Patient preference for radiotherapy fractionation schedule in the palliation of painful bone metastases.

PURPOSE: The radiotherapeutic management of painful bone metastases is controversial, with several institutional and national guidelines advocating use of single-fraction radiotherapy. We aimed to determine patient choice of fractionation schedule after involvement in the decision-making process by use of a decision board. PATIENTS AND METHODS: Advantages and disadvantages of two fractionation schedules (24 Gy in six fractions v 8 Gy in one fraction) used in the randomized Dutch Bone Metastasis Study were discussed with patients using a decision board. Patients were asked to choose a fractionation schedule, to give reasons for their choice, and to indicate level of satisfaction with being involved in decision making. RESULTS: Sixty-two patients were entered. Eighty-five percent (95% confidence interval, 74% to 93%) chose 24 Gy in six fractions over 8 Gy in one fraction (P <.0005). Variables including age, sex, performance status, tumor type, pain score, and paying class were not significantly related to patient choice. Multiple fractionation was chosen for lower re-treatment rates (92%) and fewer fractures (32%). Single-fraction treatment was chosen for cost (11%) and convenience (89%). Eighty-four percent of patients expressed positive opinions about being involved in the decision-making process. CONCLUSION: Decision board instruments are feasible and acceptable in an Asian population. The vast majority of patients preferred 24 Gy fractionated radiotherapy compared with a single fraction of 8 Gy. These results indicate the need for further research in this important area and serve to remind both clinicians and national or institutional policy makers of the importance of individual patient preference in treatment decision making.     

Not asking cancer patients about their preferences does make a difference. A cross‐sectional study examining cancer patients’ preferred and perceived role in decision‐making regarding their last important cancer treatment

We examined whether not having been asked by their clinicians about how involved cancer patients would like to be in their treatment decisions is related to discordance between patients’ preferred and perceived involvement in treatment decision‐making. This was a cross‐sectional survey of adult cancer patients recruited from five medical and radiation oncology outpatient clinics in Australia. Discordance of patients’ preferred and perceived decision‐making roles was assessed via an adapted version of the Control Preferences Scale. Logistic regression modelling was conducted to assess the relationship between role discordance and whether patients were not asked but wanted to be asked about how involved they would like to be in deciding on their treatment. Of 423 study participants, almost a third (n = 128, 31%) reported discordance between their preferred and perceived involvement in their treatment decisions. Of those reporting discordance, 72% (n = 92) were less involved than they would have liked to have been. Not being asked about their preferences for involvement in treatment decisions, despite wanting this, was associated with discordance between patients’ preferred and perceived involvement in treatment decision‐making (p < 0.04). To achieve patient‐centred care, it is vital that clinicians seek patients’ views about how involved they would like to be in deciding on their cancer treatment.     

Decision‐making preferences and information needs among Greek breast cancer patients

Objectives: We aimed at assessing Greek breast cancer patients' preferences for participation in treatment decision making and their information needs. Methods: In a cross‐sectional study, 329 breast cancer patients were administered at the Control Preferences Scale, a card‐sort measurement designed to elicit preferences for participation in decision making. Information needs were assessed with Cassileth's Information Styles Questionnaire. Results: The majority of patients (71.1%) preferred to play a passive role in treatment decision making, with most of them wanting to delegate responsibility of the decision completely to their doctor (45.3%). A collaborative role was preferred by 24%, whereas only 4.6% chose an active role. Most women expressed a general desire for as much information as possible about their illness (62.6%), but a substantial proportion (37.4%) did not want detailed information; instead, they wished to avoid awareness of bad news. Women who desired less informational details and preferred a passive role requested less frequently a mammography (p<0.001) and/or Pap test (p<0.0005) prediagnostically. Conclusions: This study's findings showed that the proportion of patients who wanted to play a passive role in decision making is the highest reported compared to similar studies from other countries, indicating the impact of the dominating paternalistic model of the doctor–patient relationship in the Greek medical encounter. The association of desired information details and decision‐making preferences with screening for cancer procedures prediagnostically highlights the significance of providing the patients with the appropriate information and the choices available for their treatment. Copyright © 2010 John Wiley & Sons, Ltd.     

