The concept of the Advanced Practice Radiation Therapist (APRT) was created in 2004, in response to pressures on the radiation treatment sector in Ontario. This led to development, piloting and integration of the Clinical Specialist Radiation Therapist (CSRT) into Ontario's cancer care framework. A national certification process, competency profile and protected title of APRT(T) were established in 2017, under the Canadian Association of Medical Radiation Technologists (CAMRT), in collaboration with Cancer Care Ontario/Ontario Health. This report describes the approach to development, validation and measuring impact of the CSRT role in Ontario, specifically in palliative care (pCSRT). It also presents information to assist jurisdictions interested in developing a pCSRT position, describing competency development, assessment, and assumption of practice, and providing some keys to success. This is foundational for consistent expansion of the pCSRT role to other regions to continue to increase system capacity while improving the quality of cancer care.

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Background: Cancer Care Ontario has mandated that all health care professionals working within oncology centres in Ontario should routinely screen and address symptoms of anxiety and depression in cancer patients. This study aims to assess the informational needs of Radiation Therapists (RTs) concerning the discussion and management of anxiety and depression symptoms in patients receiving radiation therapy treatment. It will also attempt to determine whether RTs believe that reviewing patients' self-reported symptoms should be included as part of their routine patient assessment. Methodology:A questionnaire was initially piloted at the host institution to six randomly chosen RTs and then sent via email to all Radiation Therapists practicing in Ontario, Canada (n= 921). The online questionnaire consisted of multiple choice questions and was divided into four themes: 1) RT comfort levels surrounding the topics of anxiety and depression, 2) management of anxiety and depression in cancer patients, 3) further education needed/requested in anxiety and depression symptom management and 4) the Edmonton Symptom Assessment System (ESAS). Data analyses included the calculation of means and two sample two-sided t-tests to examine the relationships between various demographics and responses.Results: RTs feel more comfortable in the discussion of issues surrounding anxiety when compared to depression. The most common positive factor affecting RTs' comfort levels addressing emotional distress is previous experience with patients who have expressed these symptoms; whereas the most common adverse factor affecting comfort levels is the lack of education regarding emotional distress. Eighty-seven percent (87%) of RTs would