Gunita Mitera

Canadian Partnership Against Cancer Corporation, Toronto, Ontario, Canada

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Publications (34)66.21 Total impact

  • International journal of radiation oncology, biology, physics 11/2015; 93(3):E494. DOI:10.1016/j.ijrobp.2015.07.1809 · 4.26 Impact Factor

  • International journal of radiation oncology, biology, physics 11/2015; 93(3):E500. DOI:10.1016/j.ijrobp.2015.07.1824 · 4.26 Impact Factor
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    ABSTRACT: Choosing Wisely Canada, modeled after Choosing Wisely in the United States, is intended to identify low-value or potentially harmful practices relevant to the Canadian health care environment. Our objective was to use multidisciplinary, pan-Canadian, physician-based consensus to identify a list of low-value or harmful cancer practices frequently used in Canada. A Task Force convened by the Canadian Partnership Against Cancer included physician representation from the Canadian Society of Surgical Oncology, Canadian Association of Medical Oncologists, and Canadian Association of Radiation Oncology, and an expert advisor. The methodology included four phases: identify potentially relevant items, develop a long list, refine and reduce the long list to a short list, and select and endorse a final list. A framework-driven consensus process and a series of electronic surveys and voting processes were used to capture consensus. Sixty-six potentially relevant cancer-related practices were identified. The long list (41 practices) was reduced to a short list of 19 practices. Of the 10 practices on the final list, five are completely new, and five are revisions or adaptations of practices from previous US society lists. Six of the 10 involve multiple disease sites, and four are disease-site specific. One relates to diagnosis, six relate to treatment, two relate to surveillance/survivorship, and one practice spans the cancer care continuum. The cancer list was developed in partnership with the Canadian Society of Surgical Oncology, Canadian Association of Medical Oncologists, and Canadian Association of Radiation Oncology. Using knowledge translation and exchange efforts, this list should empower patients with cancer and physicians to assist in a targeted conversation about the appropriateness and quality of individual patient care. Copyright © 2015 by American Society of Clinical Oncology.
    Journal of Oncology Practice 05/2015; 11(3):e296-e303. DOI:10.1200/JOP.2015.004325
  • Gunita Mitera ·

    Journal of Medical Imaging and Radiation Sciences 03/2015; 46(1):13-15. DOI:10.1016/j.jmir.2015.02.001

  • Asia-Pacific Journal of Clinical Oncology 12/2014; 10:25-26. · 1.54 Impact Factor

  • Asia-Pacific Journal of Clinical Oncology 12/2014; 10:59-60. · 1.54 Impact Factor

  • Journal of Medical Imaging and Radiation Sciences 06/2014; 45(2):173. DOI:10.1016/j.jmir.2014.03.042

  • Journal of Medical Imaging and Radiation Sciences 06/2014; 45(2):172-173. DOI:10.1016/j.jmir.2014.03.040

