Breast Cancer Patients' Perceptions of Adjuvant Radiotherapy: an Assessment of Pre-Treatment Knowledge and Informational Needs.

There is little knowledge about breast cancer patients' information-seeking behaviors, needs, and perceptions of breast radiation therapy (BRT) prior to radiation oncology consultation. This study assessed these parameters to evaluate potential gaps and overlaps in the BRT educational process. Breast cancer patients > 18 years referred for adjuvant BRT at a tertiary cancer center completed an anonymous survey prior to their consultation. Response rate was 86% (118/137). The most commonly reported sources of information about BRT were healthcare providers (55%), family or friends treated with BRT (53%), and the Internet (45%). Most (79%) had little or no knowledge about BRT. Sixty-seven percent were a little or moderately concerned about BRT, while 29% were very concerned. Half were unsure about the benefit of BRT and 46% thought it would provide a moderate to significant benefit. While seeking information about BRT, a wide range of topics were encountered. The most common ones were fatigue (68%), skin care (57%), skin problems (54%), effects on healthy body tissues (43%), the immune system (37%), and pain (34%). Topics considered most important for the radiation oncologist to address were BRT effects on the heart (74%), second cancers (74%), immune system (66%), pain (64%), and lungs (62%). Although commonly encountered, fatigue (56%) and skin care (49%) were of lesser importance. In conclusion, breast cancer patients encounter a broad range of information about BRT prior to their radiation oncology consultation, which may contribute to worry and misconceptions. Potentially rare and serious side effects were considered important to address.

Relationships between family physicians' referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: a survey of rural and urban family physicians.

BACKGROUND: The primary objective of this research was to assess the relationship between FPs' knowledge of palliative radiotherapy (RT) and referral for palliative RT. METHODS: 1001 surveys were sent to FPs who work in urban, suburban, and rural practices. Respondents were tested on their knowledge of palliative radiotherapy effectiveness and asked to report their self-assessed knowledge. RESULTS: The response rate was 33%. FPs mean score testing their knowledge of palliative radiotherapy effectiveness was 68% (SD = 26%). The majority of FPs correctly identified that painful bone metastases (91%), airway obstruction (77%), painful local disease (85%), brain metastases (76%) and spinal cord compression (79%) can be effectively treated with RT, though few were aware that hemoptysis (42%) and hematuria (31%) can be effectively treated. There was a linear relationship between increasing involvement in palliative care and both self-assessed (p < 0.001) and tested (p = 0.02) knowledge. FPs had higher mean knowledge scores if they received post-MD training in palliative care (12% higher; p < 0.001) or radiotherapy (15% higher; p = 0.002). There was a strong relationship between FPs referral for palliative radiotherapy and both self-assessed knowledge (p < 0.001) and tested knowledge (p = 0.01). CONCLUSIONS: Self-assessed and tested knowledge of palliative RT is positively associated with referral for palliative RT. Since palliative RT is underutilized, further research is needed to assess whether family physician educational interventions improve palliative RT referrals. The current study suggests that studies could target family physicians already in practice, with educational interventions focusing on hemostatic and other less commonly known indications for palliative RT.

Referral Patterns of Patients for Palliative Radiation Therapy in British Columbia: A Comparison Between Rural and Urban Family Physicians.

BACKGROUND: Previous studies have shown that palliative radiation therapy (PRT) is often underused, especially in rural and remote settings despite evidence supporting its effectiveness in managing symptoms from advanced or metastatic cancer. PURPOSE: To identify factors which influence family physicians (FPs) in British Columbia (BC) to refer patients for PRT at the BC Cancer Agency (BCCA) and to compare referral patterns between FPs in rural and urban areas. METHODS AND MATERIALS: A total of 1,001 questionnaires were sent to all FPs practicing in rural areas and randomly to FPs in urban areas (351 and 650, respectively). Rural and urban areas were chosen based on our previous study of utilization rates of PRT in BC. The questionnaire was adapted from a previously validated survey, and was used to obtain information on referral practices of FPs in BC. FPs who did not practice family medicine or where 80% of their practice was spent with either obstetrical or pediatric patients were excluded. RESULTS: The overall response rate was 33% (44% rural vs. 28% urban). Rural FPs were more involved in both palliative care and metastatic cancer management of their patients (88% vs. 74%; P = .01 and 58% vs. 39%; P = .01). No difference was observed in the FPs' awareness of the BCCA's Radiation Oncology Program. The most significant factors influencing an FP to refer a patient for PRT were: poor functional status, inconvenience to travel and life expectancy. A higher proportion of rural FPs had 10 years or less of experience in family practice than the urban FPs (P = .03). There was no significant difference in the formal training or additional training between the rural and urban FPs. CONCLUSIONS: This study found that FPs practicing in rural areas were more involved in palliative management of their patients and participated more in the care of patients with advanced or metastatic cancer than those in urban areas. They also more commonly referred patients for palliative radiotherapy than their urban counterparts. The reported factors that influenced rural and urban FPs to refer were patients' functional status and life expectancy, combined with uncertain benefit and potential side effects of radiotherapy. More than twice as many FPs from rural compared to urban areas were influenced by perceived inconvenience to travel for palliative radiotherapy. After controlling for potential confounding factors, FP awareness of the radiotherapy program, high participation in advanced, metastatic, or palliative care of cancer patients, formal training in radiation oncology, and additional training in palliative care were all associated with an increased probability of ever referring for palliative radiotherapy.

