Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals
Purpose: This study aimed to characterize contemporary management of Canadian patients with cardiovascular implantable electronic devices (CIEDs) undergoing radiation therapy (RT) in light of updated American Association of Physicists in Medicine guidelines. Methods and Materials: A 22-question web-...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109423000131 |
| _version_ | 1797900659165495296 |
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| author | Amir H. Safavi, MD, MSc Alexander V. Louie, MD, PhD Alyaa H. Elzibak, PhD Andrew Warner, MSc Elysia K. Donovan, MD, MSc Jay S. Detsky, MD, PhD |
| author_facet | Amir H. Safavi, MD, MSc Alexander V. Louie, MD, PhD Alyaa H. Elzibak, PhD Andrew Warner, MSc Elysia K. Donovan, MD, MSc Jay S. Detsky, MD, PhD |
| author_sort | Amir H. Safavi, MD, MSc |
| collection | DOAJ |
| description | Purpose: This study aimed to characterize contemporary management of Canadian patients with cardiovascular implantable electronic devices (CIEDs) undergoing radiation therapy (RT) in light of updated American Association of Physicists in Medicine guidelines. Methods and Materials: A 22-question web-based survey was distributed to members of the Canadian Association of Radiation Oncology, Canadian Organization of Medical Physicists, and Canadian Association of Medical Radiation Technologists from January to February 2020. Respondent demographics, knowledge, and management practices were elicited. Statistical comparisons by respondent demographics were performed using χ2 and Fisher exact tests. Results: In total, 155 surveys were completed by 54 radiation oncologists, 26 medical physicists, and 75 radiation therapists in academic (51%) and community (49%) practices across all provinces. The majority of respondents (77%) had managed >10 patients with CIEDs in their career. Most respondents (70%) reported using risk-stratified institutional management protocols. Respondents used manufacturer recommendations, rather than American Association of Physicists in Medicine or institutionally recommended dose limits, when the manufacturer limit was 0 Gy (44%), 0 to 2 Gy (45%), or >2 Gy (34%). The majority of respondents (86%) reported institutional policies to refer to a cardiologist for CIED evaluation both before and after completion of RT. Cumulative dose to CIED, pacing dependence, and neutron production were considered during risk stratification by 86%, 74%, and 50% of participants, respectively. Dose and energy thresholds for high-risk management were not known by 45% and 52% of respondents, with radiation oncologists and radiation therapists significantly less likely to report thresholds than medical physicists (P < .001). Although 59% of respondents felt comfortable managing patients with CIEDs, community respondents were less likely to feel comfortable than academic respondents (P = .037). Conclusions: The management of Canadian patients with CIEDs undergoing RT is characterized by variability and uncertainty. National consensus guidelines may have a role in improving provider knowledge and confidence in caring for this growing population. |
| first_indexed | 2024-04-10T08:49:28Z |
| format | Article |
| id | doaj.art-c92be54154f149fabc6fd5bb7acfe5f4 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-10T08:49:28Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-c92be54154f149fabc6fd5bb7acfe5f42023-02-22T04:32:03ZengElsevierAdvances in Radiation Oncology2452-10942023-07-0184101184Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology ProfessionalsAmir H. Safavi, MD, MSc0Alexander V. Louie, MD, PhD1Alyaa H. Elzibak, PhD2Andrew Warner, MSc3Elysia K. Donovan, MD, MSc4Jay S. Detsky, MD, PhD5Department of Radiation Oncology, University of Toronto, Toronto, Ontario, CanadaDepartment of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario, CanadaDepartment of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario, CanadaDepartment of Radiation Oncology, London Health Sciences Centre, London, Ontario, CanadaDepartment of Oncology, McMaster University, Hamilton, Ontario, CanadaDepartment of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Corresponding author: Jay S. Detsky, MD, PhDPurpose: This study aimed to characterize contemporary management of Canadian patients with cardiovascular implantable electronic devices (CIEDs) undergoing radiation therapy (RT) in light of updated American Association of Physicists in Medicine guidelines. Methods and Materials: A 22-question web-based survey was distributed to members of the Canadian Association of Radiation Oncology, Canadian Organization of Medical Physicists, and Canadian Association of Medical Radiation Technologists from January to February 2020. Respondent demographics, knowledge, and management practices were elicited. Statistical comparisons by respondent demographics were performed using χ2 and Fisher exact tests. Results: In total, 155 surveys were completed by 54 radiation oncologists, 26 medical physicists, and 75 radiation therapists in academic (51%) and community (49%) practices across all provinces. The majority of respondents (77%) had managed >10 patients with CIEDs in their career. Most respondents (70%) reported using risk-stratified institutional management protocols. Respondents used manufacturer recommendations, rather than American Association of Physicists in Medicine or institutionally recommended dose limits, when the manufacturer limit was 0 Gy (44%), 0 to 2 Gy (45%), or >2 Gy (34%). The majority of respondents (86%) reported institutional policies to refer to a cardiologist for CIED evaluation both before and after completion of RT. Cumulative dose to CIED, pacing dependence, and neutron production were considered during risk stratification by 86%, 74%, and 50% of participants, respectively. Dose and energy thresholds for high-risk management were not known by 45% and 52% of respondents, with radiation oncologists and radiation therapists significantly less likely to report thresholds than medical physicists (P < .001). Although 59% of respondents felt comfortable managing patients with CIEDs, community respondents were less likely to feel comfortable than academic respondents (P = .037). Conclusions: The management of Canadian patients with CIEDs undergoing RT is characterized by variability and uncertainty. National consensus guidelines may have a role in improving provider knowledge and confidence in caring for this growing population.http://www.sciencedirect.com/science/article/pii/S2452109423000131 |
| spellingShingle | Amir H. Safavi, MD, MSc Alexander V. Louie, MD, PhD Alyaa H. Elzibak, PhD Andrew Warner, MSc Elysia K. Donovan, MD, MSc Jay S. Detsky, MD, PhD Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals Advances in Radiation Oncology |
| title | Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals |
| title_full | Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals |
| title_fullStr | Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals |
| title_full_unstemmed | Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals |
| title_short | Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals |
| title_sort | management of patients with cardiovascular implantable electronic devices undergoing radiation therapy a national survey of canadian multidisciplinary radiation oncology professionals |
| url | http://www.sciencedirect.com/science/article/pii/S2452109423000131 |
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