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2.
Radiol Med ; 125(3): 329-335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31832987

RESUMO

INTRODUCTION: The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS: A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS: A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS: A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.


Assuntos
Desfibriladores Implantáveis , Fidelidade a Diretrizes , Marca-Passo Artificial , Radioterapia (Especialidade) , Radioterapia , Adulto , Desfibriladores Implantáveis/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Itália , Marca-Passo Artificial/estatística & dados numéricos , Doses de Radiação , Radioterapia (Especialidade)/estatística & dados numéricos , Sociedades Médicas
3.
Int J Radiat Oncol Biol Phys ; 106(1): 37-42, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31229573

RESUMO

PURPOSE: We sought to characterize temporal trends of radiation oncology resident-reported external beam radiation therapy (EBRT) case experience with respect to various disease sites, including trends in stereotactic radiosurgery and stereotactic body radiation therapy cases. METHODS AND MATERIALS: Summarized, deidentified case logs for graduating radiation oncology residents between 2007 and 2018 were obtained from the Accreditation Council for Graduate Medical Education national summary data report. Mean number of cumulative cases and standard deviations per graduating resident by year were evaluated. Cases were subdivided into 12 disease-site categories using the Accreditation Council for Graduate Medical Education classification. Analysis of variance was used to determine significant differences, and strength of association was evaluated using Pearson correlation. RESULTS: The number of graduating residents per year increased by 66% from 114 in 2007 to 189 in 2018 (P < .001, r = 0.88). The overall mean number of EBRT cases per graduating resident decreased by 13.2% from 521.9 in 2007 to 478.5 in 2018, with a decrease in the ratio of nonmetastatic to metastatic cases per graduating resident. There was significant variation among the disease categories analyzed; however, the largest proportionate decreases were seen in hematologic, lung, and genitourinary malignancies. Stereotactic radiosurgery volume per graduating resident increased from an average of 27.9 cases in 2007 to 50.3 in 2018 (P < .001, r = 0.96). Stereotactic body radiation therapy volume per graduating resident increased as well, from a mean of 6 cases in 2007 to 55.6 cases in 2018 (P < .001, r = 0.99). CONCLUSIONS: We report a longitudinal summary of resident-reported experience in EBRT cases. These findings have implications for future efforts to optimize residency training programs and requirements.


Assuntos
Internato e Residência/tendências , Neoplasias/radioterapia , Radioterapia (Especialidade)/tendências , Carga de Trabalho , Análise de Variância , Competência Clínica , Neoplasias Hematológicas/radioterapia , Humanos , Internato e Residência/estatística & dados numéricos , Estudos Longitudinais , Neoplasias Pulmonares/radioterapia , Metástase Neoplásica/radioterapia , Neoplasias/classificação , Radioterapia (Especialidade)/estatística & dados numéricos , Radiocirurgia/estatística & dados numéricos , Radiocirurgia/tendências , Radioterapia/estatística & dados numéricos , Radioterapia/tendências , Estudos Retrospectivos , Fatores de Tempo , Neoplasias Urogenitais/radioterapia , Carga de Trabalho/estatística & dados numéricos
7.
Int J Radiat Oncol Biol Phys ; 104(5): 987-996, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31085284

RESUMO

PURPOSE: The American Society for Radiation Oncology (ASTRO) annual meeting is the most prominent international conference in radiation oncology. It represents one of the greatest time efforts for ASTRO volunteers, and the quality of the annual meeting is a high priority. Measures of diversity have been linked with quality of academic efforts. We conducted a study of gender diversity of the ASTRO invited speakers, focusing on speaker and panel characteristics, and associations of these characteristics with measures of audience satisfaction. METHODS AND MATERIALS: We created a database of all invited speakers (n = 1499 cumulative speaking positions, n = 725 individual speakers) and panels (n = 381) in the ASTRO annual meetings from 2012 to 2016. Speaker characteristics were acquired using publically available online search tools (including Scopus for citation metrics). SAS software was used for statistical analysis. RESULTS: Of the 725 individual speakers, 27% were women. Men had higher median Hirsch index (H-index) (27 vs 20, P < .001), M-index (1.36 vs 1.11, P < .001), earlier first publication (1994 vs 1997), professorship (57% vs 40%, P < .001), chair status (25% vs 14%, P < .001) and fellow designations/distinctions (ie, FASTRO/FACR/FAAPM) (12% vs 9.5%, P < .17). Median panel gender distribution was 25% female, and greatest female representation was in breast, gynecology, and pediatrics. On multivariable analysis, panel characteristics associated with individual measures of audience satisfaction included single discipline presentations (metric: overall evaluation score), panels not proposed or endorsed by committee (metric: room count), higher H-index (metric: room count) and M-index (metric: request for session repeat), and panels with gender composition >50% female (metric: request for session repeat). Female conveners were associated with greater panel gender diversity. CONCLUSION: Given observations that women constitute a minority of invited speakers and that greater female representation correlates with a key panel success metric, efforts to ensure greater diversity of those included in AM speaking invitations merit serious attention.


