RADIATION TREATMENT DROPOUTS

1. Dr. Kanhu Charan Patro
M.D,D.N.B[RT],P.D.C.R,C.E.P.C
Consultant- Radiation Oncology
MAHATMA GANDHI CANCER HOSPITAL
VISAKHAPATNAM
Email-drkcpatro@gmail.com ,M-09160470564

2. BACKGROUND
Radiotherapy: Integral Part of treatment in oncology as radical and
adjunct to surgery /chemotherapy.
Dose and duration of radiation is correlated with tumor control and
survival.
Interruption in radiotherapy treatment result in poor tumor control .
Factors responsible for interruption and discontinution:
 side effects -- painful inflammation and ulceration of the mucous membranes
 Xerostomia, dysphagia and aspiration
 Co morbidities (Old Age)
 Financial issues,
 Misguidance during treatment
 Social issues etc.
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3. OBJECTIVE
To find out the barriers and
solutions to decrease the incidence
of radiation treatment interruptions
and fallouts.
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4. MATERIAL & METHOD
Prospective
May 2009 to July 2010
After tumor board decision, the patients were sent for radiation
Counseling done about all aspects at three levels,
 level I: Radiation Oncologists ,
 Level II: Radiation Coordinator-counselor ,
 Level III: radiation technologists before radiation starting.
If patient wants to discontinue radiation: counseling done to
know the cause and to sort out problem, still he/she is not
interested, we stop radiation
Anybody not coming for radiation followed up on telephone &
counseled
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5. MATERIAL & METHOD[ contd.]
Cause of stopping radiation was recorded in
following headings
Death
Referral misguidance
Financial problem
Patient satisfaction
Old age-co morbidity –social issue
Progressive disease
Change of treatment
Toxicity
Frustration due to breakdown of machine
Noncompliance.
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6. RESULT
study period of 15 months.
1220 patients were started on radiation.
100 patients wanted to stop radiation in between.
25 agreed to continue radiation after counseling.
75 patients [7%] denied of continuing radiation after
repeated counseling.
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7. TOTAL DROPOUTS
Total treatment dropouts in our study is
around 7% .
Analyzed about all above mentioned
cause and results evaluated.
In next slides we have evaluated the all
issues.
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1220
100
TOTAL STARTED ON RADIATION
TOTAL DROPOUTS

8. TOTAL RECOVERED
Those are not coming for more
than 5 days, contacted through
phone, if possible by home visit.
Counseled again at 3 levels.
At the end 25 out of 100 patients
agreed after counseling.
8
100
25
TOTAL DROPOUTS
TOTAL RECOVERED

9. DROPOUTS DUE TO DEATH
Dropouts due to death is 15% among
total fallouts.
It is mainly due to hematologic
toxicities in concurrent chemo settings,
co-morbid conditions, mismanaged
toxicities, nutrition problems,
electrolyte imbalance etc.
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100
15
TOTAL DROPOUTS
DROPOUTS DUE TO DEATH

10. DROPOUTS DUE TO SOCIAL ISSUES
Dropouts due to social issue are
mainly because of old age, social
inhibition, neglected by family
members , ignorance about the
disease, fearfulness etc.
The percentage is around 12%.
10
12
100
DROPOUTS DUE TO SOCIAL ISSUES
TOTAL DROPOUTS

11. DROPOUTS DUE TO TOXICITY
Some patients stopped taking
radiation in between due to
toxicity like mucositis, dairrhoea
etc.
20 patients out of 100 after reapted
counseling they denied of further
treatment.
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20
100
DROPOUTS DUE TO TOXICITY
TOATAL DROPOUTS

12. DROPOUTS DUE TO PROGRESSIVE DISEASE
Dropouts due to progressive
disease is around 10%.
It is usually seen in advanced
cases
Mostly in head and neck cancers
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10
100
DROPOUTS DUE TO
PROGRESSIVE DISEASE
TOTAL DROPOUTS

13. DROPOUTS -REFFERAL MISGIUDENCE
Around 9% of cases dropouts
due to referral misguidance.
When sending these patients
for co-morbid, toxicity and
tumor related issues
management to other specialty
doctors, they were misguided
about treatment issues and
other things.
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9
100
DROPOUTS DUE TO FINANCIAL
ISSUES
TOATAL DROPOUTS

14. DROPOUTS - SATISFIED WITH
RESPONSE
It is around 6% among all
dropouts.
Some patients got satisfaction after
good response in between the
treatment mostly due to the
regression of large nodal mass,
symptomatic benefit etc.
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6
100
DROPOUTS DUE TO SATISFIED
WITH RESPONSE
TOTAL DROPOUTS

