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I. J. Radiation Oncology
● Biology ● Physics
Volume 51, Number 3, Supplement 1, 2001
respectively, p ⫽ 0.016). Neither clinical stage, utilization of neoadjuvant hormonal manipulation, the choice of isotope, a history of hypertension, nor tobacco consumption had an effect on the ultimate preservation of potency. 56 patients used sildenafil with 46 (82%) reporting a favorable response. Including pharmacologic support, 92% of patients maintained potency. Conclusion: Our results suggest that brachytherapy-induced ED is more common than previously reported and may be the result of obtaining patient information by means of a validated quality of life instrument by mail and not by personal interview. Pre-implant erectile function, patient age, and a history of diabetes mellitus were associated with the development of post-treatment ED. Fortunately, the majority of patients with brachytherapy-induced ED respond favorably to sildenafil. With pharmacologic support, 92% of patients maintained potency following permanent prostate brachytherapy.
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A Randomized Assessment of Three Quality of Life (QOL) Questionnaires for Prostate Cancer Patients Undergoing Different Radiation Treatment Modalities
K.K. Senter, M. Hardy, C. Flynn, L. Lewis, M. Wallace, G. Boyea, C. Mitchell, L. Fluellen, C. St. Henry, A. Martinez Radiation Oncology, William Beaumont Hospital, Royal Oak, MI Purpose: The goal of this prospective, randomized study was to assess and compare compliance of patients diagnosed with prostate cancer to completing three different validated QOL instruments pre-treatment and six months later. Materials and Methods: Between April 2000 and April 2001, 124 patients were asked to fill out only one of three randomly selected QOL questionnaires (version A, B, C). Each addressed urinary and sexual function. One also addressed patients’ physical, social, family, emotional, and functional well being. Study patients received External Beam Radiation Therapy (EBRT) or Brachytherapy (BRACHY), according to departmental policy. Exclusion criteria included current/previous hormone therapy and prostatectomy. Patients were asked to return the questionnaire at their first treatment visit. The three tools were: A The Functional Assessment of Cancer Therapy for Prostate Patients (FACT-P), The Sexual Adjustments Questionnaire (SAQ), and The American Urological Association (AUA) Questionnaire. The Fact-P questionnaire elicits information about physical, social, family, emotional, and functional well being as they relate to prostate cancer. SAQ focuses on sexual function; the AUA on urinary symptoms. B SAQ and AUA only; identical to Version A, but does not address physical, social, family, emotional, and functional well-being. C The International Prostate Symptom Score (I-PSS) Questionnaire, which addresses urinary symptoms and Patient Sexual Function Questionnaire, which focuses on erectile function. Additionally, patients were asked to respond yes/no to four variables designed to evaluate these questionnaires: 1) ease of understanding, 2) too personal, 3)addresses concerns regarding urinary function and sexual potency and 4) willingness to complete questionnaire in six months. These variables were examined for any trends that may exist between the different questionnaires. Results: Fifteen (12%) of the 124 patients returned incomplete questionnaires due to the personal nature. When the 109 completed questionnaires were analyzed,the favorable responses of the four variables were compared. Favorable responses were received less frequently with version A when compared to version B (p⫽0.07) or Version C (p⫽0.08). Specifically, patients felt that version C addressed their concerns more effectively then version A (p⫽ 0.03). Also, patients more frequently felt that version B was less personal when compared to versions A and C (p⫽0.01). When the patient responses were analyzed by treatment type, the group receiving EBRT appeared to trend toward version B. The group receiving BRACHY appeared to trend toward version C. Conclusion: Table I demonstrates that version B or C would provide a more effective QOL assessment. Patient accrual will continue to assess possible differences between B and C questionnaires.
Evaluation Question
Version A (n⫽35)
Version B (n⫽35)
Version C (n⫽39)
1. Easy to understand 2. Too Personal 3. Addresses Concerns 4. Fill Out Again Overall Favorable Responses
86% yes 29% yes 66% yes 80% yes 76%
83% yes 14% yes 77% yes 83% yes 82%
95% yes 28% yes 79% yes 85% yes 83%
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Internet Utilization by Radiation Oncology Patients
J.M. Metz1, P. Devine2, A. DeNittis3, M. Stambaugh3, H. Jones1, J. Goldwein1, R. Whittington1 1 Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 2Radiation Oncology, Veterans Affairs Medical Center, Philadelphia, PA, 3Radiation Oncology, West Jersey Cancer Center, Voorhees, NJ Purpose: Studies describing the use of the Internet by radiation oncology patients are lacking. This multi-institutional study of cancer patients presenting to academic (AC), community (CO) and veterans (VA) radiation oncology centers was designed to analyze the use of the Internet, predictive factors for utilization, and barriers to access to the Internet. Materials and Methods: A questionnaire evaluating the use of the Internet was administered to 921 consecutive patients presenting to radiation oncology departments at AC, CO and VA Medical Centers. The study included 436 AC patients (47%), 284 CO patients (31%), and 201 VA patients (22%). A computer was available at home to 427 patients (46%) and 337 patients (37%) had Email access. The mean age of the patient population was 64 years (range⫽14-93). Males represented 70% of the patient population. The most common diagnoses included prostate cancer (33%), breast cancer (13%), and lung cancer (11%).