The role of patients’ families in treatment decision‐making among adult cancer patients in the Sultanate of Oman

There are limited numbers of studies available in Middle Eastern Arabic countries regarding participation of family ?members in cancer treatment decision‐making (TDM). The aim of this study was to evaluate the role of family members’ ?in TDM among ?adult Omani cancer ?patients. A cross‐sectional study was conducted in two main teaching hospitals. All adult Omani patients who were diagnosed with cancer and their nominated family members were invited to ?participate. A tool developed by Cancer Care Outcomes Research and ?Surveillance Consortium was used to identify the level of family involvement in TDM. A weighted kappa (k) was significant (p < .001) and showed almost full agreement between the patients’ experiences and their preferences ?(?k = .98) and between family members’ experiences and their preferences ?(?k = .96) ??of family involvement in TDM. Binary logistic regression showed significant family‐controlled TDM if the patient communicated? less with oncologists (OR = 9.89; 95% CI: 3.79–25.81); financial dependence of the patient on their families ?(OR = 6.21; 95% CI: 2.19–17.10?); and advanced stages of cancer at the time of diagnosis ?(OR = 3.10; 95% CI: 1.37–7.03). Oncologists in Oman should be aware of the strong family involvement in TDM to allow a successful cancer treatment.     

Cancer patients’ coping styles and doctor–patient communication

Monitoring and blunting styles have become relevant concepts regarding their potential impact on patients’ and doctors’ behaviors. The present study aimed at investigating the relation between cancer patients’ coping styles and doctor–patient communication and global affect. Coping styles were assessed by means of the Threatening Medical Situations Inventory (TMSI). Since a shortened version of the TMSI was used, the validity of this instrument was also evaluated. First, it was examined whether the two factor structure of the original TMSI could be confirmed in our version. Then, the relation between coping style and patients’ preferences for information and participation in decision‐making was evaluated. Second, the relation between monitoring and blunting and patients’ age, sex, education, quality of life and prognosis was investigated. Finally, the relation between patients’ coping styles and communicative behaviors and global affect of both patients and physicians during the initial oncological consultation was examined. Patients (N=123) visited their gynaecologist or medical oncologist for an initial discussion of possible treatment. Patients’ coping styles, socio‐demographics, preference for information and participation in decisionmaking, quality of life and prognosis were assessed by postal questionnaire prior to the visit to the outpatient clinic. The consultation was audiotaped and analysed according to Roter's Interaction Analysis System, to identify instrumental and affective communicative behaviors of both patients and physicians. The two factor structure of the TMSI could be confirmed. A monitoring style was related to a preference for detailed information (r=0.23) and participation in medical decision‐making (r=0.23). A monitoring style was also related to patient question‐asking (r=0.25) and patient dominance (r=0.23). To conclude, the validity of the shortened TMSI is satisfactory. Also, cancer patients’ coping styles are not related to other personal and disease characteristics. Further, a monitoring style seems to have an impact on patients’ question‐asking and dominance during the oncological consultation. Copyright © 1999 John Wiley & Sons, Ltd.     

Shared decision‐making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation

The aim of this study on shared decision‐making in the doctor–patient encounter about surgical treatment for early‐stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision‐making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision‐making protocol. Data were analysed from a multi‐disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter‐related notions of decision‐making, participation and information. Patients' responses revealed important differences between shared decision‐making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision‐making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.     

