Discover, Learn and Understand

A report from CureToday looks at the shift towards shared decision-making between patients and doctors. Patients increasingly want to receive detailed information about their treatment options and make decisions in partnership with their doctor. The importance of shared decision-making can be especially important in the treatment of various types of cancer where several treatment options may be available, such as surgery, external radiotherapy and brachytherapy. For Robert Jefferson, a 63 year-old builder diagnosed with early-stage prostate cancer, it was important for him to research the options and weigh these against his personal treatment objectives. He ultimately opted for brachytherapy over surgery because of the reduced risks of sexual dysfunction and incontinence.

Brachytherapy is now being offered at El Portal Comprehensive Cancer Center, California, USA. The introduction of the brachytherapy facilities are expected to reduce overall treatment times and reduce treatment costs. For example, for certain breast cancer patients, treatment can be reduced from six weeks to just five days. However, more importantly, brachytherapy is associated with a reduced risk of side-effects, resulting in improved quality of life for patients. The introduction of the facilities will widen patients’ options of where to receive brachytherapy treatment within the area.

Peter Garsude was diagnosed with prostate cancer at the age of 53 after a routine check-up. Having carefully researched the available treatment options, Peter opted to have brachytherapy as it avoided the need for major surgery or lengthy radiotherapy or as many potential side-effects as a radical prostatectomy, reports the Australian Senior.

aboutbrachytherapy.com certified as a provider of trustworthy health information Veenendaal, the Netherlands (19 May 2011) – Nucletron, a leading provider of state-of-the-art radiotherapy solutions for cancer treatment, have announced that their educational website, www.aboutbrachytherapy.com has received The Health On the Net Foundation (HON) seal of approval for providing useful and reliable online health information. www.aboutbrachytherapy.com was established last year to help increase awareness among cancer patients about brachytherapy, a very precise1 and highly effective2 form of radiotherapy to treat cancer. “Aboutbrachytherapy.com is a phenomenal resource that I use for each and every consultation with my patients,” said Dr Rakesh Patel, Director, Targeted Radiation Institute at Western Radiation Oncology (WRO), San Francisco Bay area, USA, and Chairman of the American Brachytherapy Society. “As a subspecialized radiation oncologist, I know that the information on the site is reliable and evidence-based, but the HON certification gives members of the public, looking for information about advanced cancer treatment options online, confidence that what they read on aboutbrachytherapy.com is trustworthy. As a health care provider, improving quality and access to state-of-the-art treatment remains a top priority.” According to research, 75% of patients with cancer have never heard of brachytherapy2 - a state-of-the-art technology that brings the radiation dose directly to the target cancer area,3 avoiding damage to healthy tissues and organs and minimising side effects.4 Of those 25% who are aware, only one in four have been offered the treatment2. This is why Nucletron developed www.aboutbrachytherapy.com as an accessible resource that provides balanced and informative information about brachytherapy, to help cancer patients make informed treatment choices in partnership with their doctors. “We are delighted that The Health On the Net Foundation have certified www.aboutbrachytherapy.com as it is an important milestone in our commitment to supporting health care professionals in improving patient care.” said Dr Jonathan Briers, Vice President, Medical Affairs at Nucletron “Three out of four cancer patients still haven’t heard about brachytherapy, but we know that many of these patients are active online and searching for valid information about their condition and treatment options. With the HON seal of approval, patients and their families know that the site respects ethical standards and they can trust information on www.aboutbrachytherapy.com and go on to have informed discussions with their doctors. At the end of the day, it’s about patients being empowered to make informed choices, especially when faced with beating cancer.” Compared to other forms of radiotherapy like external beam (EBRT), brachytherapy can deliver the required dose of radiation over a significantly shortened treatment time. In treating prostate cancer, for example, normal treatment times that can take up to seven weeks with EBRT take only one or two days with brachytherapy.5 In breast cancer, new techniques can reduce the time needed for radiotherapy after a lumpectomy from several weeks to 5 days.5 Additionally, the precise delivery of radiation reduces the risk of unnecessary damage to surrounding healthy tissue and organs which can help reduce side effects. For example, in endometrial cancer (cancer of the womb), the risk of gastrointestinal side effects is lower with brachytherapy than with EBRT,7 and again in prostate cancer the risk of side effects like incontinence and erectile dysfunction is lower than with other treatment options. These factors minimise disruption to patients and their quality of life, and allow a faster return to everyday life.4 Created in 1995, HON is a non-profit, non-governmental organization, accredited to the Economic and Social Council of the United Nations.

An analysis of 5,760 men with low-risk prostate cancer and 3,079 men with intermediate-risk prostate cancer, receiving either brachytherapy or radical prostatectomy, found no significant difference in the risk of prostate cancer specific mortality between the two treatments. Median follow-up was 4.2 years for low-risk men and 4.8 years for intermediate-risk men. The only factor identified with an increased risk of prostate specific cancer mortality was increasing age in the intermediate-risk group.

In this retrospective review of 360 men receiving brachytherapy (as monotherapy) for the treatment of prostate cancer, excellent long-term clinical and patient-reported outcomes were reported. Biochemical recurrence-free survival was 91.7% and 78.7% at 5 and 10 years, respectively. Prostate cancer-specific survival was 100% at both time points and overall survival was 92.9% and 84.4%, respectively. Overall satisfaction of brachytherapy was 95%, with greater than 92% of patients being ‘extremely satisfied’ with their treatment.

The American Society for Therapeutic Radiation Oncology (ASTRO) has published guidance on the role of external beam radiotherapy (EBRT), endobronchial brachytherapy and concurrent chemotherapy for the palliative thoracic treatment of lung cancer. Based on available evidence and opinion, endobronchial brachytherapy was considered to be an option for the palliation of endobronchial lesions causing obstructive symptoms including lung collapse, or for hemoptysis after EBRT failure. The guideline also calls for further clinical investigations into the role of brachytherapy for the palliation of lung cancer.

In this study of 1,656 prostate cancer patients receiving high-quality low-dose rate brachytherapy, excellent long-term outcomes were achieved for low-, intermediate-, and high-risk patients. At 12 years, biochemical-free survival was 95.6%, cause-specific survival was 98.2% and overall survival was 72.6% ― results which compare favorably to alternative treatments such as radical prostatectomy.

Whole breast irradiation (WBI) has become a standard treatment following breast conservation surgery. However, WBI is delivered over 5―7 weeks and is therefore associated with various logistical issues that may contribute to patients not completing their adjuvant course of radiotherapy. Accelerated partial breast irradiation (APBI) delivers localised radiotherapy via brachytherapy techniques in a much shorter period of time (5 days) in selected patients. This accelerated treatment can improve patients’ quality of life and may improve the rate of breast conservation and delivery of adjuvant radiation therapy.