perceptions of receptivity: exploring tobacco use and smoking cessation best practices from the...
Post on 17-Feb-2017
212 Views
Preview:
TRANSCRIPT
Background: Maintaining patients’ satisfaction with their care is an
important quality metric in the Ontario-based Clinical Specialist Radia-
tion Therapist (CSRT) project, run under the auspices of Cancer Care
Ontario. The current study was carried out at the Stronach Regional
Cancer Centre, and is a subset of a province-wide investigation, exam-
ining patient satisfaction with the CSRT role within designated clinical
environments.
Methods: A one-point dissemination design captured satisfaction from
palliative patients receiving care from the CSRT (n¼19) and from other
healthcare professionals (HCP) (n¼14) over a seven-month period in
2013. The ‘‘Patient Satisfaction Questionnaire’’, designed and validated
by the University of Leeds, was modified for this study. The survey in-
cludes 6 common questions and 4 additional questions for patients who
were seen by a CSRT, each using a five-point Likert scale. T-tests
compared results from both populations. Averages were calculated for
the CSRT-specific questions.
Results: For questions ‘‘I was told everything that I want to know about my
condition’’ and ‘‘I felt that the problem that I came with was sorted out prop-
erly’’, those who received care from the CSRT scored significantly (p<0.05)
higher than those who did not (p¼0.033; p¼0.037 respectively). For the
CSRT-specific questions, 89% of participants felt the experience with the
CSRT was excellent (n¼16), 78% strongly agreed/ agreed that having a
CSRT on the care team was important to his/her care at the cancer centre
(n¼14), and 89% of participants strongly agreed/agreed that having a
CSRT on the care team was important to patients’ understanding of treat-
ment (n¼16).
Conclusion: Palliative patients receiving care from a team including a CSRT
had a better understanding of treatment, and an overall excellent experience
with the CSRT. These patients were seen by the CSRT for 30-45 minutes
prior to the initial consult with the Radiation Oncologist, as well as during
treatment reviews, which allowed for greater opportunity to have questions
answered regarding patients’ conditions and radiation treatments. It is hy-
pothesized this model of care helped alleviate patient anxiety, increasing over-
all satisfaction with care.
Assessing the Psychological Impact of Daily Bowel Preparation on
Prostate Patients Who Receive Radiation Therapy
Bonnie Bristow, MRT(T), BSc, Laura D’Alimonte, MRT(T), MHSc,Merrylee McGuffin, MRT(T), MSc, Ewa Szumacher, MD, MEd, FRCPC,Marg Fitch, RN, PhD and Lisa Di Prospero, MRT(T), MScOdette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto
Background: Evidence has shown that the prostate moves under the influ-
ence of the rectum and to a lesser extent the bladder; many radiation therapy
departments have adopted standardized bladder filling and rectal emptying
protocols for radiotherapy treatment. When guidelines are not followed, daily
treatments can be delayed until appropriate volumes are attained. It is not
known what impact these delays have on our patient population. The purpose
of this study was to determine levels of distress, anxiety, depression and bother
related to bowel preparation for prostate cancer patients undergoing radiation
therapy treatment.
Methods: A prospective cohort analysis of prostate cancer patients undergo-
ing external beam radiation therapy was completed. Patients were assigned to
one of three groups; Group 1 was standard of care, Group 2 was standard of
care + increased educational information regarding bowel preparation, Group
3 was standard of care + increased educational information regarding bowel
preparation + an anti-flatulent medication. Hospital Anxiety and Depression
Scale, Distress Thermometer, and a Bowel Status Bother survey were
completed by participants at the start of their course of radiation treatment,
mid-way through and at the end. ANOVA testing was used to report differ-
ences in mean scores between the three groups.
