The EORTC QLQ43 and FACT H&N questionnaires of quality of life at 1 and 5 years after treatment and dental care in head and neck cancer patients: a pilot study.

PURPOSE: This study aimed to examine health-related quality of life (HRQoL) in head and neck cancer patients at 1 and 5 years after successful treatment of their tumors, and to explore the usefulness of 2 instruments for assessing the need of dental care services. METHODS: This cross-sectional pilot study included 20 adult patients with head and neck cancer who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT H&N) Symptom Index and the European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-H&N43) after 1 and 5 years of treatment. RESULTS: Mean (standard deviation, SD) scores of the FACT H&N Symptom Index were higher (better HRQoL) at 5 years than at 1 year (24.1 [4.4] vs. 21.1 [6.4]; p = 0.236). Only three of the ten items of FACT H&N (swallow, pain in mouth/throat or neck, and solid foods) evaluated oral health. In the EORTC QLQ-H&N43 questionnaire, scores were lower at 5 years (better HRQoL) in almost all multi- and single-item symptoms. This questionnaire includes four multi-item scales (pain in the mouth, social eating, swallowing, and problems with teeth) measuring dental and orthodontic needs. CONCLUSION: HRQoL in patients with head and neck cancer improved with the length of follow-up. The EORTC QLQ-H&N43 has more items addressing oral health compared to the FACT H&N Symptom Index and may be more adequate to assess the need of dental therapy in clinical practice.

Uncommon short- and long-term cardiological side effects of thoracic radiation: a report of two cases.

Radiotherapy is an essential treatment of more than 50% of oncohematological patients. Pericardial disorders and valvular heart disease are two common radiotherapy complications. Acute pericarditis is infrequent and usually underdiagnosed. Therefore, diagnostic suspicion and early treatment are mandatory to avoid the evolution to constrictive pericarditis. The prevalence of radiation-induced valvular heart disease is common in patients with a history of Hodgkin's lymphoma and breast cancer. It has distinctive characteristics from other etiologies and, thus, different therapeutic approaches. We present two cases of unusual complications of radiotherapy; the first one in the acute setting and the second one during the follow-up in the chronic phase. A multidisciplinary and individualized approach with specific considerations is decisive in the management of these patients.

Impact of implementing a category 1 external quality assurance scheme for monitoring harmonization of clinical laboratories in Spain.

Background: The objective of the present study was to examine the evolution of the analytical performance specifications (APS) used in External Quality Assurance (EQA) schemes, as well as the efficacy of a category 1 EQA scheme in monitoring the harmonization of clinical laboratory results in Spain. Methods: A review of the literature on the types of quality specifications used in schemes in other countries and their evolution was performed. In addition, a comparative analysis of the potential impact that different APS from eight countries had on clinical decision-making was made based on three measurands: sodium, thyroid-stimulating hormone (TSH), and activated partial thromboplastin time (aPTT). Results: Harmonization of analytical methods was demonstrated by assessing whether average results deviated from the certified reference value of control materials within the APS derived from biological variation (BV). The APS used in EQA have evolved from state-of-the-art models to BV. Poor clinical decision-making would occur if the results accepted by some APS were applied. Conclusions: In Spain, only 2 of the 18 measurands studied are considered to be well harmonized. Closer collaboration between laboratories and analytical system providers would be required to resolve discrepancies.

Patterns of care for brachytherapy in Europe: updated results for Spain.

OBJECTIVE: The aim of this follow-up pattern of care study was to evaluate current clinical practices, staffing and equipment, and to compare these results to a study performed 5 years previously. MATERIALS AND METHODS: This descriptive, pattern of care study was carried out via an online questionnaire. The survey was sent to a total of 95 cancer care centres in Spain. RESULTS: Seventy-three centres (76.8%) responded to the survey. More than half (57.5%) of responding centres offered brachytherapy (BT). A mean of 120 patients/centre were treated by BT in 2007. The most common localisations were the endometrium (29.6% of cases), prostate (29.6%), cervix uteri (14.6%), breast (12.6%), head and neck (3.6%) and vagina (2.5%). Other sites accounted for less than 2% of cases each. Most centres that offered BT (33/40 = 82.5%) were equipped with a dedicated BT operating room. The most commonly reported dosimetric method was CT dosimetry (31 of 40 centres = 77.5%), followed by plain film (30/40 = 75%), ultrasound (26/40 = 65%), MRI (8/40 = 20%), in vivo (7/40 = 17.5%) and PET-CT (5/40 = 12.5%) dosimetry. CONCLUSION: The three most common treatment sites (gynaecological, breast and prostate) remain unchanged from 2002, with prostate treatments showing large increase. Advanced dosimetric techniques (MRI, PET-CT and CT-dosimetry) continue to gain adherents. Some centres treat small numbers of patients, a finding that deserves more attention in terms of cost and quality of care. Although BT remains strong in Spain, it could be further strengthened by making modern dosimetric techniques and treatments more widely available.

