Original Report

Background At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC).

Objective To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC.

Methods This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study.

Results Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen.

Limitations This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens.

Conclusions A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen. 

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Background At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC).

Objective To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC.

Methods This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study.

Results Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen.

Limitations This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens.

Conclusions A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen. 

Click on the PDF icon at the top of this introduction to read the full article.

Background At Kaiser Permanente Antioch and Walnut Creek Cancer Centers, a modified olanzapine regimen is used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly emetogenic chemotherapy (HEC).

Objective To determine if an olanzapine, ondansetron, dexamethasone (OOD) regimen is noninferior to a fosaprepitant, ondansetron, dexamethasone (FOD) regimen in preventing CINV in patients receiving HEC.

Methods This retrospective cohort study compared the rates of CINV in patients who were treated with HEC and received either the OOD or FOD regimen. Electronic medical records were assessed for documented reports of CINV. 148 patients were included in this study.

Results Complete response (CR), defined as no emesis after Cycle 1 of HEC, in patients receiving the OOD regimen was 95.7% in the acute phase, 94.3% in the delayed phase, and 92.9% overall. CR in patients receiving the FOD regimen was 98.7% in the acute phase, 89.7% in the delayed phase, and 89.7% overall. The percentage of patients who had no nausea on the OOD regimen was 87.1 in the acute phase, 75.5 in the delayed phase, and 71.4 overall, compared with 78.2 in the acute phase, 62.8 in the delayed phase, and 62.7 overall in patients on the FOD regimen.

Limitations This study was limited by its retrospective, nonrandomized design, and short follow-up period. This study did not assess adverse effects from the antiemetic regimens.

Conclusions A modified olanzapine regimen is noninferior to a standard fosaprepitant regimen in regard to CR in showing improved control of CINV. In addition, the use of the olanzapine regimen reduces patient exposure to corticosteroids and the risk of associated side effects, and it is significantly more cost effective, compared with the fosaprepitant regimen. 

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Background Patients undergoing chemoradiation for head and neck squamous cell carcinoma (HNSCC) are predisposed to unplanned hospitalizations.

Objective To assess the factors associated with prolonged hospitalization and its impact on patient outcomes.

Methods We assessed the outcomes of patients hospitalized for ≥5 days or <5 days in 251 patients with advanced HNSCC who were undergoing radiotherapy during 2000-2012.

Results Patients who had been hospitalized for ≥5 days were more likely to be admitted for infection, acute renal failure, and/ or dehydration. We found no other patient, tumor, or treatment characteristics associated with prolonged hospitalizations. Hospitalizations of ≥5 days were associated with a higher incidence of delays in radiotherapy (RT; odds ratio [OR], 2.49; 95% confidence index [CI], 1.09-5.69; P = .03) and worse performance status after RT (OR, 5.76; 95% CI, 1.85-18.38; P = .003). On multivariate analysis, hospitalization of ≥5 days predicted for worse local-regional control (hazard ratio [HR], 1.85; 95% CI, 1.08-3.17; P = .03) and time to treatment failure (HR, 1.64; 95% CI, 1.03-2.61; P = .04), and performance status after RT predicted for worse local-regional control, time to treatment failure, progression-free survival, and overall survival.

Limitations As a retrospective review, we report only hypothesis-generating observations, which may have been affected by having incomplete patient information.

Conclusions Hospitalizations of ≥5 days was associated with infections and/or dehydration and predicted for worse disease control. Our results suggest that patients may benefit from efforts to reduce hospitalization length by minimizing precipitators of hospitalizations as well as interventions to reduce the length of hospital stays.

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Background Patients undergoing chemoradiation for head and neck squamous cell carcinoma (HNSCC) are predisposed to unplanned hospitalizations.

Objective To assess the factors associated with prolonged hospitalization and its impact on patient outcomes.

Methods We assessed the outcomes of patients hospitalized for ≥5 days or <5 days in 251 patients with advanced HNSCC who were undergoing radiotherapy during 2000-2012.

Results Patients who had been hospitalized for ≥5 days were more likely to be admitted for infection, acute renal failure, and/ or dehydration. We found no other patient, tumor, or treatment characteristics associated with prolonged hospitalizations. Hospitalizations of ≥5 days were associated with a higher incidence of delays in radiotherapy (RT; odds ratio [OR], 2.49; 95% confidence index [CI], 1.09-5.69; P = .03) and worse performance status after RT (OR, 5.76; 95% CI, 1.85-18.38; P = .003). On multivariate analysis, hospitalization of ≥5 days predicted for worse local-regional control (hazard ratio [HR], 1.85; 95% CI, 1.08-3.17; P = .03) and time to treatment failure (HR, 1.64; 95% CI, 1.03-2.61; P = .04), and performance status after RT predicted for worse local-regional control, time to treatment failure, progression-free survival, and overall survival.

