Alysa Fairchild's research while affiliated with University of Alberta and other places
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Publications (197)
Simple Summary
Accurately predicting survival in patients with cancer receiving palliative radiotherapy is important for clinical decision making in cancer care management and delivery. This remains a challenge due to the heterogeneity of cancer diagnoses and a wide variety of prognostic factors. This study aims to review the literature to identify...
Background
Individuals living with chronic advanced cancer (CAC) often face distinct physical, functional, and cognitive issues. Their rehabilitation needs are not yet routinely met, warranting further CAC-specific rehabilitation-based research. Given the complexity of functional and symptom presentations, engagement of individuals living with CAC...
Radiotherapy (RT) is often utilized for symptom control at the end of life. Palliative RT (pRT) may not be taken to completion by patients, thus decreasing clinical benefits and adversely impacting resource allocation. We determined rates of incomplete pRT and examined predictors of non-completion using an electronic questionnaire. Methods: A quest...
Patients who could benefit from palliative radiotherapy (PRT) may be in different phases of the cancer journey: they may have minimal symptoms and preserved functional status, or could be near end of life, with multiple complex care needs. Efficient triage at PRT referral is crucial to match patients with an appropriate provider and care setting as...
Purpose
Approximately half of all radiotherapy (RT) is delivered with palliative intent. Clinical research in palliative RT aims to manage symptoms, improve quality of life (QoL), evaluate supportive care, and determine optimal dose-fractionation schedules. Our aim was to describe the prevalence of palliative research at the Canadian Association of...
Objectives:
Understanding exercise motivation in rectal cancer patients during and after neoadjuvant chemoradiation therapy is important to improve adherence and achieve potential benefit. We report the motivational effects of exercise from the Exercise During and After Neoadjuvant Rectal Cancer Treatment trial.
Data sources:
We randomized 36 re...
Purpose.Approximately half of all radiotherapy (RT) is delivered with palliative intent. Clinical research in palliative RT aims to manage symptoms, improve quality of life (QoL), evaluate supportive care, and determine optimal dose-fractionation schedules. Our aim was to describe the prevalence of palliative research at the Canadian Association of...
In an era of increasing virtual communication, we
aimed to investigate current formats used by radiation oncology residents for
reviewing radiation treatment plans with attendings, preferences for formats,
and reasons contributing to preferences. Residents enrolled in Canadian
radiation oncology programs received questionnaires examining training l...
LBA492
Purpose: To determine if more patients (pts) with painful liver cancer have improved pain 1 month following radiation therapy (RT), compared to best supportive care (BSC). Methods: This multi-centre, phase III trial randomized pts with painful hepatocellular carcinoma (HCC) or liver metastases (LM) 1:1 to BSC alone or with single fraction RT...
Background
Postoperative stereotactic radiosurgery (SRS) is a standard management option for patients with resected brain metastases. Preoperative SRS may have certain advantages compared to postoperative SRS, including less uncertainty in delineation of the intact tumor compared to the postoperative resection cavity, reduced rate of leptomeningeal...
Objectives:
Nonoperative management (NOM) of locally advanced rectal cancer is an emerging approach allowing patients to preserve their anal sphincter. Identifying clinical factors associated with pathologic complete response (pCR) is essential for physicians and patients considering NOM.
Materials and methods:
In total, 412 locally advanced rec...
Background
Broadly, medical education e-learning is equivalent to in-person in student satisfaction, knowledge, skills, and outcomes. However, when e-learning is best used, and in what form is still being determined. For instance, e-learning with greater interactivity, practice, and feedback is associated with improved learner satisfaction and outc...
Purpose
Palliative radiotherapy (PRT) in advanced cancer improves symptom control and quality of life. PRT consultations take place in various clinical settings, including through dedicated rapid access clinics. We examined holistic assessment and PRT delivery by consultation setting.
Methods
We analyzed patients with breast cancer who died (01/04...
Objectives
We provide a review of external beam radiotherapy for pain associated with bone metastases, to summarize evidence associated with different radiotherapy fraction prescriptions, and outline the oncology nursing roles in a rapid-access palliative radiotherapy clinic. Additionally, we describe the clinical capacity contributed by a nurse pr...