Results: Mean age of patients was 66 years; 50% of the 30 participants had a
university education; 80% were married. Anxiety levels related to bowel prep-
aration for radiation therapy decreased over time in all groups (P¼ 0.03958)
with no difference between the groups (P¼0.447806). Depression levels
168 Conference Proceedings from RTi3 2014/Journal of Medical
across time for each group remained low (P¼ 0.577049). Overall distress
levels associated with bowel preparation were reported low amongst each
group, and no significant differences were reported (p¼0.978). There is a sta-
tistically significant difference between groups with respect to bother (bowel
status impact) (p¼0.006). Patients in Group 1 reported higher rates of bother
than Groups 2 or 3 (2.5 vs. 1.98 respectively). All groups reported high rates
of quality of life.
Conclusions: Findings from this study indicate that collectively across three
groups and over time, there were low levels of anxiety, depression and distress.
The amount of educational information, timing of it and the approach are
important factors.
Assessment of Comfort and Shrinkage in Four Styles of Thermoplastic
Masks
Valerie Dovella, Shahzad Bhuttoa,Lilian Doerwald-Munoz, BSc, MRT(T), CTICb,Orest Ostapiak, PhD, FCCPMc and Greg Sawesky, O.P(t) Dip.baMcMaster UniversitybJuravinski Cancer CentrecJuravinski Cancer Centre and McMaster University
Background: Thermoplastic masks are one of the most common immobili-
zation devices used for head and neck radiation therapy, varying in thickness,
material composition and perforation pattern. After initial fabrication howev-
er, mask shrinkage is typical due to material crystallization. This study seeks to
evaluate the amount of shrinkage in four different thermoplastic mask styles,
and assess any corresponding impact on level of comfort experienced by
participants.
Methods: Six volunteers participated in this study. Four mask styles were
evaluated, distinct by material type and perforation pattern. Masks were of
either traditional thermoplastic material or Fibreplast, a composite material
made of thermoplastic and Kevlar� fibers. Each material came in one of
two patterns: A standard perforation pattern and a variable perforation
pattern called Variable Perf TM. A total of 24 masks were made. Shrinkage
was assessed by tracking radiopaque fiducials affixed to the masks, and their
movement over three weekly CT scans. Comfort was assessed weekly from
the time masks were fabricated to the end of three weeks via questionnaires
given to participants. Questions employed either a 5-point Likert scale or a
10-point scale.
Results: Variable Perf TM pattern with standard material composition had the
maximum mean shrinkage. Greatest mean shrinkage was seen in anterior/pos-
terior direction followed by superior/inferior direction followed by the least
shrinkage laterally for all masks. The method showed reproducibility, with er-
ror variation accounting for 0.06mm laterally, 0.04mm anterior/ posterior,
and 0.1mm superior/ inferiorly. The majority of shrinkage occurred within
one week of mask fabrication. Comfort was rated the highest for the mask
style with standard perforation and thermoplastic composition.
Discussion and Conclusion: Standard perforation and thermoplastic
composition is the optimal mask style based on minimal shrinkage and lowest
discomfort rating. Masks with variable perforation had the highest mean
shrinkage in all directions. There was no significant relationship found be-
tween fibreplast material composition, comfort and shrinkage. At least one
week between mask fabrication and CT simulation is recommended to take
a considerable amount of shrinkage into account.
Perceptions of Receptivity: Exploring Tobacco Use and Smoking
Cessation Best Practices from the Perspectives of Individuals with Lung
Cancer and Health Care Professionals: Findings from Phase I
Bonnie Bristow, MRT(T) BSca, Lisa Di Prospero, MRT(T) MSc BScb,Elaine Curle, RNa, Leslie Gibson, OT Reg (Ont.) BHSc (OT) BKina,Arlene Court, BScN, CON(C)a, Andrea Eisen, MD FRCPa andMarg Fitch, RN, PhDa
aOdette Cancer Centre, Sunnybrook Health Sciences CentrebOdette Cancer Centre, Sunnybrook Health Sciences Centre, University ofToronto
Imaging and Radiation Sciences 45 (2014) 162-188
Background: Evidence shows that lung cancer patients who quit smoking may
have a better outcome than those who continue to smoke. Implementation of
the Smoking Cessation Program for patients in the Lung Site at Odette Cancer
Centre had been challenging. Health care professionals (HCP) were concerned
that asking patients with lung cancer about tobacco use and intentions to quit
smoking could potentially increase stigma, shame, and blame.
