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Biomedical subjects

Edward Chow

Publications and source records attributed to Edward Chow.

At least 37 records · Page 2Linked to original sources

Communication with referring physicians in a palliative radiotherapy clinic.

GOALS: The rapid response radiotherapy program (RRRP) at Toronto-Sunnybrook Regional Cancer Center (TSRCC) provides quick access to palliative radiotherapy for patients with a life expectancy of less than 12 months. Patients then return to their referring physician for continued oncologic management. After the initial RRRP consultation, we fax an interim consultation report to the referring physician. The purpose of this study was to assess how useful referring physicians perceive this interim report and whether this report needs to be modified to meet their information needs. METHODS: Physicians who referred patients to the RRRP and who were faxed an interim consultation report were identified over a 4-month period. These physicians were then faxed a questionnaire that asked how useful the interim report was in patient management, about their satisfaction with the information provided, to critique the report format, and whether the RRRP physician and nurse were easily accessible by telephone. MAIN RESULTS: Forty physicians referred patients to the RRRP clinic over the 4-month study period. The response rate to our survey was 58% (23/40). The vast majority of physicians (95%) stated that the interim consultation report was useful in patient management. They felt that treatment details were adequately discussed in the report. The report format was perceived to be clear and concise. Referring physicians wished to be informed about any medication changes. RRRP physicians and nurse were perceived to be easily accessible by telephone if needed. CONCLUSIONS: Results showed that referring physicians found the faxed interim consultation report useful in patient management. Suggestions were made on how to improve the report, and they will be used to further enhance physician communication and ultimately patient care.

Cancer Care Facilities↗

Computed tomography (CT) evaluation of breast cancer patients with osteolytic bone metastases undergoing palliative radiotherapy--a feasibility study.

Twenty-five patients with osteolytic metastases had computed tomography (CT) scans before and 3 months after palliative radiotherapy. The median % density change following single 8Gy, 20Gy/5#, 30Gy/10# were: 128 (range 98-255), 141 (79-342), and 145 (65-235), respectively. It is feasible to evaluate remineralization of osteolytic lesions with palliative radiotherapy.

Adult↗

Metastatic burst fracture risk prediction using biomechanically based equations.

Clinical guidelines are a useful adjunct to select patients with spinal metastases for prophylactic intervention. The objective of this study is to determine the ability of biomechanically based models to accurately predict metastatic burst fracture risk. Ninety-two vertebrae with osteolytic spinal metastases were examined retrospectively. Vertebrae were categorized as burst fractured, wedge fractured, or intact and analyzed using three predictive models: vertebral bulge (maximum radial displacement under load), vertebral axial displacement (maximum axial displacement under load), and a volumetric estimate of tumor size. The load-bearing capacity parameter (tumor volume, bone mineral density, disc quality, pedicle involvement) was determined from computed tomography while the load-bearing requirement parameter (pressure load, loading rate) was determined using computed tomography and patient records (retrieved for 37 patients [52%]). Fracture prediction was optimized using the vertebral bulge model considering only load-bearing capacity with a specificity, sensitivity, and confidence interval of 1 to yield a clear threshold for burst fracture risk. Fracture prediction in the other two models, vertebral axial displacement considering only load-bearing capacity and tumor size, also was strong with receiver-operator curve values of 0.992 and 0.988, respectively. The predictive power of these models can provide useful clinical information for prophylactic decision-making.

Adult↗

Does psychosocial intervention improve survival in cancer? A meta-analysis.

BACKGROUND: There is growing evidence that positive psychosocial intervention improves the wellbeing of cancer patients. Two meta-analyses conducted to date confirmed a significant small-to-moderate effect on quality of life. Previous randomized trials reported that psychosocial intervention also improved survival. However, more recent trials failed to detect a difference in survival. A systematic review of randomized trials that have examined the effectiveness of psychosocial intervention in cancer patients in terms of survival prolongation was conducted. METHODS: Randomized trials published between 1966 and June 2002 were identified through the databases of MEDLINE, EMBASE, CancerLit, CINAHL, Cochrane Library and reference lists of relevant articles. Relevant data were abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on overall survival at one and four years in all cancer patients and also in breast cancer patients with metastases. RESULTS: Eight trials, which involved a total of 1062 patients (all cancer histologies), were identified. One- and four-year overall survival rates were obtained from eight trials and six trials, respectively. There was no statistically significant difference in the overall survival rates at one and four years [P = 0.6; RR 0.94 (95% CI 0.72, 1.22)] and [P = 0.5; RR 0.93 (95% CI 0.77, 1.13)], respectively. Four trials examined 511 metastatic breast cancer patients. Again, there was no statistically significant difference in the overall survival rates at one and four years [P = 0.3; RR 0.87 (95% CI 0.67, 1.14)] and [P = 0.3; RR 0.91 (95% CI 0.76, 1.10)], respectively. CONCLUSIONS: Psychosocial intervention does not prolong survival in cancer. This meta-analysis can not rule out small effect sizes because of the small number of trials and small trial sizes.