Limitations As a retrospective review, we report only hypothesis-generating observations, which may have been affected by having incomplete patient information.

Conclusions Hospitalizations of ≥5 days was associated with infections and/or dehydration and predicted for worse disease control. Our results suggest that patients may benefit from efforts to reduce hospitalization length by minimizing precipitators of hospitalizations as well as interventions to reduce the length of hospital stays.

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Background Patients undergoing chemoradiation for head and neck squamous cell carcinoma (HNSCC) are predisposed to unplanned hospitalizations.

Objective To assess the factors associated with prolonged hospitalization and its impact on patient outcomes.

Methods We assessed the outcomes of patients hospitalized for ≥5 days or <5 days in 251 patients with advanced HNSCC who were undergoing radiotherapy during 2000-2012.

Results Patients who had been hospitalized for ≥5 days were more likely to be admitted for infection, acute renal failure, and/ or dehydration. We found no other patient, tumor, or treatment characteristics associated with prolonged hospitalizations. Hospitalizations of ≥5 days were associated with a higher incidence of delays in radiotherapy (RT; odds ratio [OR], 2.49; 95% confidence index [CI], 1.09-5.69; P = .03) and worse performance status after RT (OR, 5.76; 95% CI, 1.85-18.38; P = .003). On multivariate analysis, hospitalization of ≥5 days predicted for worse local-regional control (hazard ratio [HR], 1.85; 95% CI, 1.08-3.17; P = .03) and time to treatment failure (HR, 1.64; 95% CI, 1.03-2.61; P = .04), and performance status after RT predicted for worse local-regional control, time to treatment failure, progression-free survival, and overall survival.

Limitations As a retrospective review, we report only hypothesis-generating observations, which may have been affected by having incomplete patient information.

Conclusions Hospitalizations of ≥5 days was associated with infections and/or dehydration and predicted for worse disease control. Our results suggest that patients may benefit from efforts to reduce hospitalization length by minimizing precipitators of hospitalizations as well as interventions to reduce the length of hospital stays.

Click on the PDF icon at the top of this introduction to read the full article.

Background Community oncologists need a simplified methodology for assessing the value of anticancer drugs. In the United States and Europe, costs of anticancer drug were previously estimated at US$50,000 to >US$100,000 per quality-adjusted life-year (QALY). The National Institute for Health and Care Excellence in the United Kingdom states that the average cost-effectiveness ratios intervention of >US$50,000 per QALY must be questioned.

Objectives To design a drug model to estimate the amount in United States dollars (US$) paid for life-year gain (LYG) and QALY, and to apply that model in the treatment of chemo-naïve and chemo-treated patients with castrate-resistant metastatic prostate cancer (mCRPC).

Methods Cost per LYG (cost/LYG) was compared with cost per probability of survival (cost/PoS) calculated as [1.0 minus HR]. Results were expressed in relative values (RV) calculated as US$50,000 or US$100,000 per cost/outcome.

Results In patients with mCRPC, generic docetaxel demonstrated the lowest cost/LYG (US$26,330), lowest cost/ PoS (US$21,942), and the highest RV (3.80-4.56). Cost/LYG of sipuleucel-T was US$272,195, with an RV of 0.37. Significant variation between cost/LYG and cost/ PoS was noted among drugs with borderline survival and HR. In previously treated patients, the cost/LYG of cabazitaxel was US$207,240; of abiraterone, US$194,087; enzalutamide, US$223,500; and radium-223 dichloride, US$230,000, all with RVs <0.5.

Conclusions A simplified drug model to weigh cost, survival, and HR with imposed limits on cost/outcome was proposed and applied to patients with mCRPC. The results among that patient population suggested that generic docetaxel had the lowest costs, cost/outcome and the highest RV. Sipuleucel-T, abiraterone, enzalutamide, radium-223 dichloride, and cabazitaxel were overpriced for their values. Drugs with RVs of <0.5 should be scrutinized, costs negotiated, or other drugs considered, and those with RVs of <0.25, rejected.

