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Fitness to Drive in Patients with Brain Tumors: The Influence of Mandatory Reporting Legislation in Canada
Proceedings of the 53rd Annual ASTRO Meeting
2739
Fitness to Drive in Patients with Brain Tumors: The Influence of Mandatory Reporting Legislation in Canada
A. V. Louie, D. P. D’Souza, D. A. Palma, G. S. Bauman, M. Lock, B. Fisher, N. Patil, G. Rodrigues University of Western Ontario, London, ON, Canada Purpose/Objective(s): Physicians have a medical, ethical, and often a legal responsibility to understand which medical conditions impede the ability to drive, and to inform their patients of the implications of driving with these conditions. In most Canadian provinces, physicians are legally required to report drivers with medical conditions that impede their ability to safely operate a motor vehicle. While neurocognitive deficits from brain tumors may impair the ability to drive safely, criteria for determining fitness are not clearly defined. Materials/Methods: We conducted a survey of Radiation Oncology attendings and trainees at the Canadian Association of Radiation Oncology 2010 annual meeting that elicited demographics, knowledge of provincial reporting laws, and attitudes on reporting guidelines for medically unfit drivers. Eight scenarios with varying levels of disability were presented to determine the likelihood of reporting a patient as unfit to drive. Statistical comparisons were made using Fisher’s exact tests. Results: Ninety-seven Radiation Oncologists from Canada participated, with 99% of physicians approached responding. The majority of respondents (87%) felt that their provincial laws governing reporting of medically unfit drivers were unclear. Twenty-three respondents (24%) were unable to correctly identify whether their provinces had mandatory reporting legislation. In each clinical scenario, a physician’s inclination to report to the provincial licensing authority was independent of their level of training (attending versus trainee), volume of brain tumor patients seen, primary brain cancer practice, and practice setting (academic versus community). Physicians from provinces without mandatory legislation were significantly less likely to consider reporting newly diagnosed patients to provincial authorities (p = 0.001), and for all clinical scenarios, the likelihood of reporting was significantly dependent on the physician’s provincial legal obligation to report medically unfit drivers. Conclusions: The presence of provincial legislation is of primary importance in determining whether physicians will report brain tumor patients to driving authorities. It is imperative that there be development of clear, comprehensive, and objective guidelines to help clinicians in the assessment of brain tumor patients in the operation of motor vehicles. We propose the formation of a multi-disciplinary working group to formulate guidelines to assist physicians in balancing the juxtaposing responsibilities of patient advocacy and community safety. Survey of other physician specialties regarding their understanding regarding reporting obligations and accountabilities in this area would be essential in formulating such guidelines. Author Disclosure: A.V. Louie: None. D.P. D’Souza: None. D.A. Palma: None. G.S. Bauman: None. M. Lock: None. B. Fisher: None. N. Patil: None. G. Rodrigues: None.
2740
Quality Assurance Analysis of a Large Multicenter Practice: Does Increased Complexity of Intensity Modulated Radiotherapy Lead to Increased Error Frequency?
A. C. Olson, R. E. Wegner, C. Scicutella, D. E. Heron, J. S. Greenberger, S. Huq, G. Bednarz, J. C. Flickinger Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA Purpose/Objective(s): Error reduction is an important concern in clinical medicine. Intensity-modulated radiotherapy (IMRT) is an important advancement in Radiation Oncology that increases the complexity of treatment, potentially increasing the error risk. We studied the frequency and severity of errors in a large multicenter practice to ascertain the impact of quality improvement (QI) interventions over time, IMRT and type of practice. Materials/Methods: We analyzed prospective data from 3 academic and 16 community practice sites with 24,775 courses of radiotherapy (9,210 IMRT courses and 15,565 non-IMRT) between Jan 2006 - Dec 2009. All IMRT treatment was performed using one centralized dose planning center for all sites. Results: We prospectively identified various errors or potential errors in 0.14 % versus 0.40 % of the IMRT versus non-IMRT courses (13/9210 vs. 62/15565, p = 0.0004) and excluding potential errors: 0.03 % for IMRT vs. 0.21 % for non-IMRT. We developed the Clinical Radiotherapy Error Severity Scale (CRESS) to classify error severity from 1 - 10, with 1 - 3 for potential or completely correctable errors, 4 - 5 for dose variations 5%. Multivariate analyses of CRESS values, Severity.4 and any error (including potential) correlated significantly reduced errors with IMRT (P = 0.0001 - 0.0024) but no significant difference between the academic and community practice sites and no change in error frequency over time despite implementation of 39 system-wide policy changes by the centralized Quality Improvement Committee. Conclusions: Despite the increase in complexity with IMRT compared to conventional radiotherapy, it can be delivered with reduced error frequency. Author Disclosure: A.C. Olson: None. R.E. Wegner: None. C. Scicutella: None. D.E. Heron: None. J.S. Greenberger: None. S. Huq: None. G. Bednarz: None. J.C. Flickinger: None.
2741
Incidence and Predictors of Secondary Cancer Development After High-Dose IMRT and Image-Guided Brachytherapy for the Treatment of Localized Prostate Cancer
D. M. Housman, M. J. Zelefsky, X. Pei, Z. Alicikus, J. M. Magsanoc, Y. Yamada, M. Kollmeier, B. Cox, Z. Zhang Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): To report on the incidence and excess risk of second malignancy (SM) development compared with the population after external-beam radiotherapy (EBRT) and brachytherapy (BRT) to treat prostate cancer.
