Radiation therapy interruption in a poor resource setting: causes and management..

BACKGROUND: Treatment interruption is the failure to execute approved treatment plan of a patient. This adversely affects treatment outcomeif not properly managed. This retrospective study causes and management of radiation treatment interruptions during High Dose Rate Brachytherapy(HDRB) for carcinoma of the cervix in a teaching hospital in Nigeria. METHODS: Five hundred patients with cervical carcinoma, who received HDRB, post external beam radiotherapy, between August, 2008 and July, 2013 were assessed. They were grouped into (A): those who experienced treatment interruption and (B): those who did not. Each patient was scheduled to receive three fractions of HDRB over 3 weeks. Those in groups A were assessed for the exact treatment fraction missed, the cause and duration of treatment interruption and the actions taken to compensate for non-execution of treatment. RESULTS: A total of 90 patients fall into group A and most (41) of them experienced interruptions in the third fraction of their treatment. The most frequent (44%) causes of treatment interruptions observed among them were patient-related. Record of compensation for treatment interruption was not found in patients' treatment folders. This action may be due to lack of functional procedures for managing treatment interruptions and insufficient follow-up of patients, who never came back for consideration for compensation. CONCLUSION: This study showed that radiation oncology centres need to review their policies for managing treatment interruptions and documentation. Also, the mechanism for patients' follow-up should be strengthened to a reasonable extent to achieve better radiotherapy care.

Pattern of morphine prescription by doctors in a Nigeria tertiary hospital.

BACKGROUND: Morphine was reintroduced into Nigeria after a long period of absence due to technical problems relating to stock accounting. With this reintroduction, prescriber education was commenced in many centers including the University of Ibadan. AIMS AND OBJECTIVE: The aim of this study is to review the morphine prescription habits of the medical doctors practicing at the University College Hospital, Ibadan, and to assess the level of conformity with international guidelines. MATERIALS AND METHODS: All the prescriptions on oral morphine in the hospital's pharmacy records within a 6 months period were reviewed. RESULTS: The results showed that more than half (51.7%) of all morphine prescriptions were from the Radiation Oncology Department, while the newly created Day Care Hospice Unit accounted for 31.8% of the prescriptions. No prescriptions were seen from the Labor ward. Only 1.1% of all the prescriptions conformed to international guideline as contained in the "Blue Book." CONCLUSION: The results showed that there is a need for more education and advocacy programmes to increase awareness among doctors about morphine prescriptions.

Pattern of paediatric malignancies seen at the Radiotherapy Department of the University College Hospital, Ibadan, Nigeria.

BACKGROUND: Paediatric tumours are seen by the radiotherapist following referral from other specialists. Patients seen by the radiotherapists may not conform to the full spectrum seen in the hospital. OBJECTIVE: To review the pattern of presentation of paediatric malignancies seen at the radiotherapy department of the UCH, Ibadan. METHODS: Retrospective study of all patients below the age of 12 seen in Radiotherapy Department of UCH, Ibadan over a 19-year period was undertaken. Data were collected from the case files and the radiotherapy treatment cards. RESULTS: 244 cases were evaluated with age ranged between 4 months and 12 years. Male to female ratio was 1.15 to 1.0. 23 tumour types were seen with retinoblastoma accounting for about 45% of all the patients reviewed. Burkitt's lymphoma accounted for only about 2.5%. CONCLUSION: Retinoblastoma, nephroblastoma, intracranial malignancies and rhabdomyosarcoma are the tumours most commonly seen at the Radiotherapy Department of the UCH, Ibadan.