Proceedings of the 43rd Annual ASTRO Meeting
Results: Overall, 265/921 patients (29%) were using the Internet to find cancer related information. The Internet was used by 42% of AC patients, 25% of CO patients and only 5% of VA patients (p⬍.0001). A computer was available at home in 62% AC vs. 45% CO vs. 12% VA patients (p⬍.0001). Patients ⬍ 60 years were much more likely to use the Internet than older patients (p⬍.0001). Most of the Internet users considered the information either very reliable (22%) or somewhat reliable (70%). Most patients were looking for information regarding treatment of their cancer (90%), management of side effects of treatment (74%), alternative/complementary treatments (65%) and clinical trials (51%). Unconventional medical therapies were purchased over the Internet by 12% of computer users. Products or services for the treatment or management of cancer were purchased online by 12% of Internet users. Conclusion: A significant number of cancer patients seen in radiation oncology departments at academic and community medical centers utilize the Internet to obtain information about cancer. Radiation oncologists must familiarize themselves with this resource because of the large number of patients using the Internet. Veterans lack the computerized access to the Internet and remain underserved by this important resource.
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A Survey to Evaluate Patients’ Perspective Concerning E-Mail in an Oncology Practice
C.S. Katzen, A.P. Dicker Radiation Oncology, Thomas Jefferson University, Philadelphia, PA Purpose: Use of e-mail to improve physician-patient communication is becoming increasingly widespread, however, little research has been done to evaluate patients’ interest and concerns regarding this technology. The goals of this study were to (1) evaluate the effectiveness of e-mail for communication between patients and their oncologist and (2) assess from the perspective of the patient the accessibility and usefulness of e-mail to facilitate medical treatment and advice as compared to conventional mail and telephone. E-mail as a clinical tool is a new trend in medicine that is growing quickly, however, there are few reports to date that evaluate the patients’ perspective concerning e-mail usage. The use of e-mail in doctor-patient communication is potentially faster and more efficient than conventional mail and may reduce “telephone tag”. E-mail initiated by the physician also allows for potential follow-up after treatment. Our study evaluated the types of transactions (personal medical questions, referrals, etc.) for which patients’ preferred using e-mail in place of conventional communication methods. Materials and Methods: A self-administered survey (8 pages; 50 items) was mailed to 65 patients who were treated within the previous three years for prostate cancer in a radiation oncology practice. This survey explored the opinions and behaviors of patients with regard to online communication about general healthcare issues. The items included: patients’ interest in e-mail, comfort in using e-mail, concerns about confidentiality, and access to e-mail. Patients’ interest in using e-mail for specific situations were also evaluated, such as, making appointments, following up on treatment, or asking general health related questions. Patients’ concerns about using email to communicate with healthcare organizations also were assessed. Results: The response rate to the survey was 63%, with a median age of 68 years (range 53-82), and the majority of respondents were white (94%) with 6% African American. Sixty-four percent or respondents had access to an e-mail account at home or work. Among these e-mail users, 66% were between the ages of 58-68, and 34% were more than 68 years old. Eight-one percent of email users had completed some or all of college, and 19 % had completed some or all of high school. The majority of patients indicated that the benefits of e-mail were to eliminate phone calls (70%), to increase the timeliness of a message (81%), to arrange appointments (73%), to ask a physician health related questions (79%), to refill prescriptions (64 %). Only one-third of patients felt e-mail to be appropriate to ask urgent health questions. Most patients (72%) felt comfortable responding to health questions sent by their doctor by e-mail. When controlling for age within this group 57% of patients who preferred e-mail were under 68 years old and 43% of patients were over 68 years old. When evaluating education level, 64% of the patients that preferred using email had a college or graduate degree and 36% had completed some or all of high school. More than half of respondents (61%) felt comfortable answering questions via e-mail that were posed to them by someone in their doctor’s office, such as, a nurse, or physician’s assistant. Patients were evenly divided when asked about confidentiality (56% unconcerned). Conclusion: This study demonstrated that patients were interested in using e-mail in non-urgent situations and to improve the timeliness of communication. Patients preferred e-mail for increased convenience and efficiency regarding minor health problems and did not prefer it for answers to more urgent health questions. Patients with at least a college degree were inclined to use e-mail over those who had completed some or all of high school. Patients who were not currently using e-mail responded favorably to the notion of communicating via e-mail with their physician and/or physician’s staff. Our survey revealed that patient’s may prefer using email for some aspects of communication with their physician. E-mail has the potential to be integrated into a radiation oncology practice.
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PTEN Mutation Cooperates with EGFR Activation in Human Glioblastoma Cells to Increase VEGF mRNA Levels by Transactivating an Element in the Proximal Promoter
A. Maity1, N. Pore1, D.A. Haas-Kogan3, D.M. O’Rourke2 1 Radiation Oncology, University of Pennsylvania School of Medicine, Phildelphia, PA, 2Neurosurgery, University of Pennsylvania School of Medicine, Phildelphia, PA, 3Radiation Oncology, University of California at San Francisco, San Franscisco, CA Purpose: Glioblastomas often express high levels of vascular endothelial growth factor (VEGF), even under normoxic conditions. Genetic alterations that commonly occur in these tumors, including PTEN mutations and epidermal growth factor receptor (EGFR) overexpression, may contribute to this increased VEGF expression. Our previous work showed that, compared
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