Is rural radiation oncology practice quality as good as the big smoke? Results of the Australian radiotherapy single machine unit trial

Radiotherapy utilization rates in rural Australia are suboptimal, with one solution being the building of single machine units (SMUs). One concern raised with such an approach is the quality of care delivered in SMUs. The Australian and Victorian governments have established two SMUs in the state of Victoria, with each SMU operated as a satellite service of a major ‘hub’ site. We report on the planned evaluation of practice quality. Radiation oncologist (RO) clinical practice was externally audited using the Royal Australian and New Zealand College of Radiologists Peer Review Audit instrument. This tool splits RO clinical practice into documentation/quality assurance (QA) criteria and decision‐making criteria. Over the four sites, 130 patients were randomly selected for audit. At hub sites, 79.6% of all criteria audited were adequate, compared with 84.4% of criteria audited at SMUs (P = 0.0002). This difference was largely because of better adherence to documentation/QA criteria at the SMU sites. RO decision‐making and protocol adherence were routinely very high and consistent with other clinical practice audits. There were no significant differences between hubs and SMUs for adherence to decision‐making criteria; however, the few potential deficiencies in patient care identified occurred only at the hub sites. In at least one of these cases, potential suboptimal management was as a direct result of inadequate documentation. This audit found that SMUs provide as high a standard of radiotherapeutic care as larger hub departments. The findings also emphasize the need for all departments to target clinical documentation.     

Concurrent end‐phase boost high‐dose radiation therapy for non‐small‐cell lung cancer with or without cisplatin chemotherapy*

The aim of this study was to audit the results of a high‐dose, combined‐modality prospective protocol for non‐small‐cell lung cancer in terms of survival, disease‐specific survival and toxicity. One hundred and twenty‐one patients with non‐small‐cell lung cancer were treated with a concurrent, end‐phase, boost, high‐dose radiotherapy protocol with 65 Gy in 35 fractions for more than 5 weeks. Sixty‐six patients received radiotherapy alone (group 1), 29 received concurrent chemoradiation (group 2) and 26 received neoadjuvant and concurrent chemotherapy (group 3). Thirty‐four patients had stage I disease, six had stage II and 81 had stage III. Overall median survival was 23 months: 75% at 1 year and 23% at 5 years. Median survivals for patients with stage I and stages II and III disease were 43 and 19 months, respectively. For stages II and III patients by groups 1–3, median survivals were 18, 25 and 18 months, respectively, and 2‐year survivals were 36, 52 and 38%, respectively. Toxicity was acceptable. Overall, 9% had symptomatic pneumonitis and 7% had grades 3 and 4 oesophagitis. For those who had the mediastinum included in the volume, grade ≥3 oesophagitis occurred in 0, 11 and 22% (n = 110, P = 0.001), respectively, for treatment groups 1–3. Overall treatment‐related mortality was 3%, consisting of two septic deaths, one pneumonitis and possibly one late cardiac event, all occurring in patients who had chemotherapy (7% of 55 patients). Treatment‐related mortality declined over the study period. Accelerated radiotherapy was well tolerated, with only moderate increased acute toxicity when combined with concurrent platinum chemotherapy. Toxicity was enhanced by induction chemotherapy. Overall survival outcomes were excellent for this condition. Continued use of this radiotherapy schedule is recommended as the platform for assessment of other chemotherapy schedules.     

Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

To determine the therapeutic efficacy and safety of risk‐adapted stereotactic body radiation therapy (SBRT) schedules for patients with early‐stage central and ultra‐central inoperable non‐small cell lung cancer. From 2006 to 2015, 80 inoperable T1‐2N0M0 NSCLC patients were treated with two median dose levels: 60 Gy in six fractions (range, 48‐60 Gy in 4‐8 fractions) prescribed to the 74% isodose line (range, 58%‐79%) for central lesions (ie within 2 cm of, but not abutting, the proximal bronchial tree; n = 43), and 56 Gy in seven fractions (range, 48‐60 Gy in 5‐10 fractions) prescribed to the 74% isodose line (range, 60%‐80%) for ultra‐central lesions (ie abutting the proximal bronchial tree; n = 37) on consecutive days. Primary endpoint was overall survival (OS); secondary endpoints included progression‐free survival (PFS), tumor local control rate (LC), and toxicity. Median OS and PFS were 64.47 and 32.10 months (respectively) for ultra‐central patients, and not reached for central patients. Median time to local failure, regional failure, and any distant failures for central versus ultra‐central lesions were: 27.37 versus 26.07 months, 20.90 versus 12.53 months, and 20.85 versus 15.53 months, respectively, all P < .05. Multivariate analyses showed that tumor categorization (ultra‐central) and planning target volume ≥52.76 mL were poor prognostic factors of OS, PFS, and LC, respectively (all P < .05). There was one grade 5 toxicity; all other toxicities were grade 1‐2. Our results showed that ultra‐central tumors have a poor OS, PFS, and LC compared with central patients because of the use of risk‐adapted SBRT schedules that allow for equal and favorable toxicity profiles.     

