Could changes in clinical practice reduce waiting lists for radiotherapy?
Notice bibliographique
Résumé
OBJECTIVES: To describe variation in the practice of radiation oncology among the nine cancer centres in Ontario, and to explore the impact of variations in the number of treatments prescribed per case on the overall demand for radiotherapy in the province. METHODS: Prospectively collected, electronic records of all courses of radiotherapy given at the nine radiotherapy centres in Ontario between 1 January 1996 and 31 December 1997 were analysed to describe inter-centre variations in the number of radiation treatments (fractions) prescribed per case. The effect of the observed inter-centre variations in practice on the total provincial workload was modelled. RESULTS: During the two-year study, 672,292 fractions were administered as 44,096 courses of treatment. On average there were 63.6 high-energy treatment machines operating in the province over this period. The mean number of fractions per course for the province as a whole was 15.3, and ranged from 10.9 at centre D to 16.0 at centre F. The inter-centre variation in the number of fractions per course was higher when radiotherapy was used palliatively than curatively. The range of variation in the number of treatments per curative course was disease-specific; it was highest for breast cancer, and lowest for the gynaecological malignancies. If each clinical problem had been treated everywhere in the province as it was at the centre which treated it with the fewest treatments, 77,274 fewer radiation treatments each year would have been required to treat the same number of cases. This is equivalent to the capacity of 14.6 treatment machines, and exceeds the estimated shortfall in the current supply of radiotherapy in the province. Province-wide adoption of more parsimonious approaches to the use of palliative radiotherapy, or to the use of curative (adjuvant) radiotherapy in breast cancer, would produce dramatic decreases in the overall demand for radiotherapy machine time. In these particular situations, the literature indicates that shorter courses of treatment are just as effective, and as well tolerated, as longer courses. CONCLUSIONS: Variation in the way that oncologists prescribe radiotherapy is an important determinant of overall radiotherapy machine workload. Modest changes in prescribing by radiation oncologists, even within the range of current practice in Ontario, and within the range of fractionation schemes that have been shown to produce optimal results, have the potential to reduce waiting lists for radiotherapy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,015 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».