Assuntos
Congressos como Assunto/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Razão de Masculinidade , Sociedades Médicas/estatística & dados numéricos , Pessoal Administrativo/estatística & dados numéricos , Benchmarking , Congressos como Assunto/tendências , Docentes de Medicina/estatística & dados numéricos , Docentes de Medicina/tendências , Feminino , Humanos , Masculino , Editoração/estatística & dados numéricos , Editoração/tendências , Radioterapia (Especialidade)/tendências , Sociedades Médicas/tendências , Estados Unidos
8.
Int J Radiat Oncol Biol Phys ; 105(1): 31-41, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039422

RESUMO

PURPOSE: To report radiation oncology (RO) workforce and cancer incidence trends in Canada and explore the relationship between the two. METHODS AND MATERIALS: Canadian radiation oncologist, trainee, and cancer incidence data from 1990 to 2018 were collected from the following publicly accessible administrative and health information databases: Canadian Post-MD Education Registry (1990-2018), Canadian Medical Association Physician Data Centre (1994-2018), Canadian Institute for Health Information/Scott's Medical Database (1990-2017), Canadian Cancer Registry (1990-2017), and Statistics Canada (1990-2017). Descriptive statistics were used to summarize the data. RESULTS: The Canadian RO workforce grew from 240 radiation oncologists in 1990 to 567 in 2018, with the largest growth period from 2005 to 2015 adding 207 radiation oncologists. Regional analyses revealed steady or stepwise growth in all Canadian regions, except in Québec, where the number of radiation oncologists decreased from 86 in 1990 to 57 in 2003 before rising to 139 by 2018. Trainee totals were between 54 and 173 per year with 2 periods of growth (1990-1996 and 2001-2008) and regression (1996-2001 and 2008-2018), signifying trainee supply variability. Female proportions of the workforce and trainees, respectively, rose steadily from 18% to 38% and 28% to 50%, while the workforce proportion with non-Canadian medical degrees decreased from 40% to 26%. Radiation oncologists younger than 40 years increased from 70 to 171, whereas those age 60 years and older decreased from 85 in 1990 to 31 in 2002 and then increased to 108 in 2017. Annual cancer incidence rose steadily from 103,780 to 206,290 cases/year. The annual cancer incidence-to-provider ratio fluctuated (364-475:1) and trended lower with time, and proportional cancer incidence-to-provider ratios varied between 0.7:1 and 1.6:1 in Canada's regions before approaching 1:1. CONCLUSIONS: Our study demonstrates the challenges and successes of managing the Canadian radiation oncologist workforce. These data will inform policy makers and other stakeholders to ensure that the profession meets the current and future needs of Canadian cancer patients.


Assuntos
Neoplasias/epidemiologia , Médicas/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Adulto , Distribuição por Idade , Canadá/epidemiologia , Bolsas de Estudo/estatística & dados numéricos , Bolsas de Estudo/tendências , Feminino , Médicos Graduados Estrangeiros/estatística & dados numéricos , Médicos Graduados Estrangeiros/tendências , Planejamento em Saúde , Humanos , Incidência , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Médicas/tendências , Radio-Oncologistas/provisão & distribução , Radio-Oncologistas/tendências , Radioterapia (Especialidade)/educação , Radioterapia (Especialidade)/tendências , Fatores de Tempo
9.
Int J Radiat Oncol Biol Phys ; 104(5): 999-1008, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31108141