Adolescent↗

Do physicians follow systemic treatment and funding policy guidelines?

BACKGROUND: The use of bisphosphonates for the prevention of skeletal related events in women with bone metastases from breast cancer is well established. We undertook an evaluation of bisphosphonate use in clinical practice in three Canadian cancer centres. In addition we assessed whether or not physicians at these centres are following their local treatment guidelines and funding policies. METHODS: Charts and electronic files of patients who had received either clodronate or pamidronate at any time between January 2000 and December 2001 at three Canadian cancer centres were retrospectively reviewed. RESULTS: There has been a marked improvement in the time between the diagnosis of bone metastases and the commencement of bisphosphonates from a median of 155 days in 1998 to 24 days in 2001. However, despite a local funding policy requiring that oral clodronate be the first bisphosphonate used, this was the case in only 67% of patients. In addition, despite one centre's guidelines recommending that bisphosphonates be stopped once the patient was progressing, 90% of their patients remained on bisphosphonates until they died. CONCLUSIONS: A considerable amount of effort is spent on the creation of "evidence based" treatment guidelines. Funding agencies develop policies based on these treatment guidelines, but often funding is more restrictive than the treatment guideline would suggest. It is clear from this review that physicians still appear to manage a substantial proportion of patients outside of funding policies, but within evidence based recommendations. Therefore, a need exists for either the creation of guidelines and policies that physicians will follow or the implementation of methods to ensure that restrictive policies are actually followed.

Adult↗

Symptom control and palliative care content of abstracts presented at the Canadian Association of Radiation Oncologists annual meetings.

GOALS: Half of all patients referred for radiotherapy are treated with palliative intent. Recent emphasis has been placed on the importance of symptom control and palliative care (SCPC) in the radiation oncology community. The purpose of this study was to determine the number of abstracts relating to SCPC presented at the annual Canadian Association of Radiation Oncologists (CARO) meetings, and whether this number has increased over time. METHODS: SCPC abstracts presented at CARO from 1992 through 2002 were counted. Abstracts were included if they described a patient population with advanced or metastatic cancer treated with palliative intent. Abstracts were then categorized as reporting treatment outcomes, health services research, descriptive studies or literature reviews. Radiation treatment sites were recorded. MAIN RESULTS: An average of 6.7% (60/892; range 0-16.2%) of all abstracts presented at CARO from 1992 through 2002 pertained to SCPC. There was a significant increase in the proportion of SCPC abstracts accepted over time ( P=0.0012). Descriptive studies accounted for 46.7%, treatment outcomes 31.7%, health services research 13.3%, and literature reviews 8.3% of the SCPC abstracts. Bone metastases (48.3%), primary lung tumors (11.7%), and brain metastases (10.0%) were the most common treatment sites. Of all the SCPC abstracts, 45% came from dedicated palliative radiotherapy clinics. CONCLUSIONS: SCPC research is poorly represented at the annual CARO conferences. Research in this field should be promoted as the palliative patient population represents a large component of radiotherapy clinical practice. The recent emergence of dedicated palliative radiotherapy clinics should continue to increase palliative radiotherapy research.

Bone Neoplasms↗

Utilization of palliative radiotherapy for breast cancer patients with bone metastases treated with bisphosphonates-Toronto Sunnybrook Regional Cancer Centre experience.