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Background Community oncologists need a simplified methodology for assessing the value of anticancer drugs. In the United States and Europe, costs of anticancer drug were previously estimated at US$50,000 to >US$100,000 per quality-adjusted life-year (QALY). The National Institute for Health and Care Excellence in the United Kingdom states that the average cost-effectiveness ratios intervention of >US$50,000 per QALY must be questioned.

Objectives To design a drug model to estimate the amount in United States dollars (US$) paid for life-year gain (LYG) and QALY, and to apply that model in the treatment of chemo-naïve and chemo-treated patients with castrate-resistant metastatic prostate cancer (mCRPC).

Methods Cost per LYG (cost/LYG) was compared with cost per probability of survival (cost/PoS) calculated as [1.0 minus HR]. Results were expressed in relative values (RV) calculated as US$50,000 or US$100,000 per cost/outcome.

Results In patients with mCRPC, generic docetaxel demonstrated the lowest cost/LYG (US$26,330), lowest cost/ PoS (US$21,942), and the highest RV (3.80-4.56). Cost/LYG of sipuleucel-T was US$272,195, with an RV of 0.37. Significant variation between cost/LYG and cost/ PoS was noted among drugs with borderline survival and HR. In previously treated patients, the cost/LYG of cabazitaxel was US$207,240; of abiraterone, US$194,087; enzalutamide, US$223,500; and radium-223 dichloride, US$230,000, all with RVs <0.5.

Conclusions A simplified drug model to weigh cost, survival, and HR with imposed limits on cost/outcome was proposed and applied to patients with mCRPC. The results among that patient population suggested that generic docetaxel had the lowest costs, cost/outcome and the highest RV. Sipuleucel-T, abiraterone, enzalutamide, radium-223 dichloride, and cabazitaxel were overpriced for their values. Drugs with RVs of <0.5 should be scrutinized, costs negotiated, or other drugs considered, and those with RVs of <0.25, rejected.

Click on the PDF icon at the top of this introduction to read the full article.

Background Community oncologists need a simplified methodology for assessing the value of anticancer drugs. In the United States and Europe, costs of anticancer drug were previously estimated at US$50,000 to >US$100,000 per quality-adjusted life-year (QALY). The National Institute for Health and Care Excellence in the United Kingdom states that the average cost-effectiveness ratios intervention of >US$50,000 per QALY must be questioned.

Objectives To design a drug model to estimate the amount in United States dollars (US$) paid for life-year gain (LYG) and QALY, and to apply that model in the treatment of chemo-naïve and chemo-treated patients with castrate-resistant metastatic prostate cancer (mCRPC).

Methods Cost per LYG (cost/LYG) was compared with cost per probability of survival (cost/PoS) calculated as [1.0 minus HR]. Results were expressed in relative values (RV) calculated as US$50,000 or US$100,000 per cost/outcome.

Results In patients with mCRPC, generic docetaxel demonstrated the lowest cost/LYG (US$26,330), lowest cost/ PoS (US$21,942), and the highest RV (3.80-4.56). Cost/LYG of sipuleucel-T was US$272,195, with an RV of 0.37. Significant variation between cost/LYG and cost/ PoS was noted among drugs with borderline survival and HR. In previously treated patients, the cost/LYG of cabazitaxel was US$207,240; of abiraterone, US$194,087; enzalutamide, US$223,500; and radium-223 dichloride, US$230,000, all with RVs <0.5.

Conclusions A simplified drug model to weigh cost, survival, and HR with imposed limits on cost/outcome was proposed and applied to patients with mCRPC. The results among that patient population suggested that generic docetaxel had the lowest costs, cost/outcome and the highest RV. Sipuleucel-T, abiraterone, enzalutamide, radium-223 dichloride, and cabazitaxel were overpriced for their values. Drugs with RVs of <0.5 should be scrutinized, costs negotiated, or other drugs considered, and those with RVs of <0.25, rejected.

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Background About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.

Objective To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.

Methods We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.

Results 36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (P = .55 for allogeneic patients; P = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.

Limitations Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.

Conclusions In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.

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Background About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.

Objective To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.

Methods We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.

Results 36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (P = .55 for allogeneic patients; P = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.

Limitations Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.

Conclusions In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.

Click on the PDF icon at the top of this introduction to read the full article.

Background About 1 in 7 of all hospitalized patients is readmitted within 30 days of discharge. The cost of readmissions is significant, with Medicare readmissions alone costing the health care system an estimated $28 billion a year.

