Radiation therapy serves as an effective treatment modality for paediatric solid and central nervous system (CNS) tumours. Proton beam therapy (PBT) offers steeper dose gradients than conventional radiation therapy, reducing the dose to surrounding normal tissue dose. Unfortunately, PBT is unavailable in Canada and children are referred to the United States for treatment. AIMS:We describe the Canadian paediatric cancer population receiving PBT and their outcomes. MATERIALS AND METHODS:Patient demographics, treatment details, and survival outcomes were extracted for all paediatric patients from 12 of 13 provinces/territories. Eligibility criteria included: diagnosis of cancer at age ≤20 years between 2001-2021 and administration of curative-intent PBT. Temporal trends in PBT referrals were modelled using Poisson regression, and overall survival (OS) was estimated with the Kaplan-Meier method. RESULTS:Of 314 eligible children (55.7% male), most patients were from Quebec (26.4%), British Columbia (24.8%), Alberta (22.6%), and Ontario (21.0%). The median age of cancer diagnosis was 7.3 years. The most patients had CNS tumours (69.4%), with medulloblastoma, craniopharyngioma, and ependymoma being the most frequently represented. Most common solid tumours included rhabdomyosarcoma, neuroblastoma, and Ewing's sarcoma. Provinces/territories usually referred patients to PBT centres close in geographical proximity. Referrals have increased at a rate of 16% per year between 2001 and 2022. For children aged <15 years, five-year OS was 85.8% and 73.1% for CNS and solid tumours, respectively. CONCLUSION:Based on our data, there is a true need for the establishment of PBT centres in Canada for the treatment of cancers in children.

Radiotherapy is important for treating pediatric CNS tumours. The main modalities include photon therapy and PBT. PBT offers potential advantages over photon therapy in children since its precise dose control can limit long-term side effects. However, Canadian patients needing PBT are referred to the United States (US) because PBT is unavailable in Canada. We aimed to describe PBT use and outcomes over time for Canadian pediatric patients with CNS tumours. Patient demographics, treatment characteristics, and outcomes were extracted from medical records of patients from 10/13 Canadian provinces/territories. Patients diagnosed with a CNS tumour at ≤20 years old between 2001-2021 who received curative-intent PBT were included. PBT plans were compared using Fisher’s exact or Kruskal-Wallis rank sum tests. Overall survival (OS) was estimated using the Kaplan-Meier method. Of 195 patients (59.0% male) included in the study, majority were from Alberta (28.7%), Quebec (26.7%), British Columbia (22.6%), and Ontario (20.5%). Median age at diagnosis was 8.0 years. Most tumours (77.9%) were non-metastatic. Medulloblastoma was the most common diagnosis (30.8%). Provinces/territories referred patients to proton centres in the same geographical regions, except Alberta (74.5% referred to Florida). Referral numbers have increased ~180%/year since 2011. Median time from diagnosis to PBT was 126 days [11-5236] for all patients, and 36 days [21-1313] for medulloblastoma. Radiation doses, irradiation site, therapy duration, and time to treatment were not different (p≥0.2) across all PBT facilities for medulloblastoma. 5-year OS were 86.8% and 73.0% for the PBT study population and the Cancer in Young People-Canada reference population, respectively, in those aged <15 years. Given the unavailability of PBT in Canada, pediatric CNS tumour patients were referred to US PBT facilities close in proximity. Further studies are needed to better understand provincial referral patterns and barriers to equitable PBT access across Canada.

Proton beam therapy (PBT) is a form of external beam radiation therapy that provides dosimetric and clinical advantages over photon therapy for treating some children and adults with benign or malignant tumors.1 The physical properties of proton beam distribution allow for both delivery of the prescribed dose at the end of the beam range within the tumor target as well as near-zero exit dose, thereby reducing the volume of irradiated normal tissues. Clinical evidence indicates that PBT is at least as isoeffective in tumor control as photon radiation therapy, but with potential reduction in long-term toxicities.