15. DROPOUTS DUE TO FINANCIAL ISSUES
It is around 15% among all
dropouts and It is well known
factor.
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15
100
DROPOUTS DUE TO FINANCIAL
ISSUES
TOATAL DROPOUTS

16. DROPOUTS DUE TO NONCOMPLIANCE
It is around 7% among all
dropouts
Some people do not want to
continue after some hurdle on the
way of treatment.
It is mainly due to carelessness of
concerning person and family
members.
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7
100
DROPOUTS DUE TO
NONCOMPLIANCE
TOTAL DROPOUTS

17. DROPOUTS - CHANGE OF TREATMENT
6 patients dropouts due to
change of treatment in between.
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6
100
DROPOUTS DUE TO CHANGE OF
TREATMENT
TOTAL DROPOUTS

18. DROPOUTS-- MACHINE BREAKDOWN
Dropouts due to machine
breakdown in our study is nil.
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0
100
DROPOUTS DUE TO MACHINE
BREAKDOWN
TOTAL DROPOUTS

19. SUMMARY OF THIS STUDY
TOTAL DROPOUTS
DROPOUTS DUE TO MACHINE BREAKDOWN
DROPOUTS DUE TO PROGRESSIVE DISEASE
DROPOUTS DUE TO DEATH
DROPOUTS DUE TO REFERRAL MISGUIDENCE
DROPOUTSDUE TO FINANCIAL ISSUES
DROPOUTSDUE TO PATIENT SATISFACTION
DROPOUTSDUE TO SOCIAL ISSUES
DROPOUTS DUE TO TOXICITY
DROPOUTS DUE TO CHANGE OF TREATMENT
DROPOUTS DUE TO NONCOMPLIANCE
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20. REVIEW LITERTURE
This is the first and unique study of its kind. We have
searched the pubmed, medscape etc. but not a single
study found.
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21. DISCUSSION
Treatment dropouts are a known phenomenon everywhere in
oncology, particularly in radiation in busy academic centers.
Proper counseling before starting radiation as well as
throughout the treatment in every issues starting from toxicities
to finance problem by all stages is required.
Clinical reviews at particular interval during treatment
decrease the fallouts by toxicities.
Decision change during treatment can be handled better by
proper tumor board discussion before treatment.
These are the few solutions we have mentioned below but
there is long way to go to discuss the cause and sort out the
problem as oncology is very evolving subject.
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22. DISCUSSION-contd.
 DROPOUTS DUE TO DEATH-
 Solution is cause specific and can be decreased by regular reviews and timely
referral.
 DROPOUTS DUE TO SOCIAL ISSUES
 Can be solved by proper counseling, awareness about the disease.
 DROPOUTS DUE TO TOXICITY
 Acute radiation reactions are inevitable ,but can be decrease the incidence by better
prior counseling and review at regular interval for care.
 DROPOUTS DUE TO REFFERAL MISGIUDENCE
 The cause behind this issue about little knowledge about the disease even non-
oncology doctors.
 DROPOUTS DUE TO MACHINE BREAKDOWN
 Radiation treatment usually protracted over 6weeks to 8weeks comparing to other
treatments. This factor can be minimized by AMC, deploying a engineer at site, so
that for small problem we should not close the machine and wait. We can train our
physicists / technologists to handle small machine problems.
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23. DISCUSSION-contd.
DROPOUTS DUE TO- SATISFIED WITH RESPONSE-
 It can be handled by proper counseling and discuss the issue of severity and
curability of the disease with the patient
DROPOUT DUE TO FINANCIAL ISSUES-
 It can be better handled by taking the help of various trust societies and
sometimes sending the patients to govt. hospitals before taking for treatment.
DROPOUT DUE TO NONCOMPLIANCE-
 It can be decreased by proper counseling and discuss the issue of severity with
the patient and family and when needed psychiatry consultation.
 Findings suggest the need for improving methods of patient compliance with the
counseling methods
DROPOUTS DUE TO CHANGE OF TREATMENT –

This issue can be handled by proper tumor board discussion.
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24. WEAKNESS OF MY STUDY
NOT ANALYSED STATISTICALLY.
SAMPLE SIZE IS LESS.
SINGLE INSTITUTION STUDY.
BIAS
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25. CONCLUSION
We concluded that by counseling at various levels
throughout the treatment period will decrease the
treatment fallouts in radiation treatment.
Apart from counseling we have to give the stress on
other factors which are elaborated under every cause
previously to decrease the incidence of radiation
fallouts.
It is a very small study and requires more studies to
bring out the more barriers and solutions
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26. ACKNOWLEDGEMENT
P.SRINIVAS-RADIATION CO-ORDINATOR
DR VOONA MURALIKRISHNA
MY ASOOCIATE STAFF
MY PATIENTS
MY HOSPITAL
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27. THANKS
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