Advanced Practice Providers in Radiation Oncology

Martin, Kate; Krechmer, Betty; Boyajian, Richard; Reynolds, Mary Carr; Cagney, Daniel; Martin, Neil E.

doi:10.1016/j.prro.2019.10.001

Cited by 8 publications

(12 citation statements)

References 12 publications

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“…Brain Metastasis-Promoting Breast Cancer EVs Breach the BBB in Vivo. Given that there is a high incidence of brain metastasis in triple negative breast cancer, 17 we first confirmed the pattern of metastasis of parental and a brainseeking variant of the triple negative MDA-MB-231 breast cancer cell line and found the pattern to be consistent with previous reports 18 (Supplementary Figure S1a). We then isolated a population of EVs, defined as small EVs (size <200 nm) or exosomes, from the parental and brain-seeking cells (P-EVs and Br-EVs, respectively), using the sequential centrifugation technique.…”

Section: Resultssupporting

confidence: 86%

“…16 The prognosis of breast cancer patients with brain metastasis is extremely poor, with a reported median survival of only 10 months. 17 An urgent need exists, therefore, to develop effective therapeutics for breast to brain metastasis informed by an understanding of the early mechanisms involved in brain metastasis. Here, we demonstrate that breast cancer-derived EVs can breach an intact blood-brain barrier, and we identify the mechanism driving this process.…”

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confidence: 99%

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Tumor-Derived Extracellular Vesicles Breach the Intact Blood–Brain Barrier via Transcytosis

Carman²,

et al. 2019

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Author Contributions G.M. designed and performed the experiments, analyzed and interpreted the data, and wrote the manuscript. M.A.M. designed and supervised the research, analyzed and interpreted the data, and wrote the manuscript. C.V.C. co-designed and assisted with high spatiotemporal resolution microscopy experiments. E.J.H. and J.R.P. co-designed and assisted with zebrafish experiments. N.M. and T.P. co-designed and performed the BBB-on-a-chip experiments. C.C.D. assisted with some of the experiments. L.I.Z. and D.E.I. provided zebrafish and BBB-on-a-chip models, respectively.

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Section: Resultssupporting

confidence: 86%

mentioning

confidence: 99%

Tumor-Derived Extracellular Vesicles Breach the Intact Blood–Brain Barrier via Transcytosis

Carman²,

et al. 2019

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“…Although there is an attending physician-of-the-day assigned to oversee simulation and treatment planning and also to help guide treatment decision-making, our NP is able to practice independently at a sufficiently high level and has professional development and research opportunities, which have been shown to be critical for retention. 19,20 To ensure that the workflow improvements with our NP did not come at a cost to resident education, residents on service with the physicianof-the-day would review the case with both the attending physician and our NP and take ownership of contouring, treatment planning, and interfacing with the inpatient team as they would for any other patient on their service. As residents may cover multiple clinical sites and have additional educational obligations, an additional benefit was that our NP was in-house and available to provide continuity of care and address any urgent issues that might arise.…”

Section: Discussionmentioning

confidence: 99%

“…Indirect patient care has been estimated to occupy approximately 50% of APP time in radiation oncology, 20,27 which may in turn allow physicians to focus on more complex tasks or see an increased volume of patients, 19 thereby potentially improving the financial health of the department and institution. 20 Although not specific to APPs, there are data to suggest that dedicated palliative RT consult services also may be associated with shorter treatment courses, decreased lengths of stay, and cost savings on the order of almost $21,000 per patient. 28 Importantly, almost all patients seen in collaborativepractice models are aware when their care is provided by a nonphysician provider, and based on surveys, they are extremely satisfied with their care, suggesting this is an acceptable model from a patient perspective.…”

Section: Discussionmentioning

confidence: 99%

“…One such position, an inpatient RT nurse practitioner (NP), has been described at the University of Pennsylvania. 19 In addition to roles that have been described for radiation oncology APPs who treat other disease sites, 20 an NP for inpatient palliative RT also has unique responsibilities surrounding transitions in care, 19 with the goal of minimizing treatment breaks. Inpatient palliative RT presents unique needs in an otherwise outpatient specialty; however, to our knowledge, the effect of dedicated APPs on delivery of palliative RT has not been previously described.…”

Section: Introductionmentioning

confidence: 99%

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Timing of Urgent Inpatient Palliative Radiation Therapy