Exploring consent to randomized placebo-controlled clinical trials in oncology

Aims: Randomized placebo‐controlled trials are critical for advancing knowledge in oncology, yet little is known about optimal communication for informed consent. This study aimed to identify patient preferences for and satisfaction with three consultation styles (information‐focused, emotion‐focused and collaborative) in simulated discussions of four clinical trial concepts (randomization, placebo, tissue analysis and oncologists’ recommendation). Methods: In total 75 Australian cancer patients and carers, or both, viewed videotaped simulated consultations with a doctor and patient discussing a randomized, placebo‐controlled trial. Their satisfaction and preferences for both consultation style and information were assessed. The patients’ characteristics and decision‐making preferences were also evaluated as potential predictors for consultation style preference. Results: Participants preferred a collaborative consultation style when discussing randomization (74.6%), placebo (71.4%) and oncologist's recommendation (77%). However an emotion‐focused consultation style was preferred when discussing tissue analysis (81%). The participants represented a highly information‐seeking group, although most favoured collaborative or passive roles in treatment decision‐making. Limited variables were identified that predict consultation style preference. Conclusion: While supporting the value of a collaborative approach to clinical trial communications, the study finding that tissue analysis requires a more emotion‐focused approach highlights a new focus for trial communication and confirms the need for doctors to remain flexible in their consultation style.     

Short-time splenic irradiation for splenomegaly

BACKGROUND: Splenic irradiation is routinely used in the supportive treatment of lymphoepithelial and hemopoietic diseases associated with splenomegaly. A new short-time irradiation schedule with conventional dosage (Group A: 2 Gy/fract.) was compared retrospectively with low-dose prolonged treatment schedules (Group B: < or = 1 Gy/fract.) to establish its tolerance and its efficacy in terms of relieving splenomegaly-associated symptoms. PATIENTS AND METHOD: Between 12/1996 and 3/2002 49 patients (6 with CLL, 14 with CML, 6 with NHL, 16 with MPD, 6 with OMF and 1 with AML) underwent 85 treatment courses (13 courses low-dose prolonged treatment and 72 courses short-time treatment).The spleens had been exposed to pretreatment doses of 3-70 Gy (mean 20.75 Gy). Splenic size was 12-35 cm (mean 22.76 cm). One treatment was done with 60Co. 9-20 MeV electron beams were used in 23 treatments and 6 MV photons in 61 treatments. Blood counts were monitored daily. Clinical improvement (pain relief, improvement of splenomegaly-associated symptoms), spleen volume reduction and effects on blood counts were evaluated and documented at the end of the treatment. RESULTS: Of the 85 treated patients, 55 (Group A: 47/72, Group B: 8/13) showed a > 10% reduction of spleen volume and 62 (Group A: 57/72, Group B: 5/13) clinical improvement. 15 of 49 patients underwent multiple irradiation (2-8 courses) without clinical or hematologic complications. The intervals between the courses were 2-19 months. Rapid response in terms of reduction in splenic size in 23 patients permitted field reduction during treatment. Significant hematologic abnormalities were absent throughout. CONCLUSION: The short-time treatment schedule ensured a rapid response with relief of pain and improvement of gastrointestinal and pulmonary symptoms at an overall treatment time shorter than that of low-dose prolonged treatment schedules. No differences in terms of hematologic abnormalities were found between single doses of 2 Gy and < or = 1 Gy.     

