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