Positive surgical margin rates during the robot-assisted laparoscopic radical prostatectomy learning curve of an experienced laparoscopic surgeon.

INTRODUCTION: Since its introduction, robot-assisted laparoscopic radical prostatectomy (RARP) has gained widespread popularity, but is associated with a variable learning curve. Herein, we report the positive surgical margin (PSM) rates during the RARP learning curve of a single surgeon with significant previous laparoscopic radical prostatectomy (LRP) experience. METHODS: We performed a prospective cohort study of the first 400 men with prostate cancer treated with RARP by a single surgeon (BS) with significant LRP experience. Our primary outcome was the impact of case timing in the learning curve on margin status. Our analysis was conducted by dividing the case numbers into quartiles (Q1-Q4) and determining if a case falling into an earlier quartile had an impact on margin status relative to the most recent quartile (Q4). RESULTS: The Q1 cases had an odds ratio for margin positivity of 1.74 compared to Q4 (p=0.1). Multivariate logistic regression did not demonstrate case number to be a significant predictor of PSM. The mean Q1 operative time was 207.4 minutes, decreasing to 179.2 by Q4 (p<0.0001). The mean Q1 estimated blood loss was 255.1 ml, decreasing to 213.6 by Q4 (p=0.0064). There was no change in length of hospitalization within the study period. CONCLUSIONS: Even when controlling for copredictors, a statistically significant learning curve for PSM rate of a surgeon with significant previous LRP experience was not detected during the first 400 RARP cases. We hypothesize that previous LRP experience may reduce the RARP PSM learning curve.

Development, characteristics and validity of the EORTC QLQ-PR25 and the FACT-P for assessment of quality of life in prostate cancer patients.

This review aims to compare and contrast the development, characteristics and validity of two widely used quality of life assessment tools in patients with prostate cancers: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-PR25) and Functional Assessment of Chronic Illness Therapy (FACT-P). Both questionnaires present several strengths as well as some limitations in measuring the quality of life of prostate cancer patients. Each tool may be selected accordingly based on study design and needs.

Symptom clusters in patients with metastatic cancer: a literature review.

This article reviews the literature reporting empirically determined symptom clusters in patients with metastatic cancer. A literature search was conducted on symptom clusters within heterogeneous metastatic cancer patient populations using MEDLINE, EMBASE, and CINAHL. Studies examining predetermined symptom clusters were excluded. A total of eight relevant studies published between 2005 and 2011 were identified. The number of symptom clusters extracted varied from two to eight clusters per study, comprising of two to eight symptoms per cluster. There were no clusters consistently identified within all eight studies. Notable differences in symptoms assessed, assessment tools, statistical analysis, patient demographics were observed between the studies. The lack of consensus among the inter-study symptom clusters are likely due to the differences in patient population as well as study methodology. Further exploration in metastatic symptom cluster research will ideally improve patient outcomes by facilitating improved symptom management in future clinical practice.

Comparison of the EORTC QLQ-BM22 and the FACT-BP for assessment of quality of life in cancer patients with bone metastases.

INTRODUCTION: Maintenance or improvement in quality of life (QoL) is the main goal of palliative treatments for bone metastases. Validated and comprehensive tools assessing QoL for specific patient subgroups are required in order to accurately assess and make informed decisions about palliative treatments. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for patients with bone metastases (QLQ-BM22) and the Functional Assessment of Cancer Therapy Quality of Life Measurement in patients with bone pain (FACT-BP) are the only two palliative QoL tools available that have been validated for use specifically for bone metastases patients. The purpose of this study was to compare the development and characteristics of these two tools, as well as their current use in palliative research. METHODS: Studies detailing the development process for the QLQ-BM22 and the FACT-BP were identified. A comparison between both questionnaires in terms of development, characteristics, validation and use was conducted. RESULTS: The QLQ-BM22 was developed with collaboration from patients, healthcare professionals and review of the literature, whereas the FACT-BP was created strictly through interviews with patients. Scoring, organization, response options and item format are different; however, recall period is the same. Both tools showed good internal consistency and construct validity. The QLQ-BM22 showed good test-retest reliability, while this has not been tested with the FACT-BP. The QLQ-BM22 has been internationally validated among a large sample of patients undergoing a variety of treatments, demonstrating its ability of detect meaningful QoL changes in diverse bone metastases populations. On the other hand, the FACT-BP demonstrated high internal consistency at all assessments, indicating that it may be utilized as a stand-alone measure of bone pain. CONCLUSION: Both the QLQ-BM22 and FACT-BP are designed for assessment of QoL issues specific to cancer patients with bone metastases. Each instrument has unique strengths and weaknesses and choice between these tools is dependent on the investigator and study needs.

Projected referral to other healthcare services in an outpatient palliative radiotherapy clinic.

AIMS: To investigate the projected referral to other healthcare services in an outpatient palliative radiotherapy clinic. METHODS: Patients referred for palliative radiotherapy from 1999 to 2002 inclusive and 2007 to 2009 inclusive were evaluated. The Edmonton Symptom Assessment System, which assesses nine symptoms, was completed by 1439 patients prior to radiotherapy consultation. The numeric scale was converted into a categorical scale of none, mild, moderate and severe. Patients with moderate-to-severe symptoms were identified as potential referrals to other healthcare services. RESULTS: Tiredness (66%), poor sense of wellbeing (64%), pain (57%) and poor appetite (52%) had the most patients scoring in the moderate-to-severe range. Moderate-to-severe anxiety and depression occurred in 39 and 30% of patients, respectively, reflecting the percentage of projected referrals for symptom and/or psychosocial management. CONCLUSION: Cancer symptoms are complex, and a multidisciplinary and collaborative approach should be taken to provide timely management and maintain patients' quality of life.

Poor Accrual in Palliative Research Studies: An Update From the Rapid Response Radiotherapy Program.

BACKGROUND: In June 2003, the Rapid Response Radiotherapy Program (RRRP) implemented changes to recruitment strategies in attempts to increase patient accrual to research studies. Such modifications included the use of a dedicated research assistant to screen for and identify eligible study patients, the introduction of more appropriate inclusion criteria, and the switch towards telephone interviews to minimize patient burden. The purpose of this study is to provide an update on patient accrual in the RRRP. METHODS: All patients seen in the RRRP from January 2002 to December 2009 were recorded in a prospective database. Reasons for referral, eligibility for clinical trials, reasons for non-accrual, and various demographics information were recorded. Descriptive statistics summarized findings. RESULTS: A total of 4726 patient visits were recorded from January 1st, 2002 to December 31st, 2009. Prior to changes, the overall rate of accrual into research studies was 14.9% versus 48.1% after changes were implemented. Patients were not accrued onto studies mainly to due ineligibility according to study protocol. Other reasons such as language barrier (12.1%), physician objection (3.5%), patient declining participation (11.3%) and lack of a research assistant (9.3%) were cited. CONCLUSIONS: Changes in clinical structure and study design can significantly impact accrual patterns in palliative radiotherapy studies. Despite these changes however, the majority of patients are still not enrolled in studies. Therefore additional efforts need to be made to maximize patient accrual and minimize attrition.