S565
2739
Fitness to Drive in Patients with Brain Tumors: The Influence of Mandatory Reporting Legislation in Canada
A. V. Louie, D. P. D’Souza, D. A. Palma, G. S. Bauman, M. Lock, B. Fisher, N. Patil, G. Rodrigues University of Western Ontario, London, ON, Canada Purpose/Objective(s): Physicians have a medical, ethical, and often a legal responsibility to understand which medical conditions impede the ability to drive, and to inform their patients of the implications of driving with these conditions. In most Canadian provinces, physicians are legally required to report drivers with medical conditions that impede their ability to safely operate a motor vehicle. While neurocognitive deficits from brain tumors may impair the ability to drive safely, criteria for determining fitness are not clearly defined. Materials/Methods: We conducted a survey of Radiation Oncology attendings and trainees at the Canadian Association of Radiation Oncology 2010 annual meeting that elicited demographics, knowledge of provincial reporting laws, and attitudes on reporting guidelines for medically unfit drivers. Eight scenarios with varying levels of disability were presented to determine the likelihood of reporting a patient as unfit to drive. Statistical comparisons were made using Fisher’s exact tests. Results: Ninety-seven Radiation Oncologists from Canada participated, with 99% of physicians approached responding. The majority of respondents (87%) felt that their provincial laws governing reporting of medically unfit drivers were unclear. Twenty-three respondents (24%) were unable to correctly identify whether their provinces had mandatory reporting legislation. In each clinical scenario, a physician’s inclination to report to the provincial licensing authority was independent of their level of training (attending versus trainee), volume of brain tumor patients seen, primary brain cancer practice, and practice setting (academic versus community). Physicians from provinces without mandatory legislation were significantly less likely to consider reporting newly diagnosed patients to provincial authorities (p = 0.001), and for all clinical scenarios, the likelihood of reporting was significantly dependent on the physician’s provincial legal obligation to report medically unfit drivers. Conclusions: The presence of provincial legislation is of primary importance in determining whether physicians will report brain tumor patients to driving authorities. It is imperative that there be development of clear, comprehensive, and objective guidelines to help clinicians in the assessment of brain tumor patients in the operation of motor vehicles. We propose the formation of a multi-disciplinary working group to formulate guidelines to assist physicians in balancing the juxtaposing responsibilities of patient advocacy and community safety. Survey of other physician specialties regarding their understanding regarding reporting obligations and accountabilities in this area would be essential in formulating such guidelines. Author Disclosure: A.V. Louie: None. D.P. D’Souza: None. D.A. Palma: None. G.S. Bauman: None. M. Lock: None. B. Fisher: None. N. Patil: None. G. Rodrigues: None.
2740
Quality Assurance Analysis of a Large Multicenter Practice: Does Increased Complexity of Intensity Modulated Radiotherapy Lead to Increased Error Frequency?
A. C. Olson, R. E. Wegner, C. Scicutella, D. E. Heron, J. S. Greenberger, S. Huq, G. Bednarz, J. C. Flickinger Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA Purpose/Objective(s): Error reduction is an important concern in clinical medicine. Intensity-modulated radiotherapy (IMRT) is an important advancement in Radiation Oncology that increases the complexity of treatment, potentially increasing the error risk. We studied the frequency and severity of errors in a large multicenter practice to ascertain the impact of quality improvement (QI) interventions over time, IMRT and type of practice. Materials/Methods: We analyzed prospective data from 3 academic and 16 community practice sites with 24,775 courses of radiotherapy (9,210 IMRT courses and 15,565 non-IMRT) between Jan 2006 - Dec 2009. All IMRT treatment was performed using one centralized dose planning center for all sites. Results: We prospectively identified various errors or potential errors in 0.14 % versus 0.40 % of the IMRT versus non-IMRT courses (13/9210 vs. 62/15565, p = 0.0004) and excluding potential errors: 0.03 % for IMRT vs. 0.21 % for non-IMRT. We developed the Clinical Radiotherapy Error Severity Scale (CRESS) to classify error severity from 1 - 10, with 1 - 3 for potential or completely correctable errors, 4 - 5 for dose variations 5%. Multivariate analyses of CRESS values, Severity.4 and any error (including potential) correlated significantly reduced errors with IMRT (P = 0.0001 - 0.0024) but no significant difference between the academic and community practice sites and no change in error frequency over time despite implementation of 39 system-wide policy changes by the centralized Quality Improvement Committee. Conclusions: Despite the increase in complexity with IMRT compared to conventional radiotherapy, it can be delivered with reduced error frequency. Author Disclosure: A.C. Olson: None. R.E. Wegner: None. C. Scicutella: None. D.E. Heron: None. J.S. Greenberger: None. S. Huq: None. G. Bednarz: None. J.C. Flickinger: None.
2741
Incidence and Predictors of Secondary Cancer Development After High-Dose IMRT and Image-Guided Brachytherapy for the Treatment of Localized Prostate Cancer
D. M. Housman, M. J. Zelefsky, X. Pei, Z. Alicikus, J. M. Magsanoc, Y. Yamada, M. Kollmeier, B. Cox, Z. Zhang Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): To report on the incidence and excess risk of second malignancy (SM) development compared with the population after external-beam radiotherapy (EBRT) and brachytherapy (BRT) to treat prostate cancer.
S565