The purpose of this study was to explore the perspectives regarding to-
bacco use and smoking cessation of patients with lung cancer and health
care professionals. It seeks to understand similarities and differences in per-
spectives in order to inform patient centred approaches to offering smoking
cessation services.
Methods: This study utilized a qualitative descriptive method two phased
approach. Phase I: three health care professional focus groups were held. Phase
II: 19 semi- structured patient interviews completed. All patient interviews and
focus groups were audio recorded and transcribed verbatim. Inclusion criteria
for patients included a diagnosis of lung cancer, currently smoking or have
smoked in the past. Multiple readings of each focus group transcript were per-
formed using narrative thematic analysis to identify major themes.
Results: Findings from the HCP focus groups highlighted emerging themes
relating to: Identification of smokers (Triggers to start a conversation and
Consistency of approach), HCP perception of patient’s receptivity (Judge-
ment and Rapport), Rationale for smoking cessation (Repetition and rein-
forcement during treatment, Palliative patients, Addiction) and Barriers to
practice (Staff setting an example, Follow-up).
Conclusions: Findings from this study will support and guide a patient cen-
tred approach to smoking cessation best practices, effective communication
strategies, and full implementation of the Smoking Cessation Program in
the Lung Site.
Radiation-Induced High Toxicities and Local Recurrence in Stage 3 and
4 Oropharynx Cancer Patients
Dana Al-Qinneh, Bsc (Biology)a and Lorella Divanbeigi, MRTTb
aPrincess Margaret Cancer Centre - University of Toronto - The MichenerInstitutebThe Princess Margaret Cancer Centre
Background: Radiation therapy (RT) is an integral part of oropharynx cancer
management with potential side effects. Radiation induced mucositis, derma-
titis, dysphagia, and weight loss are the most commonly reported toxicities of
head and neck radiotherapy (Nutting et al., 2011). Although there have been
new advances and modifications to the treatment, there have been limited im-
provements to local control (DeArruda et al., 2006). The local recurrence
(LR) rate for grade 3 and 4 oropharyngeal cancer at 2yrs and 5yrs is 20%
and 43%, respectively (Al-Mamgani et al., 2013). Presently there are no clin-
ical parameters that have been identified as having a relationship in predicting
LR. This highlights the need for a research-based study that deduces a surro-
gate clinical marker for local control that could be used to potentially predict
recurrence rates, in hopes that we eventually lower the local recurrence rates.
Purpose: Tumour recurrence or the developments of new primaries are the
major causes of treatment failures (Fang, Tsai & Chen, 2007). However,
with the association of toxicities to local control, one would have a predictive
factor of risk of recurrence during treatment. The primary objective of this
study would be to deduce whether or not a relationship between weight loss
and radiation-induced toxicities (mucositis, erythema) and LR (at 2yrs), exists.
Method: Between January 2007 and December 2011, 232 patients with his-
tologically confirmed cancer of the oropharynx that underwent IMRT at the
Princess Margaret Cancer Centre were reviewed retrospectively. The inclusion
criterion includes patients with 1) stage III or IV oropharyngeal cancer, 2)
received RT dose of 70Gy/35 fractions, and 3) received concurrent chemo-
therapy (cisplatin). Acute toxicities (mucositis, erythema and weight loss) as
graded according to the Radiation Therapy Oncology Group (RTOG) radi-
ation morbidity scoring criteria evaluated by the radiation oncologist were
analyzed. Comparisons of local control between the cohorts with severe
toxicity (RTOG 2-3) vs. non-severe toxicity (RTOG 0-1) were determined
through the Kaplan-Meier method. A log-rank test for significance
(p<0.05) was also carried out.
