Oncology patients' experience of a routine surveillance CT examination: Relationships and communication

IntroductionThe question of radiographers' capacity to establish short time relationships as well as decoding patients' needs and expectations simultaneously with performing high technological examination frequently arises in the clinical practice. Additionally, the constant focus on technology and the fact that radiographers work in high productive departments accentuates the issue. Patients' experiences with radiology seem to be a neglected area of research and may help to identify areas for improvement in this highly technological and productive field. The purpose of the study was to explore oncology patients’ experiences of a routine surveillance CT examination and their need for relationships and communication with the radiographer as part of the CT examination.MethodsThe study included patients diagnosed with cancer and in need of a CT examination as part of their course of treatment, and 21 semi-structured interviews were conducted. The interviews were analysed using qualitative content analysis. Themes were constructed and narratively reported. To increase validity, the themes were identified, discussed and formulated by the author group.ResultsFour themes were constructed based on the analysis: 1: The professional radiographer, 2. Disease and treatment, 3. The examination environment and 4: While waiting.ConclusionThe lack of focus on radiographers' capacity to establish relations, to consider each patient as an individual human being and being able to show sincere interest and empathy were highlighted. Findings illuminated the patient's need for relationship and communication with the radiographer as part of a CT examination.     

Relationships Between Health Care Disparities and Coverage Policies for Breast,Colon, and Lung Cancer Screening

Disparities in outcomes exist for breast, colon, and lung cancer among diverse populations, particularly racial and ethnic underrepresented minorities (URMs) and individuals from lower socioeconomic status. For example, blacks experience mortality rates up to about 42% higher than whites for these cancers. Furthermore, although overall death rates have been declining, the differential access to screening and care has aggravated disparities. Our purpose is to assess how the coverage policies of CMS and the United States Preventive Services Task Force (USPSTF) influence these disparities. Additionally, barriers are often encountered in accessing screening tests and receiving prompt treatment. To narrow, and potentially eliminate, outcomes disparities, CMS and USPSTF could consider revising their decision-making processes regarding coverage. Some options include (1) extending their evidence base to include observational studies that involve groups at higher risk; (2) lowering the threshold ages for screening to encompass differences in incidence; (3) CMS approving screening CT colonography coverage, which can even increase compliance with other screening tests; (4) clarifying and streamlining guidelines; (5) supporting research on improving access to screening; and (6) encouraging the development of more navigation services for URMs.     

Implementation of an HDR brachytherapy–based breast IORT program: Initial experiences

PurposeA multidisciplinary team at our institution developed a novel method of intraoperative breast radiation therapy (precision breast intraoperative radiation therapy [PB-IORT]) that uses high-dose-rate brachytherapy with CT on-rails imaging to deliver high-dose, customized radiotherapy to patients with early-stage breast cancer. This report summarizes our program's experience developing and implementing PB-IORT.Methods and MaterialsLiterature on PB-IORT was reviewed including published articles and abstracts. To evaluate case volume, all patients with a breast cancer diagnosis who underwent breast surgery or breast radiation (2010–2017) at our academic institution were identified. Patients were stratified into pre-IORT and post-IORT eras with initiation of our PB-IORT program in October 2013. Overall trends in surgical and radiation therapy volume in each era were analyzed by linear regression. Travel distance for all surgical patients was calculated using Google Maps (Alphabet Inc.) and then compared between IORT and non-IORT patients.ResultsData from a PB-IORT Phase 1 trial found that the primary endpoints were met and that PB-IORT is feasible and safe. The direct health system's delivery costs for PB-IORT exceed those of 16-fraction whole-breast irradiation when accounting for consumable supplies (multilumen balloon applicator = $2,750 per patient). There was a significant increase in yearly growth of breast cancer surgical volume with PB-IORT.ConclusionsAccrual rates for the ongoing Phase II trial have been quicker than expected in an area where more research is needed. The rapid accrual indicates patient interest and demand for this treatment and that it is very feasible to get more data from randomized trials.     

A Geospatial Analysis of Factors Affecting Access to CT Facilities: Implications for Lung Cancer Screening

ObjectiveThe association between access to CT facilities for lung cancer screening and population characteristics is understudied. We aimed to determine the relationship between census tract–level socioeconomic characteristics (SEC) and driving distance to an ACR-accredited CT facility.MethodsCensus tract–level SEC were determined from the US Census Bureau. Distance to nearest ACR-accredited CT facility was derived at the census tract level. Census tract–level multivariable regression modeling was used to determine the relationship between driving distance to a CT facility and census tract SEC, including population density (a marker of rural versus urban), gender, race, insurance status or type, and education level.ResultsIn an adjusted multivariable model, census tract–level population density was the greatest relative determinant of distance to a CT facility. Namely, rural census tracts had relatively longer distances to CT facilities than urban census tracts (P < .001). Census tracts with higher uninsured, Medicaid, undereducated (less <high school degree) populations had relatively greater distances to CT facilities (p<0.001), whereas those with higher non-White, female, and Medicare populations had shorter distances (p<0.001).DiscussionRural populations have relatively less geographic access to CT facilities. Furthermore, other vulnerable populations, such as the uninsured, those on Medicaid, and the undereducated, may also have relatively less access to CT imaging facilities. These variations in access to CT may affect the uptake and utilization of lung cancer screening.