RESUMO

PURPOSE: Women remain underrepresented at all levels within the field of radiation oncology. We sought to study current female residents' experiences and concerns to inform interventions to promote gender equity. Furthermore, we evaluated interest in a professional society specifically for women radiation oncologists. METHODS AND MATERIALS: An anonymous 76-item survey was designed and distributed to current women residents in radiation oncology in 2017-2018. Analyses describe personal, program, and family characteristics and experiences before and after joining the field. RESULTS: Of 170 female residents surveyed, 125 responded (74% response rate). Over one-quarter were in programs with ≤2 female residents (29%) and ≤2 female attendings (29%). One-third (34%) reported having children. Over half (51%) reported that lack of mentorship affected career ambitions. Over half (52%) agreed that gender-specific bias existed in their programs, and over a quarter (27%) reported they had experienced unwanted sexual comments, attention, or advances by a superior or colleague. Only 5% reported no symptoms of burnout. Almost all (95%) agreed that radiation oncology is perceived as family friendly; however, only 52% agreed that it actually is. An overwhelming majority (90%) expressed interest in joining a professional group for women in radiation oncology. CONCLUSIONS: In the first study to our knowledge to focus specifically on the experiences of women residents in radiation oncology, a number of areas for potential improvement were highlighted, including isolation and underrepresentation, mentorship needs, bias and harassment, and gender-based obstacles such as need for support during pregnancy and motherhood. These findings support the organization of groups such as the Society for Women in Radiation Oncology, which seeks to target these needs to promote gender equity.


Assuntos
Gestão de Mudança , Internato e Residência/organização & administração , Mentores/estatística & dados numéricos , Radioterapia (Especialidade)/organização & administração , Sexismo , Esgotamento Profissional/epidemiologia , Mobilidade Ocupacional , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Gravidez , Radioterapia (Especialidade)/estatística & dados numéricos , Grupos de Autoajuda , Sexismo/estatística & dados numéricos , Assédio Sexual/estatística & dados numéricos , Apoio Social , Inquéritos e Questionários/estatística & dados numéricos
10.
Int J Radiat Oncol Biol Phys ; 105(1): 42-51, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31082493

RESUMO

PURPOSE: To identify and report radiation oncologist (RO) workforce demographics, clinical workload trends, and equipment inventory in Canada. METHODS AND MATERIALS: The Canadian Association of Radiation Oncology (CARO) distributed an online survey to RO administrative leaders at 47 Canadian cancer centers providing radiation therapy services from June to December 2017. The survey queried RO staff demographics, clinical workload, and equipment inventory from 2014 to 2016. RESULTS: The response rate was 98% and represented 46 of 47 centers for analysis. In 2016, 510 ROs were in practice, with 98 ROs (19.2%) having <1.0 full-time equivalent (FTE) clinical work activities because of administration, research, or part-time employment. Most ROs worked full-time (92.0%), were affiliated with a university (77.5%), and worked in communities with a population >200,000 (84.9%). Approximately half (52.3%) were ≥46 years old. The male-to female ratio was 1.5:1 or higher in all regions of Canada except for Quebec, where there was no gender gap. Part-time employment was more common among female ROs (P < .01). Although FTE staff levels rose steadily between 2014 (456.3) and 2016 (475.8), an increase in patient workload resulted in a rise in the average annual consults per FTE-RO (from 257 to 267). Over a 2-year period, there were 63.5 FTE-recruitments and 44.0 FTE-departures (18.3 FTE-retirements; 25.7 FTE-migration) for a net gain of 19.5 RO-FTEs. An 8.4% increase in FTE staffing to 516 RO-FTEs in 2019 is anticipated, with 22 ROs expected to retire by 2019. There were 251 megavoltage linear accelerators across Canada, with most (39.8%) located in Ontario. Approximately one-fifth (20.7%) of these were older than 10 years and operating beyond the equipment's recommended life span. CONCLUSIONS: The Canadian RO workforce demonstrated incremental growth, but rising annual caseloads suggest that radiation therapy demand outpaced RO supply gains. Government funding is required to replace aging equipment in Canada.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Aceleradores de Partículas/provisão & distribução , Radio-Oncologistas/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Canadá , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Radio-Oncologistas/provisão & distribução , Radioterapia (Especialidade)/instrumentação , Radioterapia/estatística & dados numéricos , Aposentadoria/estatística & dados numéricos , Razão de Masculinidade , Sociedades Médicas
13.
Int J Radiat Oncol Biol Phys ; 104(2): 456-462, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30763663