Overview of brachytherapy resources in Latin America: a patterns-of-care survey.

PURPOSE: Relatively little is known about available resources and patterns of practice for brachytherapy (BT) in Latin America. To rectify this situation, we performed a patterns-of-care survey whose aim was to assess the human and material resources available for BT in Latin America and document current clinical practices. METHODS AND MATERIALS: A total of 392 radiotherapy (RT) centers located in 17 Latin American countries were asked to complete an online survey that included detailed questions about BT practices, facilities, and staffing. The study was coordinated through central offices located in Spain and Peru. National coordinators were appointed to manage the survey in each individual country. RESULTS: Overall, 77 of the 392 institutions (20%) completed the questionnaire. Of the 14 countries with at least one response, the participation rate was 35% (77 of 223 RT centers). The average number of patients (RT+BT) per center was 917. The mean number of BT patients per center increased by 46% (from 105 to 153 patients) from 2002 to 2007. Gynecologic localizations (endometrium, cervix, and vagina) accounted for 95% of treatments, and the uterine cervix was the most common tumor site (75% of all treatments). CONCLUSIONS: In Latin America, BT is most commonly used to treat gynecologic tumors, particularly of the cervix. Relatively few interventions were performed for breast and prostate. This was the first study of its kind in this region and should be repeated periodically.

Patterns of care for brachytherapy in Europe: updated results.

OBJECTIVE: This descriptive survey evaluated brachytherapy (BT) practices and resources in the European area. This was a follow-up study to the original patterns of care for brachytherapy in Europe (PCBE). MATERIALS AND METHODS: A total of 1121 radiotherapy (RT) centres from 41 countries were asked to complete an online questionnaire on BT practices and resources. Countries with fewer than 50% of centres responding were excluded. Participating countries were divided into three groups based on gross domestic product (GDP); group I contained the countries with the highest GDP. RESULTS: The response rate was 56% (633/1121 centres) with 30/41 countries (73%) meeting the inclusion criteria. Sixty percent of reporting centres provided brachytherapy. Responding centres treated an average of 138 (±10, 1 SD) patients with BT; in group I, the mean was 110/centre, an increase of 18% from 2002. CT-dosimetry increased to 61% of centres vs. 33% in 2002. HDR (high-dose rate) BT was the most commonly reported technique (65% of centres). Most BT interventions were for gynaecological tumors (59% of all cases), followed by prostate (17%), breast (9%), lung/bronchus (3%), and esophagus tumors(2%). CONCLUSION: Gynaecological BT remains the most common application, although both prostate and breast BT have increased. CT-based dosimetry has become increasingly common since 2002. The use of HDR and PDR (pulsed-dose rate) techniques has increased markedly, while both LDR and MDR (medium-dose rate) have declined.

External beam radiotherapy plus high-dose-rate brachytherapy for treatment of locally advanced prostate cancer: the initial experience of the Catalan Institute of Oncology.