Conference Proceedings from RTi3 2014/Journal of Medical
Results: Compared to patients who experienced a high-grade skin reaction
(RTOG 2-3), patients who experienced a non-severe skin reaction (RTOG
0-1), had a higher local failure rate, 6.0% vs 3.1% for high-grade skin reac-
tion, and higher locoregional failure 9.0% vs 5.0% for high-grade skin reac-
tion. Similarly patients who experienced a low-grade mucositis reaction
(RTOG 1-2) had a higher local failure rate (6.0% vs 1.8%) and locoregional
failure (7.7% and 4.5%) than patients who experienced a higher-grade
mucosal toxicity (RTOG 3). There was little significance observed between
patients who reported severe weight loss (>10% body weight) and non-severe
weight loss (<10% body weight), in terms of local failure (3.8% vs. 3.9%)
and locoregional failure (5.4% and 6.9%).
Discussion and Conclusion: Patients who experience a higher-grade radia-
tion induced skin or mucosal reaction during treatment have a lower local
failure and locoregional failure rate. This finding has the potential to provide
health care providers with a definitive link between the effectiveness of radi-
ation therapy and side effects. This would in turn help us to reduce the per-
centage of tumour recurrences in a patient population with high local
recurrence rates.
Factors that Influence the Acceptability of Telemedicine as a means to
Evaluate Treatment Outcome for Patients Completing Palliative
Radiotherapy
Michelle Lau, MRT(T), CMD, BSc(RadSci), MHScMRS, Rebecca Wong,Andrea Bezjak and Wilfred LevinPrincess Margaret Cancer Centre
Purpose: To determine factors and barriers that may influence the accept-
ability of telemedicine as a means to evaluate treatment outcome for patients
completing palliative radiotherapy.
Methods: Adult patients seen in consultation for consideration of palliative
radiotherapy were approached for this needs-assessment study, and data
related to patient and caregiver demographics, information regarding their
use and habits with communication technology, and views regarding
follow-up care, as well as the use of telemedicine for post-treatment follow-
up, were gathered using a questionnaire. Data examination strategies with lo-
gistic regression and summative content analysis for synthesis of emerging
themes were used.
Results:Majority (90%) of the participants (n¼48; 62 were approached from
April to August 2013) have access to mobile phones and use the internet at
home on a daily basis, and they also communicate with their friends and fam-
ily regularly using phone, email, and texting. A large proportion of patients
(94%) would participate in virtual follow-up post-palliative-radiotherapy if
it is available, and would access mainly this service via communication means
of electronic mail (46%) and telephone (35%). Patients expressed that
continual care by the palliative radiation medicine team should be automatic
post-treatment, whether it be on an out-patient basis or via telemedicine.
There were no apparent barriers affecting patient participation in virtual
follow-up appointments, that is, there was no particular demographic variable
that correlates with acceptability of communication technologies and
telemedicine.
Conclusion: There is currently no standard follow-up process for patients af-
ter completion of palliative radiotherapy treatments. Patients and caregivers
support the implementation of a follow-up process using telemedicine and
would use it as an alternative option to in-hospital appointments. Continuity
of care via follow-up is important because it helps to maintain quality of life
for these patients and their caregivers, and also increase collection of treatment
outcome data for continual quality improvement of palliative radiotherapy
practice.
A Retrospective Analysis of Factors Affecting Treatment Outcome and
Patient Experience in Elderly Head and Neck Cancer Patients: The
Odette Cancer Centre Experience
Nikolaus Gregor, HBSc, Angela Turner, MRT(T), MHSc andDr. Justin Lee, MDOdette Cancer Centre
Imaging and Radiation Sciences 45 (2014) 162-188 169
top related