RESUMO

PURPOSE: Medical students may take a year off during medical school (a "gap year") to strengthen their applications for competitive specialties such as radiation oncology. This can incur significant financial and opportunity costs. We sought to understand the prevalence, nature, and funding of gap years undertaken by radiation oncology applicants. METHODS AND MATERIALS: An anonymous survey was emailed to all applicants to a single radiation oncology program from 2015 to 2017. Survey questions assessed gap year utilization, funding, motivations, and perceptions. Separately, all 2017 Electronic Residency Application Service (n = 176) applications to this program were reviewed for reference. RESULTS: The 2017 cohort had a response rate of 69% (n = 121), with an overall response rate of 39% (n = 194) for applicants between 2015 to 2017. Of non-MD/PhD respondents, 33% (n = 53) reported taking a gap year. The main reason for a gap year (68%) was to produce more publications, and 50% of all respondents viewed a gap year as "important" or "very important" for matching in radiation oncology. Twenty-eight students (53%) reported using personal loans, savings, or family support to cover gap year expenses. Most who took a gap year (83%) viewed funding as "difficult" or "extremely difficult" to obtain. Fewer publications before gap year and more dedicated research time were significant predictors of undertaking a gap year, whereas sex, marital status, dependent status, and financial aid were not significant. CONCLUSIONS: Research productivity is commonly perceived as important for matching in radiation oncology, leading many applicants to take gap years, which are usually supported by personal financial resources. We did not identify statistically significant socioeconomic disparities between applicants that took a gap year and those who did not. However, further study is warranted to determine whether pressure to take a gap year, particularly in the absence of readily available funding sources, deters some potential applicants from pursuing radiation oncology altogether.


Assuntos
Internato e Residência/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Fatores de Tempo , Eficiência , Feminino , Apoio Financeiro , Humanos , Masculino , Estado Civil/estatística & dados numéricos , Motivação , Editoração/estatística & dados numéricos , Radioterapia (Especialidade)/educação , Pesquisa/estatística & dados numéricos , Critérios de Admissão Escolar , Inquéritos e Questionários/estatística & dados numéricos , Apoio ao Desenvolvimento de Recursos Humanos/economia
14.
Brachytherapy ; 18(3): 361-369, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30723021

RESUMO

PURPOSE: To understand the reasons behind current low utilization of brachytherapy for locally advanced cervical cancer in the United States. METHODS AND MATERIALS: A 17-item survey was e-mailed to the American Brachytherapy Society (ABS) listserv of active members in 2018. Responses of attending physicians in the United States were included in the analysis. RESULTS: Among a total of 135 respondents, 81 completed the survey. Eighty-four percent agree/strongly agree that cervical brachytherapy is underutilized, and 46.9% disagree/strongly disagree that residents are receiving adequate training for brachytherapy; 75.3% agree/strongly agree that inadequate maintenance of brachytherapy skills is a major obstacle to brachytherapy use; and 71.6% agree/strongly agree that increased time requirement constitutes a major obstacle. Over 97% will recommend brachytherapy for most patients with cervical cancer if given access/time; 72.8% always perform their own brachytherapy, whereas 29.6% reported some type of barrier exists in performing brachytherapy themselves, with time required to perform brachytherapy (9.9%) being a leading factor. A quarter (24.7%) routinely refer to other radiation oncologists for brachytherapy. Even among ABS members, 37.0% reported that they would perform an intensity-modulated radiation therapy or stereotactic body radiation therapy boost in specific scenarios in potentially curable patients. The most common scenario is inability to place a uterine tandem (56.7%). CONCLUSIONS: The underutilization of brachytherapy in cervical cancer is widely recognized by ABS members with inadequate training during residency and inadequate maintenance of skills being possible major contributing factors. Even among ABS members, there are identifiable barriers. Continued advocacy and future initiatives in enhancing access to brachytherapy training and efficiency are needed.


Assuntos
Braquiterapia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Neoplasias do Colo do Útero/radioterapia , Adulto , Competência Clínica , Feminino , Humanos , Pessoa de Meia-Idade , Radioterapia (Especialidade)/educação , Radiocirurgia , Radioterapia de Intensidade Modulada , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo
15.
Int J Radiat Oncol Biol Phys ; 104(4): 740-744, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-30677470