Prognostic factors for tumour response and skin damage to combined radiotherapy and hyperthermia in superficial recurrent breast carcinomas

Prognostic factors for complete tumour response and acute skin damage to combined hyperthermia and radiotherapy were analysed in material of patients with breast cancer, recurrent in previously irradiated areas. Radiotherapy was given daily to a total absorbed dose of 30·0 Gy in 2 weeks or 34·5 Gy in 3 weeks. The first radiotherapy schedule was combined with heat twice weekly, a total of four heat treatments (schedule A). The second radiotherapy schedule was combined with heat either once or twice a week resulting in a total of three (schedule B) or six (schedule C) heat treatments. Heat was induced with microwaves (2450, 915 or 434 MHz) via external applicators and always given after the radiotherapy fraction. The complete response (CR) rate in evaluable patients was 71% (49/69). There was no significant difference in CR rate between the three different hyperthermia schedules. The CR rates were 74% (14/19), 65% (15/23) and 74% (20/27) for schedules A, B and C respectively. The only factor predicting CR, evaluated both uni- and multivariately, was the CRE-value for the present radiotherapy dose (p = 0·02). If only tumours treated with 915 MHz were taken into account, however, then the highest minimum temperature at a given heat session predicted complete response (p = 0·03). This was true also in a multivariate analysis of this subgroup of tumours. A Kaplan-Meier analysis (log rank test) showed no significant difference in duration of CR between the different treatment schedules. Cox's proportional hazards method revealed three significant factors: tumour size (negatively correlated, p = 0·007), the time interval between the diagnosis of the primary tumour and the present treatment (p = 0·02) and the average temperature (0·03). Maximum acute skin reactions in the treatment field were scored according to an ordinal scale of 0–8, modified after WHO 1979. Twenty-six treatment areas (32%) expressed more severe skin damage (score ≥5) in terms of desquamation with blisters (14%) and necrosis or ulceration (19%). Factors correlated with skin damage were the size of the lesion area (p = 0·011), the highest average maximum temperature during a given heat session (p = 0·03) and the fractionation schedule of hyperthermia (p = 0·05). The extent of previous radiotherapy absorbed dose, previous surgery in the treated area or previous chemotherapy had no significant influence on the acute skin reactions.     

Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study

PURPOSE: To study the impact of preoperative radiation dose escalation and postoperative adjuvant chemotherapy on the outcome of tethered and fixed rectal carcinoma. METHODS AND MATERIALS: We have treated 156 patients with 3 consecutive preoperative chemoradiation protocols with escalating treatment intensity. Schedule 1 consisted of 40 Gy radiation with concurrent 5-fluorouracil (5-FU) infusion and mitomycin C. Schedule 2 used a sandwich design with preoperative (40 Gy) and postoperative (18 Gy) radiation with concomitant 5-FU infusion, leucovorin, and mitomycin C. In schedule 3, the preoperative radiation dose was increased to 50 Gy and adjuvant 5-FU/leucovorin chemotherapy was added following surgery. There were 54, 27, and 75 patients treated in schedules 1, 2, and 3, respectively. RESULTS: The resectability was 91% for schedule 1 and 100% for both schedules 2 and 3. A dose-response relationship was observed between the radiation dose and the tumor downstaging and local control. The pathological complete response (T0N0M0) rates for schedules 1, 2, and 3 were 4%, 15%, and 25%, respectively. The respective rates of tumor downstaging were 41%, 33%, and 68%, respectively. The 5-year local relapse-free rates were 67% for schedule 1 (40 Gy), 96% for schedule 2 (58 Gy), and 92% for schedule 3 (50 Gy) (p = 0.0011). The addition of postoperative chemotherapy appeared to improve both the survival and the relapse-free survival. The 5-year survival was increased from 52% to 84% (p = 0.0004) and the 5-year progression-free survival was improved from 48% to 74% (p = 0.0008). CONCLUSION: Preoperative 5-FU infusion, leucovorin, mitomycin C, and 50-Gy pelvic radiation, followed by postoperative bolus 5-FU/leucovorin chemotherapy, appeared to be an effective treatment for tethered/fixed rectal cancers. However, its therapeutic efficacy could only be validated in randomized studies.     