Development of Dual Language Information Cards as a Tool for Communication Between Radiation Therapists and Cantonese-Speaking Patients Undergoing Radiation Treatments for Head-and-Neck Cancer.

The establishment of an effective relationship between patient and provider is dependent upon effective communication. However, this can be difficult to achieve with patients who do not speak English as their first language. Language barriers are associated with adverse effects on quality of care, treatment outcomes, and patient and provider satisfaction. These patients are more likely to experience acute side effects and more likely to use emergency room services for problems that are treatable in primary care settings. Interpreter services and dual language providers are often used to overcome these barriers, but they are often limited by their cost and availability. The radiation therapy environment provides further challenges to overcoming these barriers by virtue of the outpatient setting and high volume of appointments. As part of their efforts to improve patient care, the British Columbia Cancer Agency (BCCA)-Vancouver Centre radiation therapy department introduced dual language cards as a tool to facilitate communication between Cantonese-speaking patients and radiation therapists. This paper outlines the method of devising and evaluating a dual language tool.

Inequities in Access: How Utilization of Palliative Radiation Therapy in British Columbia Varies with Geography.

PURPOSE: Referral and utilization rates are important measures of the quality of service offered by hospitals and clinics, specifically in regard to access to appropriate care. This study measured referral rates and utilization rates for palliative radiation therapy (PRT) for the different health authorities in British Columbia (BC), Canada, to establish areas where there were variations in access. METHODS AND MATERIALS: Incident data was taken from the British Columbia Cancer registry between 1986 and 1999. Radiation therapy (RT) data were extracted between 1986 and 2005. The extra years were included to allow time for any disease progression that may have occurred. Referral rates were defined as the percentage of incident cases that had a consultation at the British Columbia Cancer Agency. The PRT utilization rate was defined as the percentage of incident cases receiving at least one course of palliative radiation therapy. Data were analysed for each of the 16 Health Service Delivery Areas in BC. RESULTS: Significant geographical variations in both referral rates and utilization rates were identified. Generally, both referral rates and utilization rates were lower in areas where there is limited or difficult access to a cancer centre. After building a cancer centre in the Interior region of BC, both referral and utilization rates increased. INTERPRETATION: Utilization of palliative radiation varies depending on where people live. Access to RT is lower in remote geographical areas, implying a barrier to essential health care services. This seems to be related to lower referral rates in those areas.

How gender, age, and geography influence the utilization of radiation therapy in the management of malignant melanoma.

PURPOSE: Comparing radiation therapy utilization rates (RTUR) to those predicted by best evidence is a useful measure of the equity and accessibility of service delivery. In this study the RTUR for melanoma was established for British Columbia, Canada, and compared with the rate suggested by the evidence. Demographic variables, specifically age, gender, and geography that influenced the RTUR were examined with a view to identifying methods of improving underutilization. METHODS AND MATERIALS: The RTUR in the management of malignant melanoma was taken from British Columbia Cancer registry data for 1986 to 1998. Variations in utilization based on age, gender, health authority, stage of disease, and referral patterns were analyzed. RESULTS: An RTUR of 11% was identified. This was consistent over time. Referral rates decreased between 1986 and 1998. RT is used mostly for later stage disease. Males were more likely to receive RT than females, related to later stage of disease in men. Referral rates decreased, but RTUR for referred cases increased, in health authorities that did not have a cancer center. CONCLUSIONS: Use of RT is influenced by age and by stage of disease. Overall RTUR in British Columbia is lower than suggested by best evidence. Referral patterns are influenced by geography. RTUR was higher in males, consistent with a different pattern of disease in males compared with females.