Implications of Cancer Staging Uncertainties in Radiation Therapy Decisions

Introduction . Radiation therapy (RT) for cancer is a critical medical procedure that occurs in a complex environment involving numerous health professionals, hardware, software, and equipment. Uncertainties and potential incidents can lead to inappropriate administration of radiation to patients, w...

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Bibliographic Details
Published in:Medical decision making 2006-05, Vol.26 (3), p.226-238
Main Authors: Lee, Robert C., Ekaette, Edidiong, Kelly, Karie-Lynn, Craighead, Peter, Newcomb, Chris, Dunscombe, Peter
Format: Article
Language:English
Subjects:
Breast Neoplasms - pathology
Breast Neoplasms - radiotherapy
Cancer
Care and treatment
Decision Support Techniques
Decision-making
Female
Health aspects
Homeopathy
Humans
Materia medica and therapeutics
Neoplasm Metastasis - diagnosis
Neoplasm Staging
Practice Patterns, Physicians
Radiography, Medical
Therapeutics
Uncertainty
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Summary:Introduction . Radiation therapy (RT) for cancer is a critical medical procedure that occurs in a complex environment involving numerous health professionals, hardware, software, and equipment. Uncertainties and potential incidents can lead to inappropriate administration of radiation to patients, with sometimes catastrophic consequences such as premature death or appreciably impaired quality of life. The authors evaluate the impact of incorrectly staging (i.e., estimation of extent of cancer) breast cancer patients and resulting inappropriate treatment decisions. Methods . The authors employ analytic and simulation methods in an influence-diagram framework to estimate the probability of incorrect staging and treatment decisions. As inputs, they use a combination of literature information on the accuracy and precision of pathology and tests as well as expert judgment. Sensitivity and value-of-information analyses are conducted to identify important uncertainties. Results and conclusions . The authors find a small but nontrivial probability that breast cancer patients will be incorrectly staged and thus may be subjected to inappropriate treatment. Results are sensitive to a number of variables, and some routinely used tests for metastasis have very limited information value. This work has implications for the methods used in cancer staging, and the methods are generalizable for quantitative risk assessment of treatment errors.
ISSN:0272-989X
1552-681X
DOI:10.1177/0272989X06288684