Objective To identify the rates of and causes for readmission within 100 days of patients receiving a hematopoietic stem cell transplant.

Methods We performed a retrospective review of 235 consecutive transplant recipients (autologous, n = 144; allogeneic, n = 91) to determine rates and causes for readmission within 100 days of patients receiving a transplant. Medical records and hospital readmissions were reviewed for each patient.

Results 36 allogeneic patients accounted for 56 readmissions. 23 autologous patients accounted for 26 readmissions. Autologous transplant recipients were most commonly readmitted for the development of a fever (n = 15 patients) or cardiopulmonary issues (n = 4). The most prevalent reasons for readmission in the allogeneic recipients included a fever (n = 21) or the development or exacerbation of graft-versus-host disease (n = 5). The readmission length of stay was 6 days (median range, 1-91 days) for allogeneic patients and 4 days (median range, 1-22 days) for autologous patients. There was no difference in survival between the readmitted and the non-readmitted cohorts (P = .55 for allogeneic patients; P = .24 for autologous patients). Although allogeneic graft recipients demonstrated a higher readmission rate (39.6%) compared with autologous recipients (16%), none of the variables examined, including age, gender, performance status, diagnosis, remission status at the time of transplant, comorbidities, type of preparative chemotherapy regimen or donor type, identified patients at increased risk for readmission.

Limitations Variations in clinical care, physician practices, and patient characteristics need to be considered when examining readmission rates. Most of the allogeneic patient population included unrelated donor recipients (65%) who received nonmyeloablative conditioning regimens (81% of allogeneic recipients). These features may not be characteristic of other centers.

Conclusions In these high-risk patients, readmissions following a transplant are common. Enhanced predischarge education by nurses and pharmacists, along with ongoing outpatient education and rigorous outpatient follow-up through phone calls or social media may decrease readmission rates.

Click on the PDF icon at the top of this introduction to read the full article.

Background and objective Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.

Methods Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets.

Results From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (P = .031).

Limitations Small sample size and small variations in bladder volumes.

Conclusions A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.

Funding/sponsorship None  

Click on the PDF icon at the top of this introduction to read the full article. 

Background and objective Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.

Methods Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets.

Results From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (P = .031).

Limitations Small sample size and small variations in bladder volumes.

Conclusions A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.

Funding/sponsorship None  

Click on the PDF icon at the top of this introduction to read the full article. 

Background and objective Our group created and routinely reviewed a dedicated prostate intensity-modulated radiation therapy (IMRT) delivery program. Previously, a retrospective review of our experience demonstrated that a larger bladder volume reduced radiation dose to the rectum. We conducted an observational study to confirm this relationship.

Methods Men receiving definitive radiation for prostate cancer were eligible for the study. Eligible patients received 2 computed axial tomography (CT) scans on the day of their planning CT scan: 1 with a full bladder and 1 with an empty bladder. On each CT data set, the prostate, rectum, bladder, penile bulb, and femoral heads were contoured. 2 IMRT plans were completed on each dataset: 1 by a medical dosimetrist and 1 by a medical physicist. The study plans targeted the prostate to 79.2 Gray (Gy) while respecting predefined dose tolerances to the other contoured structures. Rectal doses were compared on empty and full bladder CT data sets.

Results From June 29, 2010 to December 14, 2011, 17 full bladder data sets and 15 empty bladder data sets were available for analysis. Median change in bladder volume was 63 ml. Full vs empty bladder set-up was associated with a statistically significant reduction in the mean rectal dose of 25.41 Gy vs 27.6 Gy (P = .031).

Limitations Small sample size and small variations in bladder volumes.

Conclusions A greater bladder volume resulted in a reduced mean dose to the rectum irrespective of planning method.

Funding/sponsorship None  

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Background Our hospital did not provide a weekly speech and language therapy (SLT) service for head and neck cancer patients during radiotherapy treatment. SLT is recommended in the international guidelines, but many centers do not offer this service. In the case of our hospital, SLT was not provided because there were no funds to cover the costs of additional staff.

Objectives To create a new service model within a multidisciplinary setting to comply with the international SLT guidelines and without increasing staff. We aimed to measure the accessibility and efficiency of a new model of service delivery at our center both for patients and for the service.

