RESUMO
PURPOSE: To investigate patterns of practice among Spanish radiation oncologists in the use of multiparametric magnetic resonance imaging (mpMRI) for the treatment of prostate cancer (PCa). We evaluated (1) access to mpMRI, (2) current clinical practices, and (3) physician expectations of mpMRI. METHODS: Cross-sectional survey of 118 radiation oncologists at 75 Radiation Oncology (RO) departments in Spain. RESULTS: A total of 55 radiation oncologists from 52 RO departments (52/75; 69%) completed the survey. Prostate mpMRI is performed at 94.5% of the centres that provided data. The most common indications for mpMRI in routine clinical practice were: (1) detection/localization of the tumour prior to second biopsy (82.7%), (2) cancer staging (80.8%), and (3) detection of recurrence after definitive treatment (80.8%). Most respondents (72.7%) reported modifying the primary radiotherapy treatment when mpMRI findings indicate a more advanced T stage with a resultant change in the risk group. Most respondents (90.5%) treat macroscopic local recurrence after prostatectomy with high doses, ranging from 71 to 83 Gy; in 37.7% of cases, the full dose is delivered to the entire prostate bed. In pelvic nodal recurrence, more than half (59.3%) of the respondents reported performing elective pelvic radiotherapy, including the prostate bed, with a boost to the involved nodes. CONCLUSIONS: This survey shows that prostate mpMRI is routinely used by radiation oncologists in Spain in a wide range of clinical scenarios. The findings reported here underscore the need to standardize treatment protocols for definitive and salvage radiotherapy in patients evaluated with mpMRI.
Assuntos
Imageamento por Ressonância Magnética , Padrões de Prática Médica/estatística & dados numéricos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Radio-Oncologistas/estatística & dados numéricos , Estudos Transversais , Humanos , Masculino , Próstata/patologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Radio-Oncologistas/educação , Espanha , Inquéritos e QuestionáriosRESUMO
ABSTRACT Purpose: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. Materials and Methods: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. Results: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. Conclusions: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.
Assuntos
Humanos , Masculino , Neoplasias Testiculares/radioterapia , Padrões de Prática Médica/estatística & dados numéricos , Seminoma/radioterapia , Conduta Expectante/métodos , Radio-Oncologistas/estatística & dados numéricos , Neoplasias Testiculares/patologia , Neoplasias Testiculares/tratamento farmacológico , Estados Unidos , Conhecimentos, Atitudes e Prática em Saúde , Vigilância da População/métodos , Inquéritos e Questionários , Quimioterapia Adjuvante , Seminoma/patologia , Seminoma/tratamento farmacológico , Progressão da Doença , Estadiamento de NeoplasiasRESUMO
PURPOSE: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. MATERIALS AND METHODS: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. RESULTS: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. CONCLUSIONS: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.
Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Seminoma/radioterapia , Neoplasias Testiculares/radioterapia , Conduta Expectante/métodos , Quimioterapia Adjuvante , Progressão da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Estadiamento de Neoplasias , Vigilância da População/métodos , Seminoma/tratamento farmacológico , Seminoma/patologia , Inquéritos e Questionários , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Estados UnidosRESUMO
INTRODUCTION: Google is the most popular search engine in the United States, and patients are increasingly relying on online webpages to seek information about individual physicians. This study aims to characterize what patients find when they search for radiation oncologists online. METHODS AND MATERIALS: The Centers for Medicare and Medicaid Services (CMS) Physician Comparable Downloadable File was used to identify all Medicare-participating radiation oncologists in the United States and Puerto Rico. Each radiation oncologist was characterized by medical school education, year of graduation, city of practice, gender, and affiliation with an academic institution. Using a custom Google-based search engine, up to the top 10 search results for each physician were extracted and categorized as relating to: (1) physician, hospital, or health care system; (2) third-party; (3) social media; (4) academic journal articles; or (5) other. RESULTS: Among all health care providers in the United States within CMS, 4443 self-identified as being radiation oncologists and yielded 40,764 search results. Of those, 1161 (26.1%) and 3282 (73.9%) were classified as academic and nonacademic radiation oncologists, respectively. At least 1 search result was obtained for 4398 physicians (99.0%). Physician, hospital, and health care-controlled websites (16,006; 39.3%) and third-party websites (10,494; 25.7%) were the 2 most often observed domain types. Social media platforms accounted for 2729 (6.7%) hits, and peer-reviewed academic journal websites accounted for 1397 (3.4%) results. About 6.8% and 6.7% of the top 10 links were social media websites for academic and nonacademic radiation oncologists, respectively. CONCLUSIONS: Most radiation oncologists lack self-controlled online content when patients search within the first page of Google search results. With the strong presence of third-party websites and lack of social media, opportunities exist for radiation oncologists to increase their online presence to improve patient-provider communication and better the image of the overall field. We discuss strategies to improve online visibility.
Assuntos
Internet/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Distribuição de Qui-Quadrado , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Porto Rico , Radio-Oncologistas/classificação , Mídias Sociais/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: Radiation therapy is a keystone to improve survival and quality of life in breast cancer patients. In Mexico, however, scarce information is available on the obstacles faced by radio-oncologists to provide appropriate treatment. OBJECTIVE: To determine the most frequent issues faced by physicians to provide radiation therapy for metastatic breast cancer in Mexico. METHODS: A survey of 16 multiple-choice questions to be answered electronically by 167 radio-oncologists currently working in Mexico was designed and thereafter analyzed for differences between private and public practices, based on the responses from the surveyed participants. RESULTS: 98.5% of surveyed responders attended patients with breast cancer. We observed a significant difference between private vs. public practice for the main difficulties in providing radiation therapy, with an increased frequency (85.8%) of "treatment cost by itself" in private practice vs. 50.7% in public practice (p < 0.05). Significant differences were observed in the "Time to initiate treatment" question, with "Less than one week" as the response in 86% of those physicians in private practice vs. 50% for those in public practice (p < 0.001). CONCLUSIONS: Using a survey targeted at radio-oncologists, we analyzed the most important obstacles for accessing radiation therapy for metastatic breast cancer in Mexico. This information may be useful for healthcare decisions related to radiation therapy in women with breast cancer in Mexico.