Importance:
Palliative thoracic radiotherapy (RT) can alleviate local symptoms associated with advanced non-small cell lung cancer (NSCLC), but esophagitis is a common treatment-related adverse event. Whether esophageal-sparing intensity-modulated RT (ES-IMRT) achieves a clinically relevant reduction in esophageal symptoms remains unclear.
Object...
Background
Early integration of Specialist Palliative Care (SPC) with oncological care improves quality of life (QOL) of patients with advanced cancer; however, patients tend to access SPC late in their disease trajectory, if at all. Routine referral of all patients to SPC would quickly overwhelm available resources, suggesting a need for widesprea...
Background. Frameless fixation with a thermoplastic mask is an alternative to traditional frame-based immobilization for Gamma-Knife stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). However, interruptions during beam-on time can significantly prolong treatment delivery, impacting patient experience and unit workflow...
Purpose
We previously demonstrated that exercise during and after neoadjuvant chemoradiation (NACRT) for rectal cancer may improve the rate of pathologic complete/near complete response. Here, we report the effects of exercise on symptom management and quality of life (QoL).
Methods
Rectal cancer patients (N = 36) were randomized to a supervised h...
Purpose/Objective(s)
At least half of patients who die of cancer suffer from symptoms that adversely affect quality of life, many of which are amenable to palliative radiotherapy (PRT). In this population, urgent assessment and PRT initiation can be beneficial. At our institution, patients requiring PRT can be assessed in multiple settings, includi...
Purpose/Objective(s)
Approximately half of all radiotherapy is delivered with palliative intent. Clinical research in palliative radiotherapy (PRT) aims to manage symptoms, improve quality of life (QoL), evaluate supportive care interventions, and determine optimal dose-fractionation schedules, amongst other goals. The Canadian Association of Radia...
Purpose/Objective(s)
Despite level one evidence that early integration of specialist palliative care (SPC) improves quality of life, patients tend to access SPC late in their disease trajectory, if at all. Widespread accessibility of generalist PC competencies has been increasingly provided by dedicated palliative radiotherapy (PRT) clinics, such a...
Purpose/Objective(s)
Currently, neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is a standard treatment for patients with stage II and III rectal cancer. However, non-operative management of rectal cancer is an emerging approach to allow patients to preserve their anal sphincter. Factors that may help identify patients most l...
Purpose/Objective(s)
Optimizing provision of supportive care in incurable cancer can be facilitated by routine screening for symptoms and functional interference to direct referrals to appropriate allied health professionals (AHP) and specialist palliative care (SPC). At the Cross Cancer Institute (CCI), patients requiring consultation for palliati...
Palliative radiation therapy is an essential but often impromptu service, depending on the patient condition and symptom burden. Radiation oncologists are the usual consultant in this setting, however, there is potential to extend capacity with the addition of advanced providers such as a nurse practitioner.
Purpose: to examine characteristics and...
Objectives:
To discuss the symptom burden experienced among patients with castrate-resistant prostate cancer and bone metastases and the role of the oncology nurse practitioner in evaluation for palliative radiotherapy.
Data sources:
These include PubMed, international consensus documents, and clinician experience.
Conclusion:
Men with advance...
Background:
Radiation dose schedules for neoadjuvant chemoradiation for rectal cancers differs, with the most common dose schedule using 5040 cGy in 28 fractions.
Objectives:
The aim of this retrospective study was to assess the benefit of higher radiation doses beyond 5040cGy in the context of pathological response and follow up events.
Settin...
BACKGROUND
Neoadjuvant chemoradiation (NACRT) improves outcomes for rectal cancer patients, however, there are dose-limiting toxicities and only a 15-27% pathologic complete response (pCR) rate. Exercise may help manage toxicities and improve treatment response in this clinical setting but feasibility and early efficacy have not been established. E...
Introduction:
The study evaluated the effect of chemotherapy dose-capping on disease recurrence, toxicity and survival of rectal cancer patients treated with chemoradiotherapy (CRT).
Methods:
601 consecutive rectal cancer patients treated with concurrent CRT were retrospectively analysed. Dose-capped patients were defined as having a body surfac...
Background:
A mainstay therapy for pain relief from uncomplicated bone metastases is external beam radiation therapy. Single fraction radiation therapy (SFRT) is more convenient and cost-effective, causes fewer acute side effects, and is equivalent to multiple fraction radiation therapy for pain relief. Despite these advantages, radiation oncologi...
