Breast Cancer Patient Preference for Adjuvant Radiotherapy Post-Lumpectomy: Whole Breast Irradiation versus Partial Breast Irradiation – Preliminary Results

in 2012 at a regional cancer centre (RCC), the need for ensuring patient safety beyond traditional methods was investigated. An adverse event occurred when a patient was seriously injured as a result of a fall off the treatment couch while it was in an elevated position. This incident prompted a root cause analysis investigation, leading to routine use of safety straps for all patients at this facility. This event highlights the potential for repetition at another treatment facility. Our aim is to share the multi-institutional implementation process of safety strap use during radiation therapy treatment to improve patient safety. Methodology: The provincial radiation therapy community (PRTC) reviewed current state (practice) and supporting evidence. A position statement was prepared and is undergoing endorsement from Cancer Care Ontario (CCO) for consideration of implementation at all RCCs. The position statement included recommendations for staff training, patient teaching (awareness), documentation and monitoring. Results: To date, 11 of 15 cancer centres (73%) are utilizing safety straps for all patients undergoing simulation and radiation therapy treatments with changes to current policy. Two additional centres are expected to begin use of the straps within the next two months. The remaining centres are beginning local discussions. Feedback has been positive from both staff and patients. Pragmatic challenges involved the selection of suitable straps to meet infection control guidelines and cost effectiveness. A few centres were challenged with staff supporting this practice change early on; however, the approach of using evidence-informed decision making was intentionally used to mitigate this initial resistance. Discussion and Conclusions: This initiative demonstrates that it is possible to substantially impact the culture of safety within the province through systematic changes and evidenced-informed practice changes. Key success factors include: reporting of incidents provincially, open sharing of current practices and policy development, enriching the professional community, and standardizing processes within practice.

An Analysis of Peer Review Outcomes: A Single Centre Perspective Dina Thompson, MRT(T) and Woodrow Wells, MD, FRCPC Southlake Regional Health Centre E-mail: [email protected] Background: Cancer Care Ontario began a pilot project in early 2014, the Peer Review Data Collection Quality Assurance Project, with an aim to collect the outcome of peer review across the province. Current departmental policy states that all radiation treatment plans undergo a multi-disciplinary peer review process. As a participating centre in the CCO pilot project, outcomes of peer review were collected and evaluated in order to facilitate quality improvement internally. Methods: From February 11 to October 31, 2014, the outcome of every treatment plan was evaluated and categorized into three main categories: 1) no revision recommended, 2) no revision recommended but plan did not follow department policy/protocol, or 3) revision to plan was recommended. Cases were further categorized according to the type of revision recommended, whether it constituted a major or minor impact to the patient outcome, and a major or minor plan change. Outcomes were analyzed for trends. Results: In total, 1135 cases underwent peer review. Of these cases, 78 separate changes were recommended. 31 of the 78 were classified as having a significant impact on the outcome of the patient, and 23 were classified as having a major plan change. Only 15 of these recommendations were not implemented, and all were classified as having a minor impact on the patient outcome. Future protocol review was recommended for 17 cases, 15 plans were identified as deviating from protocol, and finally, 14 documentation errors were identified at time of peer review. Conclusions: This analysis has provided our institution with data to identify areas for improvement and efficiency. First, in times of extremely high workload it has helped to guide decision making on implementation of revisions: those that would result in a major impact on plan workload, but with a minor gain to patient outcome may not be implemented. Second, when policies were identified for future review or inadequate to meet specific patient needs,

this information was passed onto the corresponding site teams. This has helped to ensure constant analysis and review of policies and protocols, resulting in continuous quality improvement of radiation treatment plans.

Breast Cancer Patient Preference for Adjuvant Radiotherapy Post-Lumpectomy: Whole Breast Irradiation versus Partial Breast Irradiation – Preliminary Results Merrylee McGuffin, MSc, BSc, MRT(T) Odette Cancer Centre E-mail: [email protected] David Chun-Leung Chau, BSc (c) University of Waterloo Lisa Di Prospero, MSc, BSc, MRT(T) Odette Cancer Centre Department of Radiation Oncology, University of Toronto Deb Feldman-Stewart, PhD Queen’s University Tamara Harth, MLIS Odette Cancer Centre Jean-Philippe Pignol, FRCPC, MD Erasmus MC: University Medical Centre Rotterdam Edward Chow, FRCPC, MD, Danny Vesprini, FRCPC, MD, Eileen Rakovitch, FRCPC, MD, Mary Doherty, FRCPC, MD and Justin Lee, FRCPC, MD Odette Cancer Centre Department of Radiation Oncology, University of Toronto Alex Kiss, PhD Odette Cancer Centre Ewa Szumacher, FRCPC, MD Odette Cancer Centre Department of Radiation Oncology, University of Toronto Background: Currently, the standard treatment for early stage breast cancer is breast conserving surgery followed by whole breast irradiation (WBI). Recently, there has been increased interest in partial breast irradiation (PBI) as an alternative to WBI. However, patient preference as to what type of radiotherapy regimen they would prefer and why is unclear in the literature. This study was conducted to determine whether patients with early stage breast cancer would prefer PBI or WBI, and to identify important factors for patients when making their treatment decision. Methods: Based on our previous study of early stage breast cancer patient information needs, the relevant literature, and the ASTRO consensus statement guidelines, an educational tool and questionnaire were developed. New patients over 40 years of age with a diagnosis of early stage, node-negative breast cancer referred for adjuvant radiotherapy at a large cancer centre in Canada were invited to participate and complete the questionnaire. Descriptive statistics were used to describe all variables of interest. The proportion of patients preferring WBI or PBI was summarized using 95% confidence intervals. A chi-square analysis was carried out to assess the bivariate relationships between treatment preference in relation to demographic variables, as well as Likert scale responses from the questionnaire. Results: Out of 54 patients enrolled in the study, 18 preferred PBI and 36 preferred WBI post lumpectomy. Factors rated as important by patients in making their decision included convenience [PBI¼12(67%),WBI¼23(64%)]; financial factors [PBI¼8(44%),WBI¼16(44%)]; radiation dose to the breast [PBI¼13(72%),WBI¼31(86%)]; invasiveness [PBI¼11(61%), WBI¼31(86%)]; recurrence rate [PBI¼18(100%),WBI¼36(100%)]; survival [PBI¼18(100%), WBI¼36(100%)]; effectiveness [PBI¼17(94%),WBI¼36(100%)]; standard method of treatment [PBI¼10(55%),WBI¼34(94%), p¼0.001]; and radiation dose to surrounding organs [PBI¼15(83%),WBI¼36(100%)]. Conclusions: Our preliminary data show that patients with early breast cancer prefer WBI as an adjuvant treatment post lumpectomy. Of the items listed in the survey, choosing the standard method of treatment was the only statistically significant factor influencing patient preference in the decision making process.

Conference Proceedings from RTi3 2015/Journal of Medical Imaging and Radiation Sciences 46/S1 (2015) S2-S30

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