Canada-wide comparison of patient reported outcomes by complexity of radiotherapy technique for bone metastases
Radiotherapy (RT) is a common and cost effective treatment for patients with painful bone metastases (BoM). Complex and lengthy RT courses are increasingly used for BoM, despite substantial evidence and Choosing Wisely Canada guidelines recommending the use of single fraction RT (SFRT) over lengthy courses. Reluctance to adopt SFRT is based on lack of evidence of its effectiveness in patients ineligible for trials, such as those with poor performance status and BoM complicated by fracture or neurological compromise. Unfortunately, guidelines recommending SFRT use in Ontario did not lead to a durable change in practice. Therefore, evidence of SFRT’s effectiveness in a broad population is necessary, including patients ineligible for trials. Comparison of SFRT to lengthier and complex techniques, such as intensity modulated RT (IMRT) and Stereotactic Ablative Body RT (SABR), will build a population-level evidence base to support increased prescription of SFRT in BC and across Canada.
My research team has demonstrated it is feasible to collect and use Patient Reported Outcomes (PRO) on a population scale in BC. We used these PRO to demonstrate that pain improvement is similar between SFRT and weeklong RT courses, the results of which have led to increased prescription of SFRT across all six BC cancer centres. This gained international attention and the Canadian Partnership for Quality Radiotherapy (CPQR) has since invited me to lead PRO collection across the Canadian RT community. Under the current proposal, we will apply a similar integrated knowledge translation (iKT) approach used in our BC-based research to demonstrate evidence for SFRT on a population-level.
Our primary KT goal is to use our research results to increase evidence-based prescription of SFRT. As we did in BC, we will integrate nursing, radiation therapy, and oncology into all stages of PRO collection and comparison between treatments, with subsequent educational outreach and centre-specific interactive small group discussions of research results. We will engage with various levels of health government, leverage our existing relationship with CPQR and the Canadian Partnership Against Cancer, and create an advisory committee of key stakeholders including policy makers, oncologists, and allied health professionals from each province. Impact evaluation of end-of-grant KT activities will focus on reach, collaboration, practice change indicators, and behaviour changes to increased use of SFRT.