FUTILE RADIOTHERAPY AT THE END OF LIFE: DETERMINING
PREDICTORS OF PALLIATIVE RADIOTHERAPY NOT TAKEN TO
COMPLETION
Siddhartha Goutam1, Jordan Stosky2, Jackson Wu3, Alysa
Fairchild1, Marc Kerba3
1University of Alberta, Edmonton, AB2McGill University, Montreal, QC3University of Calgary, Calgary, AB
Purpose: Radiotherapy (RT) is a highly effective...
Aim
The aim of this study was to identify dosimetric parameters that predict late small bowel (SB) toxicity following neo-adjuvant long course chemoradiation (CRT) for rectal cancer.
Materials and Methods
486 consecutive patients with locally advanced rectal cancers (clinical T3/T4 or N1/N2) who received CRT followed by surgery and had dosimetric...
Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO...
Introduction:
Early integration of palliative care (PC) with oncological care is associated with improved outcomes in patients with advanced cancer. Limited information exists on the frequency, timing, and predictors of PC consultation in patients receiving oncological care. The Cross Cancer Institute (CCI) is the sole tertiary cancer center servi...
Purpose
Many patients with advanced cancer receive primary supports from informal caregivers (IC). As patient health deteriorates, IC assume increasing responsibility, often accompanied by distress. We investigated the quality of life (QOL) of IC of patients referred to a palliative radiotherapy (PRT) program.
Methods
IC accompanying patients to a...
Prior Pan-Canadian surveys of Radiation Oncology (RO) residents reveal a decrease in Canadian RO employment opportunities. Canadian RO resident levels increased from 130 in 2003, peaked at 209 in 2009, then decreased to 130 in 2017. Recognizing that RO has entered another period of transition, we re-examined resident motivations and perspectives on...
Background:
Prophylactic cranial irradiation (PCI) improves survival and prevents intracranial recurrence (IR) in limited stage (LS) and extensive stage (ES) small cell lung cancer (SCLC). However, despite PCI, IR affects 12%-45%, and limited data exist regarding salvage brain reirradiation (ReRT). We performed a population-based review of IR in S...
306
Background: Palliative radiation therapy (RT) is offered to patients with cancer for symptom management. RT planning and delivery is resource intensive. Benefits may take weeks to develop. Palliative RT at the end of life may not be completed due to patient and disease factors. RT courses that are not completed may indicate a need for improved...
Background and purpose
We prospectively assessed the contributions of PET to initial staging, early detection of treatment failures, and prognostication in patients with anal squamous cell carcinoma (ASCC).
Materials and methods
Consecutive patients with ASCC referred for radical chemoradiotherapy (CRT) consented to undergo FDG-PET imaging pre-tre...
Purpose/Objective(s):
Previous Pan-Canadian surveys of Radiation Oncology (RO) residents performed in 2003 and 2009 identified job availability as a major concern, and characterized a perceived decline in employment opportunities for radiation oncologists in Canada. The Canadian post-MD education registry indicates that Canadian RO trainee levels r...
53
Background: Radiotherapy (RT) is a resource intensive cancer treatment. Benefits may take weeks to realize, whereas side effects are more immediate. RT is commonly delivered with palliative intent often near the end of life (EOL). In patients with limited life expectancy, single fractions (sf) may substitute for multi-fraction (mf) treatments. O...
Background:
Palliative radiation therapists (PRTs) have been integrated in varying capacities into outpatient palliative radiation therapy (RT) services across Canada for over 2 decades. At our institution, PRTs have developed an essential role over 11 years within a palliative radiation oncology (PRO) clinic that focuses on integrating symptom ma...
Approximately 5–10% of all patients with cancer will develop leptomeningeal metastatic disease (LM), often synchronously with parenchymal brain metastases and extracranial disease progression. The vast majority are symptomatic. As much of the literature is comprised of retrospective single-institution reviews of patients with various histologies tr...
Small cell carcinoma is rarely found to originate from the hypopharynx and there exists no treatment guidelines due to the small number of cases. Here, we present a case of a female patient with metastatic small cell carcinoma originating from the posterior hypopharynx with lymph node involvement. Her treatment consisted of chemotherapy with etopos...