BACKGROUND: The use of both bisphosphonates and palliative radiotherapy for the prevention and treatment of skeletal complications in women with bone metastases from breast cancer is well established. We undertook an evaluation of palliative radiotherapy utilization rates in breast cancer patients who received bisphosphonates for the treatment of bone metastases in a major Canadian cancer center. METHODS: Charts and electronic files of breast cancer patients with bone metastases who had received either clodronate or pamidronate at any time between January 2000 and December 2001 at our center were retrospectively reviewed. The utilization rates of palliative radiotherapy in these patients were examined. RESULTS: The percentage of patients receiving bisphosphonates for the treatment of bone metastases who also received palliative radiotherapy to bone remained relatively constant over our study period in the range of 70%. In patients commenced on bisphosphonates before 1998, 42.9% received palliative radiotherapy as initial therapy for bone metastases, whereas in 2001 only 27.8% of patients received palliative radiotherapy before commencing bisphosphonate therapy. There has been a marked improvement in the time between the diagnosis of bone metastases and the commencement of bisphosphonates from a median of 446 days before 1998 to 21 days in 2001. At the same time, there was also an improvement in time between diagnosis of bone metastases and initiation of palliative radiotherapy from a median of 265 days before 1998 to 49 days in 2001. CONCLUSION: Use of bisphosphonates has not reduced the utilization rates of palliative radiotherapy in breast cancer patients with bone metastases. There is a trend of initiating bisphosphonates before delivery of palliative radiotherapy. The latter was also delivered earlier in the course of bone metastases.

Adult↗

Radiotherapeutic approaches to metastatic disease.

Bone metastases in patients with prostate cancer are common. Prostate cancer patients also have a relatively long survival. Palliative radiation can provide effective symptom control in many clinical settings. This article focuses on the management of bone pain and its complications (pathological fractures and spinal cord compression) with radiation treatment.

Bone Neoplasms↗

Quality of life in surgical treatment of metastatic spine disease.

STUDY DESIGN: Overall quality of life after surgical management of metastatic disease of the spine was prospectively assessed using a validated global health status quality-of-life instrument-the Edmonton Symptom Assessment Scale. OBJECTIVES: To prospectively evaluate the efficacy of surgery in patients with metastatic spinal disease with respect to quality of life. SUMMARY OF BACKGROUND DATA: Management of spinal metastases is palliative and is aimed at improving quality of life at an acceptable risk. Although previous studies have evaluated physical outcomes, improvements in pain, and neurologic function after surgery, a multidimensional assessment of quality of life is more relevant in the palliative patient. METHODS: Twenty-five consecutive patients undergoing surgery for spinal metastases were prospectively evaluated. Pre- and postoperative assessments were performed using the Edmonton Symptom Assessment Scale. The surgical procedure consisted of decompression and instrumented stabilization. RESULTS: After surgery, the largest improvement was noted in the domain of pain (P < 0.00001). There were also significant improvements noted in the domains of tiredness (P = 0.004), nausea (P = 0.01), anxiety (P = 0.006), drowsiness (P = 0.044), appetite (P = 0.02), and well-being (P = 0.004). CONCLUSIONS: The current study demonstrates that in the appropriate patient, surgical management brings about a positive effect on the overall quality of life in patients with spinal metastases. The greatest benefit occurred in the reduction of a patient's level of pain.

Adult↗

Multidisciplinary radiation oncology palliative care rounds as a continuing educational activity implementing the rapid response radiotherapy program at the toronto sunnybrook regional cancer centre.

BACKGROUND: This paper describes the development of the Rapid Response Radiotherapy Program and evaluates the continuing medical education (CME) series, in the form of multidisciplinary monthly Radiation Oncology Palliative Care Rounds at the Toronto Sunnybrook Regional Cancer Centre. METHODS: Palliative care rounds were initiated by the multidisciplinary committee in September, 1998. From January, 2000, to June, 2002, attendees used a standard 5- point Likert rating scale to conduct formal evaluations. RESULTS: A total of 203 evaluation forms examining 20 rounds have been collected. Findings indicated that 86.8, 96.0, 87.1, and 90.8% of participants thought the material of the presentation was relevant to their practice, interesting, and instructional. Overall 90.1% of the respondents highly rated the grand rounds (rating of 4 or 5). CONCLUSION: The grand rounds are an effective CME activity at our hospital.

Attitude of Health Personnel↗

A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic.

