Incidence and management of noncancer pain in cancer patients referred to a radiotherapy center.

OBJECTIVES: The incidence of noncancer pain (NCP) in cancer patients is unknown. An analysis of incidence, severity, impact on quality of life (QoL), and appropriateness of NCP treatment in a cohort of cancer patients referred to a radiotherapy center is reported. MATERIALS AND METHODS: Pain was scored from 0 (absence) to 3 (severe) and the adequacy of analgesic therapy was evaluated according to International Guidelines. Correlation between Pain Management Index and World Health Organization Analgesic Ladder was used to analyze the appropriateness of NCP treatment. In addition, pain was differentiated according to its origin and types and a comparison was performed between cancer pain (CP) and NCP. RESULTS: A total of 903 patients were eligible and 865 (95.8%) were considered evaluable. Three hundred ninety-eight patients (46.0%) had pain. CP and NCP pain incidence was 11.2% and 34.8%, respectively. Pain intensity was higher in patients with CP versus NCP (P=0.021). A neuropathic pain lower incidence (P=0.024) in NCP versus CP was recorded. Moreover, NCP was more inadequately treated than CP (P<0.001). QoL was significantly lower in patients with NCP when compared with patients without pain (P<0.001). In addition, QoL of patients with CP was significantly lower than QoL of patients with NCP (P<0.001). DISCUSSION: In a cancer patients' population referred to a radiotherapy center, the NCP incidence was higher than the CP incidence and NCP intensity was only slightly lower than CP. NCP was significantly pharmacologically undertreated and it was related to a decline in QoL.

Daily on-line set-up correction in 3D-conformal radiotherapy: is it feasible?

AIMS AND BACKGROUND: The aim of this report was to investigate the feasibility in terms of treatment time prolongation of an on-line no-action level correction protocol, based on daily electronic portal image verification. METHODS AND STUDY DESIGN: The occupation of a linear accelerator (LINAC) delivering 3-D conformal treatments was monitored for two weeks (from Monday to Friday, 10 working days). An electronic portal image device I-View (Elekta, UK) was used for setup verification. Single-exposure portal images were acquired daily using the initial 8 monitor units delivered for each treatment field. Translational deviations of isocenter position larger than 5 mm or 7 mm, for radical or palliative treatments, respectively, were immediately corrected. In order to estimate the extra workload involved with the on-line protocol, the time required for isocenter check and table correction was specifically monitored. RESULTS: Forty-eight patients were treated. In all, 482 fractions had electronic portal images taken. Two hundred and forty-five setup corrections were made (50.8% of all fractions). The occupation of the LINAC lasted 106 h on the whole. Twelve h and 25 min (11.7% of LINAC occupation time) were spent for portal image verification and setup correction. On the average, 4.3 fractions per hour were carried out. CONCLUSIONS: When used by trained therapists, ideally, portal imaging may be carried out before each fraction, requiring approximately 10% of LINAC occupation time.

Hospital costs incurred by the Italian National Health Service for invasive cervical cancer.

METHODS: A longitudinal, retrospective, cohort study was designed to assess the mean treatment cost of invasive cervical cancer, cross-linking clinical and administrative databases. The study was performed from the Italian NHS perspective. Costs were estimated using DRG charges. All patients with histological diagnosis of invasive cervical cancer admitted to Gynecologic Oncology centres of the Catholic University of the Sacred Heart between 2000 and 2007 were enrolled. RESULTS: Overall, 351 patients (212 with LACC and 139 with ECC) were eligible for analysis. The mean direct medical cost by patient was € 22,200 ± 21,600 with a significantly higher burden for LACC compared with ECC patients (€ 28,696 ± 24,874 versus € 12,329 ± 8,726). Radical surgery accounted for € 6,851 ± 1,406, and € 7,709 ± 3,710 in ECC and LACC group, respectively; the resulting difference achieved a statistical significance. The extent of disease, disease progression/recurrence, and length of hospitalization confirmed their independent role as cost predictive factors. CONCLUSIONS: The combined use of administrative and clinical databases allowed a feasible assessment of the mean cost induced by the invasive cervical cancer. Management of LACC patients was associated with higher costs due to the utilization of several therapeutic strategies and more frequent appearance of disease progression/recurrence.

Videoconferencing to enhance the integration between clinical medicine and teaching: a feasibility study.

AIMS AND BACKGROUND: The aim of the study was to analyze the feasibility of a setting up of a radiotherapy department using videoconferencing technology. MATERIAL AND METHODS: A videoconferencing network was started to link an academic center of radiotherapy to a peripheral center of research at the start of its activity. Two years of data of involved professionals, subjects of links, audio, video link problems and running costs were recorded. RESULTS: A total of 418 links was established for an overall duration of 458 hours. The participants included all departmental staff. Videoconferencing involved teaching, ward organization, medical care and scientific subjects. In the second year ofexperience, the number of videoconferencing links was higher than the first (232 vs 186). Link times were reasonable for both skilled and unskilled operators. Overall, the cost per minute of link was 0.2 Euro, and the mean cost per link was 13 Euros. Videoconferencing was integrated with fax and computer networks to enhance sharing paper and electronic documents. Audio-video technical problems progressively decreased: the link was definitively interrupted or its activation unfeasible in only 1.0% of cases. CONCLUSIONS: Our experience suggests that the establishment of a link between radiotherapy departments addressed to these aims is feasible by a videoconferencing network.