currently applied IGABT, and it needs further attention. © 2014 Elsevier Inc. All rights reserved.
Wilbur K.,Qatar University |
Babiker A.,Qatar University |
Al-Okka M.,Qatar University |
Jumaat E.,Qatar University |
And 2 more authors.
BMJ Open | Year: 2015
Objectives: To explore pharmacist and nurse views and experiences in educating patients regarding their treatment safety and tolerability as well as the roles of other professions in this regard. Design: In this qualitative study, six focus group discussions were conducted. Setting: The National Center for Cancer Care and Research in Qatar. Participants: Eleven pharmacists and 22 nurses providing direct patient care. Results: Concepts related to three key themes were drawn from the seeding questions and included factors for determining the level of risk they communicated: the specific treatment regimen in question; the patient; and their assessment of the patient. Patient-related considerations arose from additional subthemes; both nurses and pharmacists described aspects related to the perceived psychological health status of the patient, as well as anticipated comprehension, as ascertained by demonstrated education and language abilities. In all discussions, it was noted that physician and family non-disclosure of cancer diagnosis to the patient profoundly influenced the nature of information they provided. While a high level of cohesion in safety communication prioritisation among these two health disciplines was found, a number of pharmacists asserted a more formal role compared to informal and repeated teaching by nurses. Conclusions: Nurses and pharmacists in this Middle East healthcare environment were not reluctant to discuss treatment side effects with patients and draw on similar professional judgements in prioritising treatment risk information. We found that they did not always recognise each other's informal educational encounters and that there are opportunities to explore increased collaboration in this regard to enhance the patient care experience. © 2015, BMJ. All rights reserved.
Wilby K.J.,Qatar University |
Alyafei S.A.,National Center for Cancer Care and Research
Journal of Pain and Palliative Care Pharmacotherapy | Year: 2014
Palliative care is an emerging concept in the countries of the Gulf Cooperation Council, a political and economic union of Arab states bordering the Persian Gulf, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Clinical pharmacy services have not yet been evaluated in this region. The objectives of this study were to create a baseline inventory of clinical pharmacy interventions in palliative care and to assess the perceived importance of interventions made. This was a prospective, single-center characterization study. Interventions were documented from September 30 to December 1, 2013. They were characterized into predetermined categories and analyzed using descriptive statistics. Physician acceptance rate and intervention rate per patient were calculated. Classification categories were sent to 10 practicing pharmacists in each of Qatar and Canada, who ranked the categories on the basis of perceived importance. A total of 96 interventions were documented, giving 3 interventions per patient and an acceptance rate of 81%. Discontinuing therapy (29%), initiating therapy (25%), and provision of education/counseling (13.5%) were most common. No differences were found between rankings from pharmacists in Qatar or Canada. Clinical pharmacy interventions are frequent, and those relating to alterations in drug therapy are most common. Interventions align with the perceived importance from pharmacists in both Qatar and Canada. © 2014 Informa Healthcare USA, Inc.
Petric P.,National Center for Cancer Care and Research |
Mohammed-Al-Hammadi N.,National Center for Cancer Care and Research
Journal of Contemporary Brachytherapy | Year: 2014
Magnetic resonance imaging (MRI) represents the reference imaging modality for image guided adaptive brachytherapy (IGABT) of cervix cancer. Accurate interpretation of pre-treatment MRI is required for proper understanding of the tumor extent and topography at IGABT. Planning and optimal timing of the application begins already before treatment, and may need to be adapted during external beam irradiation (EBRT) according to additional clinical and/or radiological findings. The level of MRI utilization in IGABT depends on the infrastructural capabilities of individual centers, ranging from no use at all to repetitive imaging during EBRT and each IGABT fraction. In this article, we summarize the role of different imaging modalities and practical aspects of MRI interpretation in cervix cancer IGABT, concentrating on the systematic evaluation of post-insertion images. MRI with the applicator in place from the radiation oncologist's perspective should begin with immediate identification of eventual complications of the application procedure and assessment of the implant adequacy, followed by appropriate corrective measures in case of adverse findings. Finally, the tumor extent, topography, and treatment response should be evaluated in the context of initial clinical and radiological findings to allow for an appropriate selection and delineation of the target volumes.
