Quality assurance in radiotherapy: analysis of the causes of not starting or early radiotherapy withdrawal

Abstract

BackgroundThe aim of this study was to analyse the reasons for not starting or for early of radiotherapy at the Radiation Oncology Department.MethodsAll radiotherapy treatments from March 2010 to February 2012 were included. Early withdrawals from treatment those that never started recorded. Clinical, demographic and dosimetric variables were also noted.ResultsFrom a total of 3250 patients treated and reviewed, 121 (4%) did not start or complete the planned treatment. Of those, 63 (52%) did not receive any radiotherapy fraction and 58 (48%) did not complete the course, 74% were male and 26% were female. The mean age was 67 ± 13 years. The most common primary tumour was lung (28%), followed by rectum (16%). The aim of treatment was 62% radical and 38% palliative, 44% of patients had metastases; the most common metastatic site was bone, followed by brain. In 38% of cases (46 patients) radiotherapy was administered concomitantly with chemotherapy (10 cases (22%) were rectal cancers).The most common reason for not beginning or for early withdrawal of treatment was clinical progression (58/121, 48%). Of those, 43% died (52/121), 35 of them because of the progression of the disease and 17 from other causes. Incomplete treatment regimens were due to toxicity (12/121 (10%), of which 10 patients underwent concomitant chemotherapy for rectal cancer).ConclusionsThe number of patients who did not complete their course of treatment is low, which shows good judgement in indications and patient selection. The most common reason for incomplete treatments was clinical progression. Rectal cancer treated with concomitant chemotherapy was the most frequent reason of the interruption of radiotherapy for toxicity.

Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer: A mixed-methods study

“…From a cancer care policy standpoint, the American Society for Radiation Oncology (ASTRO), the European Society for Radiotherapy & Oncology (ESTRO), and the National Institute for Health and Care Excellence (NICE) all prefer the so-called modest hypofractionation (2-3 Gy per fraction) [6] for most patients with early breast cancer, recognizing the positive implications for health systems with high caseloads of patients potentially undergoing such regimen. Indeed, hypofractionation schedules reduce acute toxicity, which can lead to discontinuation of radiotherapy treatment [7]. Despite the benefits for patients and health systems and its consideration as a standard of care [8,9], hypofractionated whole-breast radiotherapy (HWBRT) still encounters resistance, and its adoption varies in clinical practice [10,11].…”

The impact of radiation treatment planning technique on unplanned hospital admissions

“…UHAs are directly antithetical to this goal and have a negative impact on patients with advanced cancer. 26 Therefore, authorization by payers should allow for the use of more conformal radiation treatment planning methods and thus the least toxic treatment option possible in the setting of palliation for patients with bone metastases.…”

Patients’ view of the differences in topical creams for radiation dermatitis prevention. A pilot study of cosmetic properties

“…4,5 Signs of ARD on the skin and symptoms include oedema, erythema, skin dryness, itching, pain, and, in the most severe cases, moist desquamation, bullae, ulcers or skin necrosis, which can cause patient discomfort 5 and discontinuation of the RT. 4,6 ARD has been linked to patient and radiation treatment factors, such as patient position, breast size, or body habitus, as well as the use of intensity modulated radiotherapy, dose to irradiated volume and concomitant treatments. Several scales have been used to evaluate skin toxicity.…”