  • Journal of Medical Imaging and Radiation Sciences 06/2014; 45(2):187. DOI:10.1016/j.jmir.2014.03.087
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    ABSTRACT: In 25% to 35% of patients with early stage I non-small-cell lung cancer (NSCLC), surgery is not feasible, and external-beam radiation becomes their standard treatment. Conventionally fractionated radiotherapy (CFRT) is the traditional radiation treatment standard; however, stereotactic body radiotherapy (SBRT) is increasingly being adopted as an alternate radiation treatment. Our objective was to conduct a cost-effectiveness analysis, comparing SBRT with CFRT for stage I NSCLC in a public payer system. Consecutive patients were reviewed using 2010 Canadian dollars for direct medical costs from a public payer perspective. A subset of direct radiation treatment delivery costs, excluding physician billings and hospitalization, was also included. Health outcomes as life-years gained (LYGs) were computed using time-to-event methods. Sensitivity analyses identified critical factors influencing costs and benefits. From January 2002 to June 2010, 168 patients (CFRT, n = 50; SBRT, n = 118) were included; median follow-up was 24 months. Mean overall survival was 2.83 years (95% CI, 1.8 to 4.1) for CFRT and 3.86 years (95% CI, 3.2 to not reached) for SBRT (P = .06). Mean costs for CFRT were $6,886 overall and $5,989 for radiation treatment delivery only versus $8,042 and $6,962, respectively, for SBRT. Incremental costs (incremental cost-effectiveness ratio [ICER]) per LYG for SBRT versus CFRT were $1,120 for the public payer and $942 for radiation treatment alone. Varying survival and labor costs individually (± 20%) created the largest changes in the ICER, and simultaneous adjustment (± 5% to ± 30%) confirmed cost effectiveness of SBRT. Using a threshold of $50,000 per LYG, SBRT seems cost effective. Results require confirmation with randomized data.
    Journal of Oncology Practice 03/2014; 10(3). DOI:10.1200/JOP.2013.001206
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    ABSTRACT: To update the 2005 Cancer Care Ontario practice guidelines for the diagnosis and treatment of adult patients with a suspected or confirmed diagnosis of extradural malignant spinal cord compression (MESCC). A review and analysis of data published from January 2004 to May 2011. The systematic literature review included published randomized control trials (RCTs), systematic reviews, meta-analyses, and prospective/retrospective studies. An RCT of radiation therapy (RT) with or without decompressive surgery showed improvements in pain, ambulatory ability, urinary continence, duration of continence, functional status, and overall survival. Two RCTs of RT (30 Gy in eight fractions vs. 16 Gy in two fractions; 16 Gy in two fractions vs. 8 Gy in one fraction) in patients with a poor prognosis showed no difference in ambulation, duration of ambulation, bladder function, pain response, in-field failure, and overall survival. Retrospective multicenter studies reported that protracted RT schedules in nonsurgical patients with a good prognosis improved local control but had no effect on functional or survival outcomes. If not medically contraindicated, steroids are recommended for any patient with neurologic deficits suspected or confirmed to have MESCC. Surgery should be considered for patients with a good prognosis who are medically and surgically operable. RT should be given to nonsurgical patients. For those with a poor prognosis, a single fraction of 8 Gy should be given; for those with a good prognosis, 30 Gy in 10 fractions could be considered. Patients should be followed up clinically and/or radiographically to determine whether a local relapse develops. Salvage therapies should be introduced before significant neurologic deficits occur.
    International journal of radiation oncology, biology, physics 03/2012; 84(2):312-7. DOI:10.1016/j.ijrobp.2012.01.014 · 4.26 Impact Factor
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    ABSTRACT: The primary objective of this pilot study was to examine the inter-rater reliability in scoring the computed tomography (ct) imaging features of spinal metastases in patients referred for radiotherapy (rt) for bone pain. In a retrospective review, 3 musculoskeletal radiologists and 2 orthopedic spinal surgeons independently evaluated ct imaging features for 41 patients with spinal metastases treated with rt in an outpatient radiation clinic from January 2007 to October 2008. The evaluation used spinal assessment criteria that had been developed in-house, with reference to osseous and soft tissue tumour extent,presence of a pathologic fracture,severity of vertebral height loss, andpresence of kyphosis.The Cohen kappa coefficient between the two specialties was calculated. Mean patient age was 69.2 years (30 men, 11 women). The mean total daily oral morphine equivalent was 73.4 mg. Treatment dose-fractionation schedules included 8 Gy/1 (n = 28), 20 Gy/5 (n = 12), and 20 Gy/8 (n = 1). Areas of moderate agreement in identifying the ct imaging appearance of spinal metastasis included extent of vertebral body involvement (κ = 0.48) and soft-tissue component (κ = 0.59). Areas of fair agreement included extent of pedicle involvement (κ = 0.28), extent of lamina involvement (κ = 0.35), and presence of pathologic fracture (κ = 0.20). Areas of poor agreement included nerve-root compression (κ = 0.14) and vertebral body height loss (κ = 0.19). The range of agreement between musculoskeletal radiologists and orthopedic surgeons for most spinal assessment criteria is moderate to poor. A consensus for managing challenging vertebral injuries secondary to spinal metastases needs to be established so as to best triage patients to the most appropriate therapeutic modality.