Methods 79 patients were recruited for the study. We followed 1 group of patients (n = 29; observation group) throughout their treatment for 6 weeks to establish if there was a clinical need to offer SLT at the treatment center. A second group of patients (n = 50; intervention group) received a weekly SLT review at the treatment center throughout their radiotherapy. Data collected at the tertiary cancer center for 6 months included: age, gender, tumor site and size, treatment modality, swallowing outcomes, communication outcomes, patient satisfaction, multidisciplinary team feedback, and time efficiency. The observation group did not participate in the intervention group because the data was collected between 2 different groups of participants. However, all participants were referred to their local SLT service at the end of their treatment if that was clinically indicated, regardless of the group they had been in.

Results The proportion of patients accessing SLT services during treatment and the time efficiency of the service were both improved with this model of delivery. The service’s compliance with international guidelines was met. More patients continued with oral intake during their treatment at our center with the new service. Improvements were also reported in communication clarity and communication confidence in the same group.

Conclusion Offering head and neck cancer patients SLT at the same time and place as their radiotherapy treatment improves patient outcomes and increases SLT efficiencies. As this was not a treatment study, further clinical trials are required with regards to functional outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Background Our hospital did not provide a weekly speech and language therapy (SLT) service for head and neck cancer patients during radiotherapy treatment. SLT is recommended in the international guidelines, but many centers do not offer this service. In the case of our hospital, SLT was not provided because there were no funds to cover the costs of additional staff.

Objectives To create a new service model within a multidisciplinary setting to comply with the international SLT guidelines and without increasing staff. We aimed to measure the accessibility and efficiency of a new model of service delivery at our center both for patients and for the service.

Methods 79 patients were recruited for the study. We followed 1 group of patients (n = 29; observation group) throughout their treatment for 6 weeks to establish if there was a clinical need to offer SLT at the treatment center. A second group of patients (n = 50; intervention group) received a weekly SLT review at the treatment center throughout their radiotherapy. Data collected at the tertiary cancer center for 6 months included: age, gender, tumor site and size, treatment modality, swallowing outcomes, communication outcomes, patient satisfaction, multidisciplinary team feedback, and time efficiency. The observation group did not participate in the intervention group because the data was collected between 2 different groups of participants. However, all participants were referred to their local SLT service at the end of their treatment if that was clinically indicated, regardless of the group they had been in.

Results The proportion of patients accessing SLT services during treatment and the time efficiency of the service were both improved with this model of delivery. The service’s compliance with international guidelines was met. More patients continued with oral intake during their treatment at our center with the new service. Improvements were also reported in communication clarity and communication confidence in the same group.

Conclusion Offering head and neck cancer patients SLT at the same time and place as their radiotherapy treatment improves patient outcomes and increases SLT efficiencies. As this was not a treatment study, further clinical trials are required with regards to functional outcomes.

Click on the PDF icon at the top of this introduction to read the full article.

Background Our hospital did not provide a weekly speech and language therapy (SLT) service for head and neck cancer patients during radiotherapy treatment. SLT is recommended in the international guidelines, but many centers do not offer this service. In the case of our hospital, SLT was not provided because there were no funds to cover the costs of additional staff.

Objectives To create a new service model within a multidisciplinary setting to comply with the international SLT guidelines and without increasing staff. We aimed to measure the accessibility and efficiency of a new model of service delivery at our center both for patients and for the service.

Methods 79 patients were recruited for the study. We followed 1 group of patients (n = 29; observation group) throughout their treatment for 6 weeks to establish if there was a clinical need to offer SLT at the treatment center. A second group of patients (n = 50; intervention group) received a weekly SLT review at the treatment center throughout their radiotherapy. Data collected at the tertiary cancer center for 6 months included: age, gender, tumor site and size, treatment modality, swallowing outcomes, communication outcomes, patient satisfaction, multidisciplinary team feedback, and time efficiency. The observation group did not participate in the intervention group because the data was collected between 2 different groups of participants. However, all participants were referred to their local SLT service at the end of their treatment if that was clinically indicated, regardless of the group they had been in.

Results The proportion of patients accessing SLT services during treatment and the time efficiency of the service were both improved with this model of delivery. The service’s compliance with international guidelines was met. More patients continued with oral intake during their treatment at our center with the new service. Improvements were also reported in communication clarity and communication confidence in the same group.

Conclusion Offering head and neck cancer patients SLT at the same time and place as their radiotherapy treatment improves patient outcomes and increases SLT efficiencies. As this was not a treatment study, further clinical trials are required with regards to functional outcomes.

Click on the PDF icon at the top of this introduction to read the full article.