Clinical significance of accounting for tissue heterogeneity in permanent breast seeds implant brachytherapy planning

Publication date: Available online 23 December 2015
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Shahram Mashouf, Emmanuelle Fleury, Priscilla Lai, Tomas Merino, Eli Lechtman, Alex Kiss, Claire McCann, Jean-Philippe Pignol
PurposeThe Inhomogeneity Correction Factor (ICF) method provides heterogeneity correction for the fast calculation TG43 formalism in seeds brachytherapy. This study compared ICF corrected plans to their standard TG43 counterparts looking at their capacity to assess inadequate coverage and/or risk of any skin toxicities for patients who received Permanent Breast Seed Implant (PBSI).Methods and MaterialsThe 2 month post implant CT-scans and plans of 140 PBSI patients were used to calculate dose distributions using the TG-43U1 formalism and the ICF method. Multiple dose-volume histogram (DVH) parameters of clinical target volume (CTV) and skin were extracted and compared for both ICF and TG43 dose distributions. Short term (desquamation and erythema) and long term (telangiectasia) skin toxicity data were available on 125 and 110 of the patients, respectively, at the time of study. The predictive value of each DVH parameter of skin was evaluated using the area under the receiver operating characteristic (ROC) curve for each toxicity endpoint.ResultsThe DVH parameters of CTV calculated using the ICF method showed an overall decrease compared to TG43 while those of skin showed an increase confirming previously reported findings on the impact of heterogeneity with low energy sources. The ICF methodology enabled us to distinguish patients for whom the CTV V100 and V90 are up to 19% lower compared to TG43, which could present a risk of recurrence not detected when heterogeneity are not accounted for. The ICF method also led to an increase in the prediction of desquamation, erythema, and telangiectasia91% of skin DVH parameters studied.ConclusionsThe ICF methodology has the advantage to distinguish any inadequate dose coverage of CTV due to breast heterogeneity, which can be missed by TG43. The use of the ICF correction also led to an increase in prediction accuracy of skin toxicities in majority of cases.

Teaser

In this study we compared a tissue heterogeneity correction algorithm (ICF method) to the standard AAPM-TG43 protocol for a cohort of patients treated with permanent breast seed implants (PBSI). Using heterogeneity correction enabled distinguishing patients who received lower dose to the clinical target volume (CTV), who would otherwise go undetected using TG43. The use of the ICF correction also led to an increase in prediction accuracy of skin toxicities in the majority of the cases.


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Psychosocial Palliative Care By William S. Breitbart and Yesne Alici. Oxford University Press, New York, 2014, 192 pages, ISBN: 9780199917402, Cost £32.99

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The willingness and actual situation of Chinese cancer patients and their family members participating in medical decision-making

Abstract

Objective

In China, not only patients and physicians are involved in medical decision-making (MDM) but also the patients' family members. The objective is to investigate the willingness and actual situation of cancer patients and their family members participating in the MDM process.

Methods

In this cross-sectional study, questionnaires were administered to 247 pairs of cancer inpatients and their relatives. Information regarding participants' willingness and actual experience during the decision-making process was documented. Eligible participants were cancer inpatients or their relatives, 18 years of age or older, and informed of the cancer diagnosis. All the patients should have received chemotherapy.

Results

The effective response rate was 72.9% (180/247). Over half of the patients (53.3%) and family members (57.8%) were willing to be part of the MDM process. In contrast, only 35.0% of patients and 46.1% of family members actually experienced this process (p = 0.001 and p = 0.011, respectively). Fewer family members (42.2%) than patients (53.3%) believed that patients should be involved in the MDM process (p < 0.001). Patients who were the head of their family (odds ratio 2.577, 95% CI 1.198–5.556, p = 0.015) experienced more involvement in MDM.

Conclusions

Although more than half of Chinese cancer patients and family members wanted to be part of MDM, the actual participation was below their expectation. Majority of family members do not want the patients to be involved in the process of MDM. Copyright © 2015 John Wiley & Sons, Ltd.

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Sleep disturbances and related factors among family caregivers of patients with advanced cancer

Abstract

Objective

Sleep disturbances among family caregivers (FCs) are common in advanced cancer. The comprehensive factors for sleep disturbances among the FCs of patients with cancer have not been investigated in Taiwan. The purposes of this study were to investigate the sleep disturbances among the FCs of patients with advanced cancer and to determine predictors of sleep disturbance.

Methods

A descriptive, cross-sectional study was conducted among 172 FCs. Data were collected using the Pittsburgh Sleep Quality Index and wrist actigraphy. A linear regression model was used to identify the predictive factors for sleep quality.

Results

Seventy-six percent of the FCs experienced some sleep disturbances. Female gender, more fatigue, greater depression, more caregiving burden, and spending over 16 h per day on caregiving tasks were risk factors for sleep disturbances in caregivers.

Conclusions

Sleep disturbances were common among the Taiwanese FCs of patients with advanced cancer. FCs with risk factors for sleep disturbances should be identified and provided assistance. Copyright © 2015 John Wiley & Sons, Ltd.

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National study of chronic disease self-management: 6-month and 12-month findings among cancer survivors and non-cancer survivors

Abstract

Objective

This study examined the applicability of the Stanford Chronic Disease Self-Management Program (CDSMP) for cancer survivors and compared outcomes among cancer survivors and participants with other chronic diseases (non-cancer survivors).

Methods

Participants were older adults (n = 1170) enrolled in the National Study of CDSMP. Detailed information about physical and psychosocial health status and health and healthcare behaviors was collected from participants (n = 116 cancer survivors and n = 1054 non-cancer survivors) via self-report before CDSMP participation and at 6-month and 12-month follow-ups. Linear and generalized linear mixed models were used to assess baseline-to-6-month and baseline-to-12-month changes.

Results

Among cancer survivors, general health, depression, and sleep significantly improved from baseline to 6 months. These significant changes were sustained at 12 months. Communication with physician, medication compliance, pain, days in poor physical health, days in poor mental health, and days kept from usual activities and physical activity also improved significantly from baseline to 12 months. Among non-cancer survivors, all outcomes except medication compliance and stress improved significantly from baseline to 6 months. At 12 months, medication compliance also improved significantly.

Conclusions

Findings suggest that participation in CDSMP, an evidence-based chronic disease self-management intervention not specifically tailored for cancer survivorship, may significantly improve physical and psychosocial health status and key health and healthcare behaviors among cancer survivors. Additional research is needed to elucidate cancer survivors' unique needs and examine the benefits of tailored versions of CDSMP. Nevertheless, CDSMP, available at scale nationally and internationally, is a promising intervention for cancer survivors and should be considered a valuable component of survivorship care. Copyright © 2015 John Wiley & Sons, Ltd.

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