PURPOSE: The objective of this study was to report initial outcomes in patients with locally advanced prostate cancer (CaP) who underwent external beam radiation therapy (EBRT) treatment combined with high-dose-rate brachytherapy (HDR-BT) as a boost. METHODS AND MATERIALS: From 2002 to 2007, 114 CaP patients underwent EBRT followed by (192)I HDR-BT. The patients were classified into intermediate- (Group 1) or high- (Group 2) risk groups. The mean total EBRT dose was 60.0Gy (95% confidence interval [CI]: 59.9-60.1) at 2Gy per fraction. After a mean of 20.6 days (95% CI: 18.4-22.8), all the patients received a single-fraction 9-Gy dose of HDR-BT boost. Of the 114 patients in the study, 103 (90.4%) underwent up to 3 years of complete androgen deprivation therapy after diagnosis. RESULTS: The mean followup for the entire group was 32.1 months (95% CI: 29.9-34.4). The 4-year biochemical failure-free survival rate was 97.4% and treatment was well-tolerated. CONCLUSIONS: Preliminary biochemical control rates after EBRT plus one fraction of 9-Gy HDR-BT are encouraging. This atypical fractionation schedule is cost-effective and reduces patient discomfort and treatment-related risks. More followup is required to confirm these findings.

Patterns of care study for brachytherapy: results of the questionnaire for the years 2002 and 2007 in The Netherlands.

PURPOSE: The goal of the ESTRO Patterns of Care study for Brachytherapy in Europe (PCBE) 2002 was to develop an aid to analyse brachytherapy practices. A 2nd version of the PCB questionnaire was created for 2007. Data over 2007 were collected at the radiotherapy institutions in The Netherlands and compared with those from 2002. The aim of this study is to describe national brachytherapy practices, to demonstrate trends, and to provide data for rational health care planning. MATERIAL AND METHODS: Data were collected using a web-based questionnaire. For each centre, a local coordinator, responsible for coordinating the questionnaires and support of the further analysis was assigned. Data from the national cancer incidence registry was used for comparison with the data from the 21 Dutch departments. RESULTS: There was a decrease in low-dose rate equipment in parallel to an increase in both pulsed-dose rate and high-dose rate equipment. The use of 3D CT and MR based imaging techniques showed a slow rise. The most common clinical procedures were for prostate, gynaecological, and oesophageal tumours. A large increase (146%) in permanent implant prostate applications using 125I seeds was observed. The numbers of oesophageal and gynaecological treatments remained stable. There is concern on the low numbers of cases treated in some institutions for a few complex treatment sites. For head and neck, anal canal, paediatrics, bladder and eye interventions it ranged from 3-20 patients per year per institution. CONCLUSIONS: The increase in number of patient treated with brachytherapy is in accordance with the increases in cancer incidence. The percentage of all radiotherapy patients treated with brachytherapy (approximately 5%) remained stable. The survey identified certain trends in resources and techniques, as well as areas of expected improvement and possible gain in clinical outcome. Data reported from this survey can be used for further planning of resources, facilities and concentration of a low-volume specialised and complex treatments.

Brachytherapy in the United Kingdom and Spain: a subset analysis of a European pattern of care survey.

PURPOSE: The aim of this pattern of care survey was to provide an overview of brachytherapy resources and practices in the United Kingdom (UK) and Spain and to identify differences that may be relevant to health-care delivery and planning. METHODS AND MATERIALS: Both countries formed part of a larger survey of European radiation oncology centres carried out in 2002. The present study includes only data from centres that perform brachytherapy and completed the questionnaire. RESULTS: Between 1997 and 2002, the number of hospitals offering brachytherapy increased by 10.2% in the UK and 21.4% in Spain. The mean number of radiotherapy patients per centre was significantly higher in the UK (2811 patients) than in Spain (1203). Gynaecological tumours accounted for most procedures (59.7% in Spain and 60.8% in the UK), followed by prostate cancer in the UK (16.7%) and breast cancer in Spain (15.5%). Significantly more procedures for breast cancer were performed in Spain (19.7 patients/centre) than in the UK (0.4 patients/centre). A significantly higher percentage of radiation oncologists in Spain performed brachytherapy, dedicating more time to brachytherapy-related work (22.2 h/week) than their colleagues in the UK (6.7 h/week). CONCLUSIONS: Brachytherapy resources and patterns of care are similar in both countries, although several notable differences exist. Radiation oncologists in Spain dedicate significantly more time to brachytherapy. Compared to the UK, brachytherapy is used more frequently in Spain as a boost in breast cancer treatments. Both countries perform more brachytherapy procedures for prostate cancer than the European average.

Stability of drugs of abuse in oral fluid collection devices with purpose of external quality assessment schemes.