    Current Oncology 12/2011; 18(6):e282-7. DOI:10.3747/co.v18i6.797 · 1.79 Impact Factor
  • G Mitera · L Zhang · A Sahgal · E Barnes · M Tsao · C Danjoux · L Holden · E Chow ·
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    ABSTRACT: To assess patients' understanding of their illness and expectations of palliative radiotherapy for symptomatic metastases before and after consultation and to explore the relationship between response and demographics/Edmonton Symptom Assessment Scale (ESAS) scores. In total, 100 participants completed a survey before and after consultation from March to October 2009. Descriptive statistics and statistical analyses were conducted to compare responses and to determine any relationship between responses and demographics or ESAS variables. Up to 25% believed their cancer was curable; there was no change in belief that radiotherapy would cure their cancer (17% before and 15% after) or prolong their life (40% before and 45% after). There were significant differences in radiotherapy expectation for symptom relief (P=0.0094) and for patients who did not know the role of radiotherapy (P=0.0025). Patient anxiety was reduced after consultation on questions about radiotherapy (P<0.001), concerns on effectiveness (P<0.0001) and side-effects of treatment (P<0.0001); 96, 24 and 46% said after consultation that they were satisfied with information from the team, better understood their diagnosis of cancer and the role of radiotherapy, respectively. A significant proportion of patients with advanced disease believe their cancer is curable, expect that radiotherapy will cure their cancer and prolong their life despite understanding the intent of radiotherapy is for symptom relief. After consultation, patients say they have a better understanding of their cancer and feel more confident about treatment. More work is needed to improve patients' understanding of their illness and expectations of the role of palliative radiotherapy.
    Clinical Oncology 09/2011; 24(2):134-8. DOI:10.1016/j.clon.2011.09.001 · 3.40 Impact Factor
  • D Andrew Loblaw · Gunita Mitera ·
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    ABSTRACT: Malignant epidural spinal cord compression is a dreaded complication of malignancy. Fortunately, it does not happen very often. Estimating the prognosis is critical to achieving a balance between effective therapy and the burden of treatment. Treatment can be individualized by reviewing simple prognosis scales. For patients with a poor prognosis, a single fraction of 8 Gy is just as effective as multiple fractions and much more convenient. Surgery and radiation should be considered for patients with a more positive prognosis. For patients not getting surgery, enrollment in clinical trials of single vs. multiple fractions of radiation should be a priority.
    The journal of supportive oncology 07/2011; 9(4):121-4. DOI:10.1016/j.suponc.2011.04.004
  • Andrew Loblaw · Gunita Mitera ·
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    ABSTRACT: Malignant epidural spinal cord compression (MESCC) is a dreaded complication of malignancy and is fortunately not common. Approximately 7% of men dying of prostate cancer will have at least one episode of MESCC during their lifetime. Treatment needs to be individualized and estimating the prognosis is critical to achieving a balance between effectiveness therapy and the burden of treatment. A consortium of multiple centers has defined prognosis scales, and multiple randomized studies have helped define the optimal dose fractionation schedule for patients getting radiotherapy. Simple prognosis scales available to assist the clinician are reviewed. For poor prognosis patients, a single fraction of 8  Gy is just as effective as multiple fractions, however, are much more convenient. For good prognosis patients, surgery and radiation should be considered. For patients not getting surgery, enrollment in clinical trials of single vs. multiple fractions of radiation should be a priority. For high-risk patients, screening strategies are being developed and hold promise for maintaining ambulation throughout the patients' lifetime.
    Current opinion in supportive and palliative care 06/2011; 5(3):206-10. DOI:10.1097/SPC.0b013e32834903c3 · 1.66 Impact Factor
  • Priya Patel · Gunita Mitera ·
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    ABSTRACT: Background: Radiation therapy (RT) staffing models have traditionally been based on the number of linear accelerators available at cancer centers (i.e., task-focused). RT treatments are becoming increasingly complex and a novel staffing model should be established that incorporates a total quality culture (TQC) to promote process-focused performance by using a patient-centered approach throughout the entire organization. Objectives: The objective of this article was to conduct a systematic scoping literature review of publications that study TQC within hospitals. The second objective was to specifically identify the publications that report on the relationship between TQC and their current RT staffing model. Methods and Results: A systematic scoping literature review was conducted in July 2010 using the Web of Science, Pub Med, and Google Scholar databases. Nine studies were identified that discussed TQC in hospitals. Five of the nine studies found that a TQC is positively correlated with patient satisfaction in hospitals. The remaining four studies discussed RT staffing based on the number of linear accelerators and did not mention a TQC. Conclusions: There are few studies that focus on the incorporation of a TQC in hospitals and RT staffing models. RT staffing models should be updated with an emphasis on "process-oriented" results. A novel RT model that includes a TQC strategy should allow radiation therapists within RT departments to be more autonomous in patient care and allowed to make more decisions in the treatment of patients.