Yee

Chan

et al. 2021

Advances in Radiation Oncology

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Purpose Urgent indications for palliative radiation therapy (RT) include malignant spinal cord compression, symptomatic brain metastases, pain, airway obstruction, and bleeding. Data on the timing of palliative RT in the inpatient setting are limited. We report our experience with inpatient palliative RT at a tertiary academic center and evaluate the effect of a dedicated inpatient palliative RT nurse practitioner (NP) on treatment timelines. Methods and Materials We performed a retrospective, single-institution review of 219 inpatients consulted for RT to sites of metastatic disease between May 2012 and May 2018. We compared time-to-treatment intervals before and after integrating an NP for palliative RT in August 2017. Results The median age of the 219 patients receiving RT was 61 years (interquartile range [IQR], 51-69 years). The most frequent indications were symptomatic brain metastases (73 patients [33%]), pain (61 patients [28%]), and cord/cauda compression (48 patients [22%]). The median time from consultation request to consult was 1 day (IQR, 0-2 days), and the median time from consultation request to first RT fraction was 3 days (IQR, 2-6 days). The median time from consultation request to RT was shorter for cord compression (2 [IQR, 1-4] days) than for pain (5 [IQR, 2-7] days) ( P = .001) or symptomatic brain metastases (3 [IQR, 1-6] days; P = .037). With an NP, patients were more likely to undergo same-day consultation and simulation (75% vs 60%; P = .045), which was associated with shorter median duration from consultation to initiation of RT (1 [IQR, 0-3] days vs 4 [IQR, 2-7] days; P <.001). After the integration of an NP for palliative RT, patients had a higher median Karnofsky Performance Score (70 [IQR, 60-80] vs 50 [IQR, 40-60]; P < .001) and were more likely to complete their prescribed RT course (93% vs 82%; P = .05) Conclusions Time from consultation request to RT is necessarily short for urgent inpatient palliative RT. Advanced practice providers may facilitate and potentially expedite treatment, with significantly shorter times to treatment among patients who undergo same-day consultation and simulation.

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Exploring opportunities & pathways for advanced practice radiation therapy roles in the United States

Skubish

Starrs

McDonagh

2021

Technical Innovations & Patient Support in Radiation Oncolo

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The evolution of practice of Radiation Therapy in the United States (U.S.) is inevitable. The scope of a radiation therapists role has progressed with advancing technology, implementation of special procedures and patient care requirements. Internationally, Canada, Australia and the United Kingdom have formalized this evolution through the Advanced Practice Radiation Therapist (APRT) role to provide new models of care, to meet growing demands in the practice of Radiation Oncology, to increase efficiency, decrease cost and retain skilled staff (Harnett et al., 2018;Society of Radiographers;Linden et al., 2019; Coleman et al., 2014) [1-4]. Through evidence based practice, the APRT role has proven to provide benefits for multiple stakeholders including service-reconfiguration to reduce wait times, developing and retaining highly skilled radiation therapists, treatment review and most importantly improving patient care within much needed patient cohorts such as the palliative population (Duffton et al., 2019) [5]. The U.S. is no exception to requiring innovative care models and solutions to similar complex, care delivery challenges experienced internationally. The U.S. is experiencing an increase in demand for cancer services and a rapid rate of technological and treatment advancements. Under the current infrastructure, this has impacted the daily tasks of physicians; increasing workload, increasing the complexity of clinical decision making, increasing movement toward site specific subspecialty practice and pushing the scope of radiation therapists informally toward maximization, increased autonomy and a higher level of education and specialized skills (American Society of Clinical Oncology, 2016; ARRT, 2020; Vu et al., 2018) [6-8].ObjectiveThe following reviews the current radiation therapy practice and professional landscape in the United States as it relates to advanced practice, exploring opportunities and challenges under the U.S. health care infrastructure. This broad analysis provides comparison to other countries and disciplines such as the Radiologist Assistant and Nurse Practitioner for potential pathways to establishing the role and describes current needs and value of the expanding scope of RT's practicing in the U.S.

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Advanced Practice Providers in Radiation Oncology

Cited by 8 publications

References 12 publications

Tumor-Derived Extracellular Vesicles Breach the Intact Blood–Brain Barrier via Transcytosis

Tumor-Derived Extracellular Vesicles Breach the Intact Blood–Brain Barrier via Transcytosis

Timing of Urgent Inpatient Palliative Radiation Therapy

Exploring opportunities & pathways for advanced practice radiation therapy roles in the United States

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