As the stability of drugs of abuse in oral fluid can affect drug testing results, we evaluated this parameter together with recovery for the principal drugs of abuse in two collection devices typically used to ship oral fluid samples to testing laboratories. Two different samples were prepared using Cozart Drug Detection System and Intercept oral fluid collection devices with 600 ng/mL of 6-monoacetylmorphine (6-MAM) and cocaine and 240 ng/mL of Delta-tetrahydrocannabinol (THC) and 11-nor-9-carboxy-Delta-tetrahydrocannabinol (THCCOOH). Samples were sent at ambient temperature by courier to the participating laboratories (n = 19) the same day of preparation. Samples were analyzed upon reception (about 48-72 hours after shipment). Percent coefficients of variation, calculated using robust mean and robust standard deviation, were around 30% for all analytes, except for THCCOOH in both samples (between 50% and 80%) and THC in 1 sample (50%). Percent coefficients of variation were also high (between 50% and 70%) for morphine and benzoylecgonine, formed after 6-MAM and cocaine spontaneous hydrolysis. On average, 9%-12% 6-MAM was converted to morphine and between 26% and 41% cocaine to benzoylecgonine. Good recoveries were observed for the acid metabolite of THC in both collection devices, whereas THC was always scarcely recovered. Depending on the collection device used, obtained results may confound the interpretation and estimation of blood drug concentration, given an oral fluid drug concentration and subsequent consideration of time elapsing from drug consumption.

Patterns of care for brachytherapy in Europe: facilities and resources in brachytherapy in the European area.

PURPOSE: The objective of the survey was to obtain detailed information on the use of brachytherapy through a web-based questionnaire. The present article describes the resources available in 2002. METHODS AND MATERIALS: The European area was divided into three groups: Group I included the 15 original member countries of the European Union plus 4 others according to economic wealth; Group II included the 10 most recent members of the European Union; and Group III included 14 other European countries. A national coordinator was designated for each country with a general coordinator to oversee the project to encourage the participation of every radiotherapy center. RESULTS: Three hundred forty-eight (47.2%) of the responding centers provided brachytherapy services and, compared to data from 1997, most showed a significant increase in the mean number of brachytherapy patients per center. The average number of radiation oncologists involved in brachytherapy was similar in the three groups. The average workload estimated in hours per week at the cancer centers was, however, higher in Groups II and III. Most centers had at least one treatment planning system, although in Group I 7.7% of the centers had three or more treatment planning systems. CONCLUSIONS: Notable differences in brachytherapy treatment were observed, especially in the workload of radiation oncologists and physicists in Groups II and III, the two groups with largest number of patients. New surveys can provide a detailed analysis of changes over time, a potentially useful tool to eliminate the differences observed.

Patterns of care for brachytherapy in Europe, in Spain and Italy: comparative results.

AIMS AND BACKGROUND: The aim of the study was to compare the facilities for brachytherapy in two similar countries, as are Italy and Spain. This survey reports the differences in the use of brachytherapy in these countries. METHODS: The data regarding brachytherapy was obtained in 2002 by means of a specially designed web site, because Internet allowed the access to the questionnaire in an easy and safe way. In the first edition of the survey, only the countries in which more than 50% of its centers had completed the questionnaire were included. Among these countries there were Italy and Spain. RESULTS: Data was available in 127 centers in Italy and 72 centers in Spain, where 35 and 39, respectively, provided brachytherapy. Although both countries had a similar number of radiotherapy patients and the average number of radiotherapy patients per center was similar in both countries (P = 0.29), there were several differences related to brachytherapy. For instance, the mean number of radiation oncologists regularly performing brachytherapy per center was higher in Spain (P = 0.001). There were also differences in the average number of patients per center in the following tumor sites: breast (P < 0.001) and gynaecological (P < 0.001). In fact, the average number of patients per center who were treated with brachytherapy in these tumor sites was higher in Spain than Italy. CONCLUSIONS: Although the estimated workload of the radiation oncologists, physicists and radiation technologists was higher in Spain, no statistically significant differences were found in the average number of patients per center for the following tumor sites: bronchus, head and neck, intracoronary, esophagus, prostate, rectum and skin. Several differences in the use of the brachytherapy procedures applied were also found.