    Journal of Medical Imaging and Radiation Sciences 06/2011; 42(2):81-85. DOI:10.1016/j.jmir.2011.03.001
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    ABSTRACT: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis.
    International journal of radiation oncology, biology, physics 04/2011; 82(5):1730-7. DOI:10.1016/j.ijrobp.2011.02.008 · 4.26 Impact Factor
  • Gunita Mitera · Anthony Whitton · Eric Gutierrez · Sheila Robson ·
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    ABSTRACT: To investigate the prevalence of total quality culture (TQC) within radiation therapy (RT) departments across Ontario, Canada. A prospective quantitative survey was distributed within RT departments across Ontario, Canada using the Miller Consulting Group Quality Culture survey. Ninety percent of managers (9/10) and 50% of employees (261/519) participated. There was concordance between managers and staff that overall RT departments exhibit a work culture that somewhat resembles TQC. Both groups scored 55% of the categories as somewhat agree with TQC and 9% of categories as no TQC. There was discordance in views for 36% of the categories, where managers scored a higher prevalence of TQC compared to their therapists. Larger RT departments (>50 employees) had more prevalence of discrepancy between group scores. This is the first study to report on the prevalence of TQC within RT departments. Strategies designed for on-going continuous improvement will benefit staff, RT managers, continuity of patient care and patient safety within RT departments.
    Radiotherapy and Oncology 02/2011; 99(1):90-3. DOI:10.1016/j.radonc.2011.01.013 · 4.36 Impact Factor
  • J Nguyen · E Chow · L Zeng · L Zhang · S Culleton · L Holden · G Mitera · M Tsao · E Barnes · C Danjoux · A Sahgal ·
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    ABSTRACT: To report pain and functional interference responses in patients radiated for painful spinal metastases, and to determine if location within the vertebral column or dose fractionation are associated with response. Patients treated with palliative radiotherapy for symptomatic spinal metastases from May 2003 to June 2005 were analysed. All patients completed the Brief Pain Inventory (BPI) assessment tool at 1, 2 and 3 months after radiotherapy. The pain response was determined using the International Bone Metastases Consensus response definitions. Given seven BPI functional interference items, a Bonferroni adjusted P value of less than 0.007 was considered significant. One hundred and nine treated patients were assessed. About 50% of patients were treated with a single fraction of 8Gy. All pain scores and functional interference scores significantly decreased over time after radiotherapy. At 3 months, 64% of patients achieved a response. Mood was significantly improved for responders (P=0.003) and a trend in improvement was observed for general activity (P=0.01) and normal work (P=0.04). Breast and prostate primaries were more likely to achieve an early response as compared with a lung primary. Neither location within the vertebral column or radiotherapy dose fractionation independently predicted for pain or functional interference responses. Conventional radiotherapy with 8Gy in a single fraction for spine metastases resulted in effective palliation of pain at 3 months and had a positive effect on a patient's mood. Location within the spine was not a predictive factor.
    Clinical Oncology 02/2011; 23(7):485-91. DOI:10.1016/j.clon.2011.01.507 · 3.40 Impact Factor
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    ABSTRACT: This is the first case study to report on using stereotactic body radiotherapy as an alternative and novel treatment modality for embolization to reduce the risk of operative bleeding for a metastatic renal cell tumor. A 58-year-old woman presented with an asymptomatic large 7-cm tumor on the parieto-occipital vertex of the skull. Given the location of this lesion along with its vascular histology, it was a challenge to provide safe and effective treatment using conventional management strategies. We report on a rare presentation of a metastatic renal cell cancer and the use of stereotactic body radiotherapy as an innovative radiation approach to deliver high-dose radiation safely to control this large aggressive and vascular metastasis. The success of this management strategy allowed for minimal intraoperative blood loss, and the patient continues with local control 1-year posttreatment.
    Journal of palliative medicine 02/2011; 14(2):157-60. DOI:10.1089/jpm.2010.0231 · 1.91 Impact Factor

Publication Stats

268 Citations
66.21 Total Impact Points


  • 2014
    • Canadian Partnership Against Cancer Corporation
      Toronto, Ontario, Canada
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2009-2012
    • University of Toronto
      • • Sunnybrook Health Sciences Centre
      • • Department of Radiation Oncology
      Toronto, Ontario, Canada
  • 2008-2011
    • Sunnybrook Health Sciences Centre
      • Department of Radiation Oncology
      Toronto, Ontario, Canada