Implications of Cancer Staging Uncertainties in Radiation Therapy Decisions

Robert C. Lee, Edidiong Ekaette, Karie-Lynn Kelly, Peter Craighead, Chris Newcomb and Peter Dunscombe
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Robert C. Lee: University of Calgary, Alberta Cancer Board, rclee@ucalgary.ca
Edidiong Ekaette: University of Calgary, Alberta Cancer Board
Karie-Lynn Kelly: University of Calgary, Alberta Cancer Board
Peter Craighead: University of Calgary, Alberta Cancer Board
Chris Newcomb: University of Calgary, Alberta Cancer Board
Peter Dunscombe: University of Calgary, Alberta Cancer Board

Medical Decision Making, 2006, vol. 26, issue 3, 226-238

Abstract: 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.

Keywords: patient safety; breast cancer; radiation; risk analysis (search for similar items in EconPapers)
Date: 2006
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:26:y:2006:i:3:p:226-238

DOI: 10.1177/0272989X06288684

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