Abstract
Background
A comprehensive assessment of cannabis use by patients with cancer has not previously been reported. In this study, we aimed to characterize patient perspectives about cannabis and its use.
Methods
An anonymous survey about cannabis use was offered to patients 18 years of age and older attending 2 comprehensive and 2 communi...
Background A comprehensive assessment of cannabis use by patients with cancer has not previously been reported.
Background:
Standard treatment for locally advanced rectal cancer includes 5-6 weeks of neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision 6-8 weeks later. NACRT improves local disease control and surgical outcomes but also causes side effects including fatigue, diarrhea, hand-foot syndrome, and physical deconditioning tha...
Background:
Gender differences may contribute to variations in disease presentations and health outcomes. To explore the gender difference in pain and patient reported outcomes in cancer patients with bone metastases undergoing palliative radiotherapy on the National Cancer Institute of Canada (NCIC) SC.23 randomized trial.
Methods:
Patients com...
Purpose:
To explore the age difference in response and patient-reported outcomes in patients with cancer having bone metastases undergoing palliative radiotherapy.
Methods:
Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life (QOL) Bone Metastases module (QLQ-BM22), EORTC QOL Core-15-Palliativ...
Purpose: Whole brain radiation therapy (WBRT) remains the standard of care for patients with multiple brain metastases, but more than half of treated patients will develop intracranial progression. Because there is no clear consensus on the optimal therapeutic approach, a prognostic index would be helpful to guide treatment options at progression....
Importance:
Many studies that found improved quality of life (QOL) after radiotherapy of bone metastases have small sample sizes and do not use specific questionnaires. How soon after radiotherapy one can expect an improvement in QOL is unknown.
Objective:
To investigate QOL at days 10 and 42 after radiotherapy with a bone metastases-specific QO...
Background: Five-year overall survival (OS) for patients with stage IV non-small cell lung cancer (NSCLC) is a dismal 1%. However, approximately 7% have limited or solitary metastases, including to the adrenal gland. Radical treatment of these oligometastases (OM) could increase local control and improve OS. Our objective was to critically analyze...
Purpose:
Previous studies have determined optimal cut points (CPs) for the classification of pain severity as mild, moderate, or severe using only the Brief Pain Inventory (BPI) or the BPI in conjunction with a quality of life (QOL) tool. The purpose of our study was to determine the optimal CPs based on correlation with only QOL outcomes.
Method...
Introduction: Bone metastases are a frequent complication of advanced cancer, the most common cause of cancer-related pain and a source of significant morbidity and mortality. Optimal management can reduce skeletal-related events and improve quality of life.
Areas covered: This article reviews the indications, treatment regimens and outcomes of pal...
39
Background: Tumour factors (eg primary site, size) helpful in prognostication in early stage cancer may be less important than patient factors, such as Karnofsky performance status (KPS), later in the disease trajectory. We evaluated the utilization of the parameters attitude (ATT) and psychosocial support (PSS) in predicting remaining lifespan...
158
Background: Radiation therapists (MRTT) have been integrated in varying capacities into outpatient palliative radiotherapy (PRT) services across Canada for nearly two decades. We explored the experience of our centre’s MRTTs who have developed an essential role over nine years, from supporting one half-day PRT clinic per week to five full days...
219
Background: The optimal dose for palliative whole brain radiotherapy (WBRT) continues to be debated. Common regimens include 20 Gy in five and 30 Gy in 10 fractions. We aimed to identify factors associated with WBRT dose schedules, hypothesizing that clinical prediction of survival (CPS) would influence prescribing practice. Methods: Demographi...
Sarah Baker, Alysa Fairchild Department of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada Abstract: Radiation-induced esophagitis is the most common local acute toxicity of radiotherapy (RT) delivered for the curative or palliative intent treatment of lung cancer. Although concurrent chemotherapy and higher...
Purpose
Validated tools for evaluating quality of life (QOL) in patients with bone metastases include the EORTC QLQ-BM22 and QLQ-C15-PAL modules. A statistically significant difference in metric scores may not be clinically significant. To aid in their interpretation, we performed analyses to determine the minimal clinically important differences (...
Caring for patients with incurable cancer presents unique challenges. Managing symptoms that evolve with changing clinical status and, at the same time, ensuring alignment with patient goals demands specific attention from clinicians. With care needs that often transcend traditional service provision boundaries, patients who seek palliation commonl...