Aim: To assess the implementation of an electronic patient reported outcomes (ePRO) application across a multi-center radiation oncology department. Process: Dalhousie University's Department of Radiation Oncology (DRO) is composed of four radiotherapy (RT) centres (Halifax, Sydney, Saint John, Charlottetown) across three provinces. The implementation of ePRO across our centres has been made possible by several key events: In 2009, a Canadian Partnership Against Cancer (CPAC) grant enabled 2 centres to begin paper-based distress screening using the Canadian Problem Checklist (CPC) and Edmonton Symptom Assessment System (ESASr). In 2015, a PRO retreat included representatives from all 4 centres to devise an action plan for ePRO implementation. In 2017, Accreditation Canada mandated routine evaluation of patient outcomes and in 2019, three DRO centres were awarded CPAC funding to launch ePROs. The fourth centre now hopes to use lessons learned in order to facilitate their ePRO implementation. Within the ePRO application (Noona) Canadian Partnership for Quality Radiotherapy (CPQR)-endorsed PRO tools are used to capture patient responses including CPC, ESASr, and the Brief Pain Inventory (BPI). Needs assessments were conducted in the areas of human resource (e.g. administrative support) as well as staff and patient education. Clinic workflows were revised to include an ePRO assessment at consultation, first and last RT review as well as follow-up in clinic or remotely. Official roll-out began in November 2021 with a phased approach across centres and tumors sites to allow for stakeholder and user feedback and to facilitate continued project planning. Benefits/Chellenges: Multi-centre and multi-disciplinary collaboration has been a major enabler of this project with significant potential to expand our Department's clinical and research programs. While the challenge of coordinating such a large-scale initiative was aggravated by constantly changing pandemic restrictions, project priority was escalated across the institutions with recognition of the electronic platform as a powerful tool to assess patient distress/symptoms remotely. While implementation of an ePRO program has been feasible, it has also been complex. Approvals from Privacy Impact Assessments to IT architectural reviews were required. An advisory board was formed to facilitate multi-stakeholder feedback including patient representatives, project managers, clinical clerks, nurses, radiation therapists, radiation oncologists, industry representatives, IT and legal. The project has been dependent on support from cancer program leadership to front line staff. Given that implementation of an ePRO application has introduced change in clinic workflow, change management strategies have been required to obtain buy-in for a system that aims to ultimately improve the quality and efficiency of patient care. Impact / Outcomes: PROs capture the patient perspective on physical, emotional and practical impacts of treatment, with the literature showing benefits to include improved patient-provider communication, patient quality of life and even survival. Future evaluation of the program will hopefully confirm that uptake and efficiency of PROs improves with use of the electronic versus paper system. More importantly, we await data collection and analysis to determine whether our multiple RT centres see improved patient outcomes through use of ePROs.

CARO-ASM 201933.3%.The most common tumour locations were the convexity of the brain (39.5%) and base of skull (30.9%).Tumour size ranged from 0.1 to 51.8 cc (median = 4.3 cc).The median PTV volume was 5.9 cm 3 and median prescription isodose line was 75%.Total dose ranged from 14 to 25 Gy in 1 to 5 fractions, with the most common schedule being 18 Gy in 3 fractions (35.8%).Treatment was completed as planned in 98.6% of patients.After a median follow-up of 50 months, crude local control rate was 97.5%.Fiveyear OS and PFS were 93.9% and 90.7%, respectively.Overall, the late Grade III/IV toxicity rate was 2.7%.Radionecrosis rate was 6.2%, with 60% of cases being symptomatic necrosis.One patient had a surgical resection and the others were managed conservatively with corticosteroids.The median time from treatment completion to radionecrosis presentation was seven months.There were no deaths attributable to ICM or treatment-related complications. Conclusions:Based on the data from our centre, SRS remains a safe modality to treat low-grade ICM with acceptable long-term toxicity and radionecrosis rates.Efficacy is similar to conventional fractionation and even larger lesions may be treated with a hypofractionated course.SRS should be offered to patients who are not ideal surgical candidates, for recurrent disease, and for those who wish to avoid an invasive operation.

Physicians, with their influence on many patients, could be key players in helping to make psychology a household Word. The MD Health e-Coach Web site was created to help physicians improve their own health and expose them to a biopsychosocial model of health. The authors discuss the site itself, the creation of the multidisciplinary research team, physician reaction, and their plans to further expand the site to a larger sample of physicians and other occupatiogal groups. By using the site, physicians experientially learn the benefits of psychologically driven health interventions and, the authors argue, are then more likely to be open to psychosocial interventions with patients.

Spirituality and Health InternationalVolume 7, Issue 3 p. 162-166 Pre-Conference Report Pre-conference report for the 4th International Multidisciplinary Conference on Spirituality and Health: Interweaving Science, Wisdom and Compassion Lyren Chiu, Corresponding Author Lyren Chiu chiu@nursing.ubc.ca Assistant Professor, School of Nursing, University of British ColumbiaSchool of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada. Tel: (604) 822-7456; fax: (604) 822-7466Search for more papers by this authorSoma Ganesan, Soma Ganesan Clinical Professor, Cross-Cultural Program, Department of Psychiatry, Faculty of Medicine, University of British ColumbiaSearch for more papers by this authorRob Rutledge, Rob Rutledge Assistant Professor, Department of Radiation Oncology, Faculty of Medicine, Dalhousie UniversitySearch for more papers by this authorJohn Toews, John Toews Professor, Department of Psychiatry, Faculty of Medicine, University of CalgarySearch for more papers by this author Lyren Chiu, Corresponding Author Lyren Chiu chiu@nursing.ubc.ca Assistant Professor, School of Nursing, University of British ColumbiaSchool of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada. Tel: (604) 822-7456; fax: (604) 822-7466Search for more papers by this authorSoma Ganesan, Soma Ganesan Clinical Professor, Cross-Cultural Program, Department of Psychiatry, Faculty of Medicine, University of British ColumbiaSearch for more papers by this authorRob Rutledge, Rob Rutledge Assistant Professor, Department of Radiation Oncology, Faculty of Medicine, Dalhousie UniversitySearch for more papers by this authorJohn Toews, John Toews Professor, Department of Psychiatry, Faculty of Medicine, University of CalgarySearch for more papers by this author First published: 13 September 2006 https://doi.org/10.1002/shi.290AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume7, Issue3September 2006Pages 162-166 RelatedInformation