Hypofractionated versus standard fractionation radiotherapy in early glottic cancer: A retrospective review

Aim: This retrospective review was conducted to compare outcomes using different fractionation schedules for early stage glottic cancer treated with radiotherapy between 1991 and 2003. Methods: The records of 87 patients with either T1 or T2 squamous cell carcinomas of the glottic larynx were analysed, dividing the patients into those treated with a hypofractionated schedule, mostly 51 Gy/16# (<53 Gy) and standard fractionation, minimum 60 Gy/30# in 2 Gy fractions. The median follow up was 4 years and 7 months. Results: Local control at 5 years was 81% with standard fractionation vs 93% in the hypofractionated group (P = 0.1). Laryngectomy free survival at 5 years was 78% with standard fractionation versus 95% in the hypofractionated arm (P = 0.017). Overall survival at 5 years was 65%with standard fractionation versus 74% in the hypofractionated arm (P = 0.55). Conclusion: In early stage glottic cancer, a hypofractionated course of radiotherapy has been shown to be a safe and possibly more effective treatment compared with standard fractionation.     

The role of clinicians in determining radioactive iodine use for low‐risk thyroid cancer

BACKGROUND:

There is controversy regarding the optimal management of thyroid cancer. The proportion of patients with low‐risk thyroid cancer who received radioactive iodine (RAI) treatment increased over the last 20 years, and little is known about the role played by clinicians in hospital‐level RAI use for low‐risk disease.

METHODS:

Thyroid surgeons affiliated with 368 hospitals that had Commission on Cancer‐accredited cancer programs were surveyed. Survey data were linked to data reported to the National Cancer Database. A multivariable analysis was used to assess the relation between clinician decision makers and hospital‐level RAI use after total thyroidectomy in patients with stage I, well differentiated thyroid cancer.

RESULTS:

The survey response rate was 70% (560 of 804 surgeons). The surgeon was identified as the primary decision maker by 16% of the surgeons; the endocrinologist was identified as the primary decision maker by 69%, and a nuclear medicine, radiologist, or other physician was identified as the primary decision maker by 15%. In a multivariable analysis controlling for hospital case volume and hospital type, when the primary decision maker was in a specialty other than endocrinology or surgery, there was greater use of RAI at the hospital (P < .001). A greater number of providers at the hospital where RAI was administered and having access to a tumor board also were associated with increased use of RAI (P < .001 and P = .006, respectively).

CONCLUSIONS:

The specialty of the primary decision maker, the number of providers administering RAI, and having access to a tumor board were associated significantly with the use of RAI for stage I thyroid cancer. The findings have implications for addressing nonclinical variation between hospitals, with a marked heterogeneity in decision making suggesting that standardization of care will be challenging. Cancer 2013. © 2012 American Cancer Society.     

Prostate cancer screening and shared decision-making preferences among African-American members of the Prince Hall Masons