Segedin B.,Institute of Oncology Ljubljana |
Petric P.,National Center for Cancer Care and Research
Radiology and Oncology | Year: 2016
Background. Modern radiotherapy techniques enable delivery of high doses to the target volume without escalating dose to organs at risk, offering the possibility of better local control while preserving good quality of life. Uncertainties in target volume delineation have been demonstrated for most tumour sites, and various studies indicate that inconsistencies in target volume delineation may be larger than errors in all other steps of the treatment planning and delivery process. The aim of this paper is to summarize the degree of delineation uncertainties for different tumour sites reported in the literature and review the effect of strategies to minimize them. Conclusions. Our review confirmed that interobserver variability in target volume contouring represents the largest uncertainty in the process for most tumour sites, potentially resulting in a systematic error in dose delivery, which could influence local control in individual patients. For most tumour sites the optimal combination of imaging modalities for target delineation still needs to be determined. Strict use of delineation guidelines and protocols is advisable both in every day clinical practice and in clinical studies to diminish interobserver variability. Continuing medical education of radiation oncologists cannot be overemphasized, intensive formal training on interpretation of sectional imaging should be included in the program for radiation oncology residents. © 2016 Radiol Oncol.
Bains S.,Lower Mainland Pharmacy Services |
Rowe H.,Surrey Memorial Hospital |
Wilby K.J.,Qatar University |
Wilby K.J.,National Center for Cancer Care and Research
Journal of Maternal-Fetal and Neonatal Medicine | Year: 2014
Objective: To develop a knowledge assessment tool to assess baseline knowledge and current practice regarding maternal-fetal medicine. Methods: A literature search was complemented with categorization of questions under five predefined domains related to maternal-fetal medicine. The final questionnaire was sent for expert review, cultural adaptation, and piloting, with feedback incorporated accordingly. Results: A questionnaire was developed consisting of questions pertaining to demographics, knowledge, and current practice. Conclusions: This tool is of interest to researchers, educators, and clinicians aiming to assess baseline knowledge, current curricula (both entry-to-practice and graduate) and continuing education opportunities for practicing pharmacists. © 2014 Informa UK Ltd. All rights reserved: reproduction in whole or part not permitted.
Steedman M.R.,World Innovation Summit for Health WISH |
Steedman M.R.,Imperial College London |
Hughes-Hallett T.,World Innovation Summit for Health WISH |
Hughes-Hallett T.,Imperial College London |
And 7 more authors.
Health Affairs | Year: 2014
Provision for end-of-life care around the world is widely variable and often poor, which leads to millions of deaths each year among people without access to essential aspects of care. However, some low- and middle-income countries have improved specific aspects of endof-life care using innovative strategies and approaches such as international partnerships, community-based programs, and philanthropic initiatives. This article reviews the state of current global end-of-life care and examines how innovation has improved end-of-life care in Nigeria, Uganda, India, Bangladesh, Myanmar, and Jordan. Specifically, we examine how opioids have been made more available for the treatment of pain, and how training and education programs have expanded the provision of care to the dying population. Finally, we recommend actions that policy makers and individuals can take to improve end-of-life care, regardless of the income level in a country. © 2014 Project HOPE- The People-to-People Health Foundation, Inc.
PubMed | Qatar University and National Center for Cancer Care and Research
Type: | Journal: Patient preference and adherence | Year: 2016
Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting.We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar.One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen.Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks.
PubMed | Hamad General Hospital, Patti Hospital and National Center for Cancer Care and Research
Type: Journal Article | Journal: World journal of surgical oncology | Year: 2016
Anal metastases from lung cancer are infrequent, and there are only 10 published cases. Life expectancy is no longer than 1year after diagnosis because of the typically advanced stage of disease. Treatment, which is typically inefficient, is administered with the intent to cure or avoid local complications.We report a case of a patient with non-small cell lung cancer presenting with perianal metastasis mimicking an abscess.Because perianal masses may be misdiagnosed, patients with lung and other cancers should be evaluated for metastatic disease.