RESUMO

PURPOSE: Insurance payers in the United States vary in the indications for which they consider stereotactic body radiation therapy (SBRT) "medically necessary." We compared changes in policies after the last update to the American Society for Radiation Oncology's (ASTRO) SBRT model policy. METHODS AND MATERIALS: We identified 77 payers with SBRT policies in 2015 from a policy aggregator, as well as 4 national benefits managers (NBMs). Of these, 65 payers and 3 NBMs had publicly available updates since 2015. For each of the indications in ASTRO's model policy, we calculated the proportion of payers that considered SBRT medically necessary. We used Fisher's exact test to compare these proportions between 2015 and now, between policies updated in the past 12 months and those updated less often, and between national and regional payers currently. RESULTS: Payers consider SBRT medically necessary most often for primary lung cancer (97%), reirradiation to the spine (91%), prostate cancer (68%), primary liver cancer (66%), and spinal metastases with radioresistant histologies (66%). Policies have become more aligned with ASTRO's model policy over time. National payers and NBMs cover indications in higher proportions than regional payers. CONCLUSIONS: Although there have been improvements over time, more work is needed to align payer policies with ASTRO's model SBRT policy, especially at the regional level.


Assuntos
Reembolso de Seguro de Saúde/normas , Neoplasias/radioterapia , Política Organizacional , Radioterapia (Especialidade)/normas , Radiocirurgia/economia , Sociedades Médicas/normas , Benchmarking , Humanos , Revisão da Utilização de Seguros/normas , Cobertura do Seguro/normas , Reembolso de Seguro de Saúde/estatística & dados numéricos , Radioterapia (Especialidade)/estatística & dados numéricos , Estados Unidos
17.
Int J Radiat Oncol Biol Phys ; 104(5): 979-986, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30684662

RESUMO

PURPOSE: Understanding the pathways and gateways to leadership and challenges faced by individuals in such roles can inform efforts to promote diversity and equity. We sought to describe the professional experiences and personal characteristics of academic radiation oncology (RO) chairs and to evaluate whether differences exist by gender. METHODS AND MATERIALS: Anonymous surveys were distributed to 95 chairs of RO departments during the 2016 annual meeting of the Society of Chairs of Academic Radiation Oncology Programs. The surveys included 28 closed-ended questions and the Leadership Practices Inventory. Results were analyzed by gender using χ2 tests, rank-sum, and t tests (significance P < .05). RESULTS: A total of 72 chairs responded (61 male, 10 female, 1 declined to identify gender) for a response rate of 76%. There were no significant gender differences in age, academic rank, publications, or prior leadership positions held at the time of the first chair appointment, but female respondents held significantly greater total direct funding from extramural grants than their male counterparts (median, $1.89 million [interquartile range, $0.5-$5 million] vs $0.25 million [interquartile range, $0-$1.0 million]; P = .006). Women were more likely to have spouses employed outside the home at time of their first chair appointment than men were, with a trend toward women experiencing greater difficulty relocating. Men and women identified budgeting and resource allocation as their greatest professional challenges. There were no gender differences in the Leadership Practices Inventory-identified leadership domains or professional goals. CONCLUSIONS: Female RO chairs are as equally qualified as men in terms of productivity or leadership skills, but they face distinct challenges in the context of a gender-structured society. The observation of higher grant funding among women at the time of chair appointment suggests a possible need for interventions such as unconscious bias training to ensure that selection processes do not unnecessarily hold women to a higher standard.


Assuntos
Centros Médicos Acadêmicos/normas , Pessoal Administrativo/normas , Radioterapia (Especialidade)/normas , Fatores Sexuais , Centros Médicos Acadêmicos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Pessoal Administrativo/economia , Pessoal Administrativo/estatística & dados numéricos , Fatores Etários , Idoso , Orçamentos , Distribuição de Qui-Quadrado , Eficiência , Emprego/estatística & dados numéricos , Docentes de Medicina , Feminino , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Radioterapia (Especialidade)/economia , Radioterapia (Especialidade)/estatística & dados numéricos , Alocação de Recursos , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
18.
Pract Radiat Oncol ; 9(2): e210-e217, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30529794

RESUMO

PURPOSE: This study aimed to present an innovative approach to quantify, visualize, and predict radiation therapy (RT) process reliability using data captured from a voluntary incident learning system, with an overall aim to improve patient safety outcomes. METHODS AND MATERIALS: We analyzed 111 reported deviations that were tripped and caught within 159 mapped RT process steps included within 7 major stages of RT delivery, 94 of which were any type of quality assurance (QA) controls. This allowed for us to compute the trip rate and fail-to-catch-rate (FCR) per each QA control with the available data. Next, we used a logistic regression model to identify significant variables predictive of FCRs, predicted FCRs for each QA control without available data, and thus, attempted to quantify RT process reliability expressed as percentage of patients with uncaught deviations after treatment planning, before their first treatment, and during treatment delivery. RESULTS: Using the predicted FCRs, we computed the upper 95% likelihood that a deviation remains uncaught in a patient's course of treatment at the following RT process stages: immediately after treatment planning at 10.26%; before the first treatment at 0.0052%; and throughout treatment delivery at 0.0276%. CONCLUSIONS: The results suggest that RT process reliability can be predicted and visualized using data from incident learning systems. If implemented and used as a safety metric, this could help RT clinics to proactively maintain their preoccupation with patient safety. RT process reliability may also help guide future work on standardization and continuous improvement of the design of RT QA programs.


