Physician self-reported treatment of brain metastases according to patients’ clinical and demographic factors and physician practice setting
| Autor: | Naren Ramakrishna, Solomon B. Makgoeng, Marie-Adele S Kress, Keith R Unger, Arnold L. Potosky |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
Lung Neoplasms medicine.medical_treatment Disease Choice Behavior Carcinoma Non-Small-Cell Lung Generalized estimating equation Melanoma Treatment patterns Aged 80 and over Practice setting Brain Neoplasms Data Collection Professional Practice Location Professional Practice Middle Aged lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Combined Modality Therapy Oncology Radiology Nuclear Medicine and imaging Female medicine.symptom Whole brain radiation therapy lcsh:Medical physics. Medical radiology. Nuclear medicine Adult medicine.medical_specialty lcsh:R895-920 Neurosurgery Radiosurgery lcsh:RC254-282 Lesion Internal medicine Physicians medicine Humans Radiology Nuclear Medicine and imaging Karnofsky Performance Status Stereotactic radiosurgery Aged Demography business.industry Research Patient Selection Brain metastases Odds ratio Radiation therapy Socioeconomic Factors Physical therapy Self Report Cranial Irradiation business Physician survey |
| Zdroj: | Radiation Oncology (London, England) Radiation Oncology, Vol 7, Iss 1, p 188 (2012) |
| ISSN: | 1748-717X |
| Popis: | Background Limited data guide radiotherapy choices for patients with brain metastases. This survey aimed to identify patient, physician, and practice setting variables associated with reported preferences for different treatment techniques. Method 277 members of the American Society for Radiation Oncology (6% of surveyed physicians) completed a survey regarding treatment preferences for 21 hypothetical patients with brain metastases. Treatment choices included combinations of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. Vignettes varied histology, extracranial disease status, Karnofsky Performance Status (KPS), presence of neurologic deficits, lesion size and number. Multivariate generalized estimating equation regression models were used to estimate odds ratios. Results For a hypothetical patient with 3 lesions or 8 lesions, 21% and 91% of physicians, respectively, chose WBRT alone, compared with 1% selecting WBRT alone for a patient with 1 lesion. 51% chose WBRT alone for a patient with active extracranial disease or KPS=50%. 40% chose SRS alone for an 80 year-old patient with 1 lesion, compared to 29% for a 55 year-old patient. Multivariate modeling detailed factors associated with SRS use, including availability of SRS within one’s practice (OR 2.22, 95% CI 1.46-3.37). Conclusions Poor prognostic factors, such as advanced age, poor performance status, or active extracranial disease, correspond with an increase in physicians’ reported preference for using WBRT. When controlling for clinical factors, equipment access was independently associated with choice of SRS. The large variability in preferences suggests that more information about the relative harms and benefits of these options is needed to guide decision-making. |
| Databáze: | OpenAIRE |
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