Effect of medical audit on prescription of palliative radiotherapy.

Bond, Mike; Elwell, Christine; Gildersleve, J.; Parmar, Simran; Owens, J. Cuthbert; Bulman, A. S.; Crellin, A.; Ash, D.

doi:10.1136/bmj.307.6895.24

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…7,11,12 Although much has been published on optimal fractionation schedules and patterns of fractionation in use, information on the adequacy of PRT use and factors affecting this use is relatively scarce. 7,8,11,12,18,19 However, a recent Swedish study estimated that PRT was underused for lung cancer, brain metastases and bone metastases.! ?…”

Section: Discussionmentioning

confidence: 99%

Symptom duration and delay in referral for palliative radiotherapy in cancer patients: a pilot study

Wirth

Smith

Ball

et al. 1998

Medical Journal of Australia

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ObjectiveTo estimate the frequency of delay in referral for palliative radiotherapy (PRT), and to identify factors associated with delay. DesignProspective survey over three months in 1997. SettingRadiotherapy department of a cancer centre in Melbourne, Victoria. Participants158 consecutive patients prescribed PRT in the lung, breast, urology and haematology units. Main outcome measuresDuration of symptoms; incidence of "unreasonable" delay in referral; and incidence of negative clinical outcome associated with referral delay. ResultsThe median duration of symptoms before prescription of radiotherapy was four weeks. Thirty‐eight patients (24%) were considered to have had an unreasonable delay in referral, with median symptom duration of 15 weeks, and median delay in referral of 12 weeks. Causes of delay were classified as "diagnostic uncertainty" (29%), "other treatment given" (18%), "patient related" (18%), "language difficulty” (3%), and "unexplained" (32%). Twenty‐seven of these 38 patients (71%) had negative outcomes, including persistent pain, neurological deterioration and persistent respiratory symptoms. ConclusionsThese data suggest that delay in referral for PAT is not uncommon, has a variety of causes and can result in negative clinical outcomes. There appears to be a need for greater awareness of patients' symptoms and of the role of PRT among clinicians caring for patients with cancer.

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Section: Discussionmentioning

confidence: 99%

Symptom duration and delay in referral for palliative radiotherapy in cancer patients: a pilot study

Wirth

Smith

Ball

et al. 1998

Medical Journal of Australia

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“…7,35,36 The number of patients receiving five or more fractions of radiotherapy for metastatic bone pain fell from 80% to 40% one year later in the first study,~ and from 62% to 27% in another. 35 The third study found that, following three audits, the number of single fractions used rose from 34% to 68%.36…”

Section: Single Treatmentsmentioning

confidence: 97%

Radiotherapy for painful bone metastases

Needham¹,

Hoskin

1994

Palliat Med

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Bone metastases are a frequent cause of morbidity in patients with malignant disease. Pain is the commonest symptom; it can be treated successfully in the majority of patients by local external beam irradiation. Controversy exists over which regimen should be used, with a single dose necessitating only one treatment visit to the radiotherapy department, or a fractionated course requiring several visits. Many radiotherapists continue to use fractionated regimens despite the current evidence that single fractions are as effective. Many reasons exist for this, including departmental policy and training, fears of recurrence, problems with retreatment of previously treated areas, fears of increased early and late morbidity, and attempts at promoting recalcification. The majority of these reasons are theoretical and have yet to be substantiated. In many patients, symptomatic bone metastases are widespread, and hemibody irradiation, although more toxic, should be considered in order to avoid the need for repeated courses of local treatment.

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