Assuntos
Segurança do Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Radioterapia (Especialidade)/estatística & dados numéricos , Radioterapia/estatística & dados numéricos , Gestão de Riscos/estatística & dados numéricos , Humanos , Modelos Logísticos , Erros Médicos/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Controle de Qualidade , Radioterapia (Especialidade)/organização & administração , Radioterapia/efeitos adversos , Radioterapia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Reprodutibilidade dos Testes , Gestão de Riscos/métodos
19.
Ann Surg Oncol ; 26(2): 660-668, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30311161

RESUMO

PURPOSE: The reasons for low clinical adoption of active surveillance (AS) for low-risk prostate cancer (PCa) remain poorly understood. Thus, we conducted a national survey of radiation oncologists (ROs) and urologists (UROs) to elucidate perceived barriers to AS for low-risk PCa. METHODS: In 2017, we undertook a four-wave mail survey of 1855 ROs and UROs. The survey instrument assessed attitudes about possible barriers towards AS for low-risk PCa. We used Pearson Chi square and multivariable logistic regression analyses to identify physician characteristics associated with attitudes about AS. RESULTS: We received 691 completed surveys for an overall response rate of 37.3%. A majority of respondents indicated that they felt comfortable recommending AS (90.0%), agreed that high-level evidence supports it (82.3%), and considered AS equally effective for survival compared with surgery and radiation therapy (84.4%). UROs were less likely to agree that patients were not interested in AS for low-risk PCa compared with ROs (16.5 vs. 48.9%; adjusted odds ratio [OR] 0.18, p < 0.001). Similarly, UROs were less likely to concur patients avoid AS because of repeat prostate biopsies than ROs (36.3 vs. 55.4%; adjusted OR 0.41, p < 0.001). ROs and UROs were more likely to agree that patients preferred treatments delivered by the respondent's specialty. CONCLUSIONS: Physician perceptions of patient lack of interest in AS, need for repeat prostate biopsies, and biases of patient treatment preferences in favor of their own specialty treatments represent key barriers to AS. Shared decision making may be a meaningful approach to engaging patients in conversations about treatment decisions.


Assuntos
Atitude do Pessoal de Saúde , Padrões de Prática Médica , Neoplasias da Próstata/terapia , Radioterapia (Especialidade)/estatística & dados numéricos , Urologia/estatística & dados numéricos , Conduta Expectante/métodos , Adulto , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Prognóstico , Inquéritos e Questionários
20.
J Radiat Res ; 60(1): 80-97, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30137391

RESUMO

We evaluated the evolving structure of radiation oncology in Japan in terms of equipment, personnel, patient load, and geographic distribution to identify and overcome any existing limitations. From March 2011 to June 2013, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2010. Data were analyzed based on the institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 211 000 and 251 000, respectively. Additionally, the estimated cancer incidence was 805 236 cases, with ~26.2% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (LINAC; n = 829), telecobalt (n = 9), Gamma Knife (n = 46), 60Co remote afterloading system (RALS; n = 28), and 192Ir RALS (n = 131). The LINAC system used dual-energy functions in 586 units, three-dimensional conformal radiotherapy functions in 663, and intensity-modulated radiotherapy (IMRT) functions in 337. There were 564 JASTRO-certified radiation oncologists, 959.2 full-time equivalent (FTE) radiation oncologists, 1841.3 FTE radiotherapy technologists, 131.3 FTE medical physicists, 121.5 FTE radiotherapy quality managers, and 649.6 FTE nurses. The frequency of IMRT use significantly increased during this year. To conclude, although there was a shortage of personnel in 2010, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility.


Assuntos
Radioterapia (Especialidade)/estatística & dados numéricos , Inquéritos e Questionários , Humanos , Japão/epidemiologia , Neoplasias/radioterapia , Aceleradores de Partículas , Radioterapia
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