Publications (Articles)

 B. ParkerR. Rajapakshe, A. Moldovan, C. Araujo , J. Crook.



Background: Widespread integration of the Internet has resulted in an increase in the feasibility of using Web-based technologies as a means of communicating with patients. It may be possible to develop secure and standardized systems that facilitate Internet-based patient-reported outcomes which could be used to improve patient care.

Objective: This study investigates patient interest in participating in an online post-treatment disease outcomes and quality of life monitoring program developed specifically for patients who have received radiation treatment for prostate cancer at a regional oncology center.

Methods: Patients treated for prostate cancer between 2007 and 2011 (N=1113) at the British Columbia Cancer Agency, Centre for the Southern Interior were invited by mail to participate in a standardized questionnaire related to their post-treatment health. Overall participation rates were calculated. In addition, demographics, access to broadband Internet services, and treatment modalities were compared between participants and nonparticipants.

Results: Of the 1030 eligible invitees, 358 (358/1030, 34.7%) completed the online questionnaire. Participation rates were higher in individuals younger than age 60 when compared to those age 60 or older (42% vs 31%) and also for those living in urban areas compared with rural (37% vs 29%) and in those who received brachytherapy versus external beam radiotherapy (EBRT) (41% vs 31%). Better participation rates were seen in individuals who had access to Internet connectivity based on the different types of broadband services (DSL 35% for those with DSL connectivity vs 29% for those without DSL connectivity; cable 35% vs 32%; wireless 38% vs 26%). After adjusting for age, the model indicates that lack of access to wireless broadband connectivity, living in a rural area, and receiving EBRT were significant predictors of lower participation.

Conclusions: This study demonstrates that participation rates vary in patient populations within the interior region of British Columbia, especially with older patients, those in rural areas, and those with limited access to quality Internet services."


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R. Mlikotic, B.ParkerR. Rajapakshe



BACKGROUND: Increased usage of Internet applications has allowed for the collection of patient reported outcomes (PROs) and other health data through Web-based communication and questionnaires. While these Web platforms allow for increased speed and scope of communication delivery, there are certain limitations associated with this technology, as survey mode preferences vary across demographic groups.

OBJECTIVE: To investigate the impact of demographic factors and participant preferences on the use of a Web-based questionnaire in comparison with more traditional methods (mail and phone) for women participating in screening mammography in British Columbia, Canada.

METHODS: A sample of women attending the Screening Mammography Program of British Columbia (SMPBC) participated in a breast cancer risk assessment project. The study questionnaire was administered through one of three modes (ie, telephone, mail, or website platform). Survey mode preferences and actual methods of response were analyzed for participants recruited from Victoria General Hospital. Both univariate and multivariate analyses were used to investigate the association of demographic factors (ie, age, education level, and ethnicity) with certain survey response types.

RESULTS: A total of 1192 women successfully completed the study questionnaire at Victoria General Hospital. Mail was stated as the most preferred survey mode (509/1192, 42.70%), followed by website platform (422/1192, 35.40%), and telephone (147/1192, 12.33%). Over 80% (955/1192) of participants completed the questionnaire in the mode previously specified as their most preferred; mail was the most common method of response (688/1192, 57.72%). Mail was also the most preferred type of questionnaire response method when participants responded in a mode other than their original preference. The average age of participants who responded via the Web-based platform (age 52.9, 95% confidence interval [CI] 52.1-53.7) was significantly lower than those who used mail and telephone methods (age 55.9, 95% CI 55.2-56.5; P<.001); each decade of increased age was associated with a 0.97-fold decrease in the odds of using the website platform (P<.001). Web-based participation was more likely for those who completed higher levels of education; each interval increase leading to a 1.83 increase in the odds of website platform usage (P<.001). Ethnicity was not shown to play a role in participant preference for the website platform (P=.96).

CONCLUSIONS: It is beneficial to consider participant survey mode preference when planning to collect PROs and other patient health data. Younger participants and those of higher education level were more likely to use the website platform questionnaire; Web-based participation failed to vary across ethnic group. Because mail questionnaires were still the most preferred survey mode, it will be important to employ strategies, such as user-friendly design and Web-based support, to ensure that the patient feedback being collected is representative of the population being served.