Purpose:
Quality of life (QOL) can be compromised in patients with bone metastases, and validated QOL instruments are required to accurately measure QOL outcomes in this population. This study investigated the validity, reliability and responsiveness of the EORTC QLQ-BM22 module with the EORTC QLQ-C15-PAL instrument in bone metastases.
Methods:...
Avascular necrosis (AVN) is the final common pathway resulting from insufficient blood supply to bone, commonly the femoral head. There are many postulated etiologies of non-traumatic AVN, including corticosteroids, bisphosphonates, and radiotherapy (RT). However, it is unclear whether there is a dose threshold for the development of RT-induced AVN...
Citations
... Individuals with lived experience of being diagnosed with prostate cancer and of the recovery processes after cancer treatment were recruited to partner with the research team members on this study. In accordance with IAP2 [48] and a conceptual model for patient engagement in chronic advanced cancer rehabilitation research (Dolgoy et al, unpublished data) [49], the level of engagement desired by the partners was documented, as well as their preferences in terms of communication, type of involvement, time available for this engagement, as well as preferred means of compensations or other support. To date, three partners with lived experience of prostate cancer have been consulted in the planning of the study, have been involved in developing the content of the intervention, and in reviewing and editing the study recruitment and consent documents. ...
... 20)). Patients with a longer predicted survival are generally more suitable for longer courses of PRT, as they are more likely to complete their treatment [45]. The use of SBRT, as demonstrated in SC24 [46], is thus likely more appropriate in patients with longer predicted survivals as well. ...
... However, not all patients responded to this approach, and no distinct clinical characteristics that explained this difference in response were found. Moreover, several studies have reported no benefit with the addition of RT to ICI [11,12]. For these reasons, there is a need for predictive and prognostic biomarkers that can guide patient selection and establish the mechanisms of AR in humans [13]. ...
... So, it is very important to provide support and understanding to athletes in retirement so that they remain motivated to sport or train (Hong & Fraser, 2023). Good motivation for a person to do sports will have a positive impact on a person's physical and mental health (Arthuso et al., 2023). Physical health will improve with the good fitness of each individual (Franklin et al ., 2023). ...
... Palliative radiotherapy is used to manage pain from non-bone lesions, such as those in the lymph nodes, skin, soft tissues, and solid organs. However, existing evidence supporting its analgesic efficacy in these non-bone lesions is less substantial, as this evidence is often derived from studies examining individual organ systems [7][8][9][10][11][12][13][14]. The analgesic effect of radiotherapy on all non-bone lesions involving different sites has not been studied in painful bone metastases. ...
... In recent years, randomized clinical trials (RCTs) using preoperative SRS have been conducted to reduce local and distant CNS recurrence [19]. Although no patients in this cohort underwent preoperative radiation, future RCTs may suggest the effectiveness of preoperative SRS, and it may be effective for BMs that involve ventricular/cisternal opening. ...
... The second search returned 18 ongoing clinical trials, of which 13 met the inclusion criteria (Supplementary File S2) [34][35][36][37][38][39][40][41][42][43][44][45][46]. No evident visual asymmetry could be detected on the generated funnel plots, excluding the presence of publication bias (Supplementary File S3). ...
... Lutsyk et al. found tumor volume less than 39.5 cm 3 was a significant predictor for achieving pCR among 187 LARC patients (18). Similarly, Yang et al. demonstrated tumor volume less than 37.3 cm 3 could be predictive for pCR in 412 LARC patients receiving nCRT (19). ...
... Triage is defined as "the process of sorting people in need of medical attention in order to determine priority" [6]. Triage is important in the setting of patients with advanced cancer who could potentially benefit from PRT [7]. Efficient triage performed at receipt of first referral is crucial to identify a patient's clinical needs and urgency in order to match them with an appropriate provider and care setting with as little wait time as is reasonably achievable. ...
... Webb and LeBlanc stated that the appropriate opioid dose is the lowest dose that relieves the patient's pain and maximizes function with the least adverse effects [60]. To minimize pain associated with inflammation from radiotherapy, nurses often administer dexamethasone pretreatment [63]. Corticosteroids address the pain that occurs from initial swelling caused by the tumor itself as it compresses the nerve roots or spinal cord, as well as any swelling that occurs because of cancer treatment [60]. ...