Objectives: Shared decision making (SDM) is recommended as one method to assist men in making an informed decision about prostate cancer screening (PCS). SDM preferences for PCS have not been evaluated among African‐American (AA) men. Given AA men's increased risk and the uncertainty surrounding screening, it is critical to determine how to assist AA men in making an informed decision. We assessed the extent to which a sample of AA men wished to engage in SDM regarding PCS and the demographic and psychological characteristics associated with SDM preferences. Methods: Participants completed a telephone interview that covered demographic and medical information, SDM preferences, PCS knowledge, decisional conflict, and satisfaction with previous screening decisions. Subjects included 286 AA men aged 40–70, who were members of a Masonic organization. Results: Fifty‐seven percent preferred SDM, 36% preferred to make their own decision, and 7% wanted their doctor to decide. A higher level of education and older age were associated with preferring SDM (p<0.05), while men with greater PCS knowledge were more likely to prefer to make the decision independently (p<0.05). Conclusions: Results suggest that physicians need to be prepared to discuss PCS with their patients. Further, more attention may be needed to engage younger, less educated, and less knowledgeable men as they may be less likely to discuss PCS. This understanding of AA men's preferences for PCS decisions helps to clarify the issues that health professionals need to consider when attempting to assist AA men in making a PCS decision. Copyright © 2008 John Wiley & Sons, Ltd.     

Patient Decision Aids for Prostate Cancer Treatment: A Systematic Review of the Literature

Treatment decision‐making can be difficult and complex for patients with low‐risk prostate cancer. To the authors' knowledge, there is no consensus regarding an optimal treatment strategy and the choice of therapy involves tradeoffs between differing harms and benefits that are sensitive to patient values. In such situations, patients are often asked to participate actively in the decision‐making process, and high‐quality decisions require a well‐informed patient whose values and preferences have been taken into consideration. Prior studies have indicated that patients have poor knowledge and unrealistic expectations regarding treatment, and physician judgments concerning patient preferences are often inaccurate. Decision aids (DAs) have been developed to help inform patients with low‐risk prostate cancer about treatment options and assist in the decision‐making process; however, little is currently known regarding the effects of such programs in this population. Thirteen studies of DAs for patients with prostate cancer were reviewed and it was found that the use of DAs can improve knowledge, encourage more active patient involvement in decision‐making, and decrease levels of anxiety and distress. The effect of DAs on treatment choice was less clear, although fewer patients chose surgery compared with historical controls, particularly in Europe. Further studies are needed to determine how best to implement DAs into practice, and whether they improve the consistency between patient preferences and treatment choice. CA Cancer J Clin 2009. © 2009 American Cancer Society, Inc.     

Assessing Inter-Fraction Changes in The Size and Position of The Penile Bulb During Daily MR-Guided Radiation Therapy to The Prostate Bed: Do We Need to Adjust How We Plan Radiation in The Post-Radical Prostatectomy Setting to Reduce Risk of Erectile Dysfunction?

BackgroundWe evaluated inter-fraction penile bulb (PB) changes in prostate cancer (PCa) patients undergoing MR-guided RT in the post-radical prostatectomy (RP) setting.Materials and Methods10 patients with PCa status-post RP received MR-guided RT from 2017-2019. Patients received daily setup volumetric MRI scans prior to RT delivery for alignment and target localization. Setup MRI datasets from Fx 1, Fx 19, and Fx 37 were fused for each patient based on soft tissue anatomy. The PB was contoured on each MRI. Data on volume (cc), superior/inferior positional change (cm), and mean dose (Gy) was collected. Differences were assessed by Student’s t-test (sig. p<0.05).ResultsThe mean PB volume change from Fx 1→ 19 was +0.34 ± 0.34 cc (p=0.11) and from Fx 1→ 37 was +0.22 ± 0.28 cc (p=0.31). The mean positional change from Fx 1→ 19 was +0.08±0.26 cm (p=0.37) and from Fx 1→ 37 was +0.05 ±0.25 cm (p=0.57). The mean change in mean PB dose from Fx 1→ 19 was +0.19±4.86 Gy (p=0.98) and from Fx 1→ 37 was -1.51≖7.46 Gy (p=0.88).ConclusionWe present the first study evaluating inter-fraction changes to the PB during MR-guided RT. We found no clinically meaningful difference in the volume, positional change, or mean dose during RT in the post-prostatectomy setting, suggesting that PB organ motion may not need to be accounted for in radiation treatment planning.