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S. Smithbower, R. Rajapakshe, J. Sam, N. Aldoff, and T. Wight



Quality control is a key factor in ensuring a high standard of care in the field of mammography. We have found that abrupt irregularities in image quality from mammography units can arise as the result of factors ranging from vendor software upgrades, having software parameters modified during unit maintenance, or even having detectors replaced. We have developed both a simple weekly quality control test performed on processed images that can quickly capture these changes in image quality, as well as a centralized software platform that automates our test across several mammography centers. Technologists acquire a phantom exposure and upload it to our regional PACS network. The images are then automatically downloaded, analysed, and the results stored by the mammoQC software. These results are instantly available to technologists via a web dashboard, where reports can be generated automatically. Our platform currently services over 25 locations in British Columbia.


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B. Parker, R. Rajapakshe, A. Yip, T. Wight, N. Aldoff, J. Sam and C. Wilson


Background: The Screening Mammography Program of British Columbia (SMPBC), Canada is a population based program that regularly performs quality assurance testing and outcomes analysis.

Methods: A study was conducted to analyze the trends in the SMPBC quality assurance data from 1994 onwards to investigate any correlation between improvements in image quality (IQ), changes in radiation dose delivered per screen and detection of breast cancers.

Results: Both IQ and cancer detection rates of invasive tumours ≤5 mm increased over 1994-2011 which came at the cost of a 127% increase in radiation dose delivered to the breast between 1994-2005 (IQ increased 21%, tumours ≤5 mm increased 107%). In subsequent years, as digital units started to replace film units the programs’ average IQ and CDRs remained unchanged, while the integration of digital units reduced the dose delivered at a populational level.

Conclusion: Improvements in IQ coincided with increased detection of small tumours.


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Tanja Hoegg, S. Esterby, P. Gill, Cynthia Araujo, and Rasika Rajapakshe

Submitted for publication in Statistics in Medicine (October 2013)

B. Parker and C. Weisstock.



A cancer diagnosis substantially impacts patients and their families, often disrupting life and work routines and intensifying psychological distress. It is becoming increasingly recognized that support, empowerment and communication are critical components of patient-centred care and are particularly important within the field of oncology. Health care providers and researchers at the BC Cancer Agency seek to address both the physical and psychological aspects of the disease through the use of technology. This commentary summarizes the emerging clinical innovations of TeleOncology, brachytherapy, and Internet-based follow up, designed to support cancer patients in British Columbia.

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C. Vandenberg, R. Rajapakshe, C. Araujo, T. Wight, J. Sam, N. Aldoff and C. Wilson

Submitted for publication in Radiation Protection Dosimetry (August 2013) 

C. WeisstockR. RajapaksheC. BitgoodS. McAvoy, P. Gordon, A. Coldman, B. Parker, and C. Wilson



Breast cancer risk estimations are both informative and useful at the population level, with many screening programs relying on these assessments to allocate resources such as breast MRI. This cross-sectional multicenter study attempts to quantify the breast cancer risk distribution for women between the ages of 40-79 undergoing screening mammography in British Columbia (BC), Canada. The proportion of women at high breast cancer risk was estimated by surveying women enrolled in the Screening Mammography Program of British Columbia (SMPBC) for known breast cancer risk factors. Each respondent's 10-year risk was computed with both the Tyrer-Cuzick and Gail risk assessment models. The resulting risk distributions were evaluated using guidelines from the National Institute for Health and Clinical Excellence. Of the 4,266 women surveyed, 3.5% of women between the ages of 40-79 were found to have a high 10-year risk of developing breast cancer using the Tyrer-Cuzick model (1.1% using the Gail model). When extrapolated to the screening population, it was estimated that 19,414 women in the SMPBC are considered to be at high breast cancer risk. These women may benefit from additional MRI screening; preliminary analysis suggests that 4-5 additional MRI machines would be required to screen these high-risk women. However, the use of different models and guidelines will modify the number of women qualifying for additional screening interventions, thus impacting the MRI resources required. The results of this project can now be used to inform decision making regarding resource allocation for breast cancer screening in British Columbia.


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