Management of metastatic spinal cord compression among Veterans Health Administration radiation oncologists
| Autor: | Helen Fosmire, Alice V. Cheuk, Drew Moghanaki, Stephen Lutz, Ruchika Gutt, Lori Hoffman-Hogg, George Dawson, Maria D. Kelly, Shruti Jolly, Sheetal Malhotra, Mitchell S. Anscher |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Palliative care medicine.medical_treatment Veterans Health Disease 03 medical and health sciences 0302 clinical medicine Spinal cord compression Internal medicine Surveys and Questionnaires Metastatic spinal cord compression medicine Humans Neoplasm Metastasis Aged Advanced and Specialized Nursing Response rate (survey) Aged 80 and over Spinal Neoplasms business.industry Radiation Oncologists Middle Aged medicine.disease Veterans health United States Radiation therapy Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Practice Guidelines as Topic Radiation Oncology Female Neurosurgery business Spinal Cord Compression |
| Zdroj: | Annals of palliative medicine. 7(2) |
| ISSN: | 2224-5839 |
| Popis: | Optimal management of metastatic spinal cord compression (MSCC) improves functional outcomes in patients with metastatic disease. This survey study evaluated management of MSCC by Veterans Health Administration (VHA) radiation oncologists (ROs), to determine whether management of MSCC correlates with American College of Radiology (ACR) guidelines, and to compare times to initiation of treatment between surgery and radiotherapy (RT).Surveys emailed to 79 VHA ROs included questions on steroid use, surgical care, palliative care, fractionation of irradiation, re-irradiation, and management of common MSCC case scenarios. Follow-up phone calls were made to encourage survey participation. Descriptive statistics and chi-square testing were done to show significant associations.The survey yielded an 81.0% response rate; 79.4% of ROs had read the ACR Appropriateness Criteria® Spinal Bone Metastases. The majority (87.3%) prefer 30 Gy/10 fractions for MSCC, and all respondents recommend steroid therapy in conjunction with RT. When used, RT was more often initiated within 24 hours than was neurosurgery (83.9% vs. 34.5%, P0.001). All ROs report use of palliative care services. Re-irradiation is given by 66.1%: 30.7% with stereotactic body radiation therapy (SBRT), 17.7% using intensity modulated radiation therapy (IMRT), and 17.7% using conventional RT. For the case scenarios, most respondents' (75%) management concurred with ACR guidelines.The majority of VHA ROs are familiar with the ACR Appropriateness Criteria® Spinal Bone Metastases and practice accordingly. Treatment within 24 hours is more likely when RT is the primary modality compared to when surgical decompression precedes RT. |
| Databáze: | OpenAIRE |
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