PURPOSE: To develop a predictive model for survival from the time of presentation in an outpatient palliative radiotherapy clinic. METHODS AND MATERIALS: Sixteen factors were analyzed prospectively in 395 patients seen in a dedicated palliative radiotherapy clinic in a large tertiary cancer center using Cox's proportional hazards regression model. RESULTS: Six prognostic factors had a statistically significant impact on survival, as follows: primary cancer site, site of metastases, Karnofsky performance score (KPS), and fatigue, appetite, and shortness of breath scores from the modified Edmonton Symptom Assessment Scale. Risk group stratification was performed (1) by assigning weights to the prognostic factors based on their levels of significance, and (2) by the number of risk factors present. The weighting method provided a Survival Prediction Score (SPS), ranging from 0 to 32. The survival probability at 3, 6, and 12 months was 83%, 70%, and 51%, respectively, for patients with SPS or=20 (n = 133) (p < 0.0001). Corresponding survival probabilities based on number of risk factors were as follows: 85%, 72%, and 52% ( or=5 factors)(n = 180)(p < 0.0001). CONCLUSION: Clinical prognostic factors can be used to predict prognosis among patients attending a palliative radiotherapy clinic. If validated in an independent series of patients, the model can be used to guide clinical decisions, plan supportive services, and allocate resource use.

Adult↗

What do patients living with advanced cancer and their carers want to know? - a needs assessment.

Our primary objective was to determine the content and format that is most suitable for educational events targeting patients and carers who are living with advanced cancer. Secondary objectives included examining the differences in information needs between patients and their carers, and providing an estimate of the rate of participation in educational events targeting such patients and carers. Out-patients receiving palliative radiotherapy at Toronto Sunnybrook Regional Cancer Center and their carers were invited to complete the Advanced Cancer Information Needs Survey. One hundred forty-four respondents participated in the survey. The participants identified the management of pain, fatigue, and home palliative care resources as the areas in which information was most needed. Carers displayed greater interest, and the range of topics in which they continue to seek additional information is wider. Thirty-one percent of respondents said they would participate in an educational event. A 'one-on-one' interview approach and short written materials were the preferred sources of information. Our study examined potential content areas and preferred format for proposed educational events targeting patients and carers living with advanced cancer. We also highlighted the reasons for, and potential limitations of this approach. The investment of future effort in evaluating the impact of 1 on 1 interviews and 'short written materials' on the informational needs of patients and carers living with advanced cancer is warranted.

Caregivers↗

Radiotherapy alone in patients with advanced nasopharyngeal cancer: comparison with an intergroup study. Is combined modality treatment really necessary?

PURPOSE: To examine the outcome of radiotherapy (RT) alone in patients with advanced nasopharyngeal cancer (NPC) and to compare the results with those reported by the Intergroup study 0099 (IGS) comparing RT to combined modality therapy (CMT). MATERIALS AND METHODS: During the period 1985-1992, 198 NPC patients presenting without distant metastatic disease were treated for cure. Of these, 172 had stage III/IV (UICC 1987, 1992). Planned RT was 2 Gy/day fraction to 60-66 Gy to the primary tumor, with 50 and 60 Gy to the node negative and to palpable nodes, respectively. Outcomes included overall survival (OS) and disease-free survival (DFS), defined from the time of registration at our institution. RESULTS: The TNM categories and other prognostic factors were similar to the IGS, though 80% had stage IV compared to 91% in IGS. The 5 year OS and DFS for the 172 patients with stage III/IV disease were 62 and 48%, respectively, as compared to the IGS results of OS 37% and DFS 29% for RT alone, and OS 67% and DFS 58% for the CMT arm of IGS. When the distribution of adverse prognostic factors was balanced between both studies the comparative results were unchanged. CONCLUSIONS: The early results for RT alone of this single institution experience are superior to those of the IGS control arm (RT), while somewhat inferior to those reported in the chemo-radiotherapy arm. The surprisingly poor outcome of the IGS/RT control arm may have resulted by chance, suggesting the need for a confirmatory randomized trial to fully establish the role of combined chemotherapy and radiation, as used in the IGS.

Adolescent↗

International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases.

PURPOSE: To reach a consensus on a set of optimal endpoint measurements for future external beam radiotherapy trials in bone metastases. METHODS: An International Bone Metastases Consensus Working Party invited principal investigators and individuals with a recognized interest in bone metastases to participate in the two surveys and a panel meeting on their preference of choice of optimal endpoints. RESULTS: Consensus has been reached on the following: (a) eligibility criteria for future trials; (b) pain and analgesic assessments; (c) radiation techniques; (d) follow-up and timing of assessments; (e) parameters at follow-up; (f) endpoints; (g) re-irradiation; and (h) statistical analysis. CONCLUSIONS: Based on the available literature and the clinical experience of the working party members, an acceptable set of endpoints has been agreed upon for future clinical trials to promote consistency in reporting. It is intended that the consensus will be re-examined every 5 years. Areas of further research were identified.

Bone Neoplasms↗