Rapid Access Palliative Radiation Therapy Programs: An Efficient Model of Care

Dennis, Kristopher; Linden, Kelly; Balboni, Tracy A.; Chow, Edward

doi:10.2217/fon.15.153

Cited by 25 publications

(16 citation statements)

References 41 publications

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“…In Start date of palliative radiotherapy addition, although the median of 6 days from the decision to treat date to the start of palliative radiotherapy for our study patients is comparable with the median of 7 days (range 0e123) for all patients with cancer from our province treated with palliative radiotherapy at TOH from 2016 to 2018, the time from biopsy to the start of radiotherapy in our study was about 20 days, with international guidelines again recommending 14 days from diagnosis to treatment for lung cancer patients [14]. Rapid access palliative radiotherapy programmes have been shown to improve access to care, while delivering more timely and efficient treatment in several settings worldwide [17]. Exploring the development of a similar model for the Inuit population from Nunavut may help to streamline their clinical pathway even further.…”

Section: Discussionmentioning

confidence: 65%

Time to Diagnosis and Treatment with Palliative Radiotherapy among Inuit Patients with Cancer from the Arctic Territory of Nunavut, Canada

et al. 2020

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Aims: The cancer burden among Circumpolar Inuit is high. Palliative radiotherapy is a mainstay treatment for controlling symptoms of advanced cancers, but Inuit are required to travel far distances to access this service. Access to palliative radiotherapy and time away from home communities have not been explored among this population. We sought to describe the time intervals from symptom onset to the start of palliative radiotherapy among Canadian Inuit patients treated at The Ottawa Hospital (TOH). Materials and methods: A retrospective review of Inuit patients from Nunavut treated with radiotherapy between 2005 and 2014 at TOH. Results: Of a total of 152 radiotherapy patients, 88 (58%) were treated palliatively. Of these, 61 (70%) had stage IV disease at diagnosis and 63 (72%) had lung cancer. The median time from referral for specialist care to the patient's first flight to Ottawa was 4 days (range 0e97). The median length of treatment was 7 days (range 0e27), but patients spent a median of 64.5 days (range 14e633) in Ottawa. The median survival from the date of pathological diagnosis was 5.2 months. Conclusions: Most Inuit radiotherapy patients at TOH were treated palliatively. Patients were brought from Nunavut relatively quickly for specialist care, which is encouraging. However, patients spent over 2 months away from home, in the context of a median survival of less than 6 months. Opportunities for improvement include both provider and system-level changes, which may be applicable to other Circumpolar Inuit regions across Europe and North America.

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Section: Discussionmentioning

confidence: 65%

Time to Diagnosis and Treatment with Palliative Radiotherapy among Inuit Patients with Cancer from the Arctic Territory of Nunavut, Canada

et al. 2020

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“…Consequently, patients’ access to quality care and an improved quality of life is made possible. [ 3 19 ] The other advantage provided using TomoTherapy MV CT in conjunction with a TomoTherapy linear accelerator for palliative treatment is that as in this procedure; the patient is both scanned and treated on the same TomoTherapy couch, the accuracy in reproducing the patient's position from scanning to treatment delivery can be greatly improved.…”

Section: Discussionsmentioning

confidence: 99%

“…In contrast, the conventional planning workflow usually requires at least 1-day turnaround. As studies have shown that dedicated rapid access palliative radiation therapy improves patients’ access to care,[ 3 ] the quick access to radiation therapy, and the rapid workflow will potentially improve these patients’ quality of life significantly; Better reproducibility in patient positioning from simulation to treatment, as the patient is simulated and treated on the same unit. The turnaround time from simulation to treatment is also greatly reduced; and For less-mobile palliative patients, it is possible to allow the patient to stay on the TomoTherapy couch from simulation until treatment, which minimizes the chance of doing damage to the patients and reduces reduced potential aggravating morbidity pain during bed transfer.…”

Section: Onclusionmentioning

confidence: 99%

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A feasibility study on the use of tomotherapy megavoltage computed tomography images for palliative patient treatment planning

Byrne²,

Archibald-Heeren³

et al. 2017

J Med Phys

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Dedicated rapid access palliative radiation therapy improves patients’ access to care, allowing more timely treatment which would positively impact on quality of life. The TomoTherapy (Accuray, Sunnyvale, CA) system provides megavoltage (MV) fan-beam computed tomography (FBCT) as the image guidance technique, and a module called “statRT” that allows the use of these MV FBCT images for direct planning. The possibility of using this imaging modality for palliative radiotherapy treatment planning is assessed against accepted planning CT standards by performing tests following AAPM TG 66 and an end-to-end measurement. Results have shown that MV FBCT images acquired by TomoTherapy are of sufficient quality for the purpose of target delineation and dose calculation for palliative treatments. Large image noise and extended scan acquisition time are the two main drawbacks, so this imaging modality should only be used for palliative treatments at areas with well-known, easily distinguishable, and relatively immobile targets such as spine and whole brain.

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“…For example, dedicated PRT programs, such as the Rapid Response Radiotherapy Program in Toronto and the Supportive and Palliative Radiation Oncology service in Boston, have demonstrated improved quality of care for patients being urgently evaluated for PRT. 19 Following management of pain and neurologic symptoms, clinicians were faced with managing fatigue in nearly half of the patients (49%). e prevalence of fatigue among cancer patients and its impact on quality of life 20 highlight the need for this key symptom to be addressed throughout the continuum of cancer care.…”

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confidence: 99%

Characteristics of urgent palliative cancer care consultations encountered by radiation oncologists.

Fareed

Krishnan²,

Spektor

et al. 2017

JCO

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135 Background: Palliative radiation therapy(PRT)is often employed in patients with advanced cancers requiring urgent consultation given the rapidity of presentation.We report on characteristics of urgent palliative oncologic issues encountered by radiation oncologists(RO). Methods: We prospectively evaluated patterns of presentation in162 consecutive consultations for urgent PRT at 3 centers from 5/19/14 to 9/26/14.Survey of palliative care issues was completed by physicians/nurse practitioners including assessment of reasons for urgent radiation oncology consultation,disease presentation characteristics and site of RT delivery.Response rate was 86% with 140 of 162 responses received. Results: Median age of patients was 63 years(29-89)with 39% > 65, 41% from 50-65 and 20% < 50 years;56% were males and 44% females. Most were married(62%)and 30% non-Caucasians.48% had ECOG PS 0-1,whereas it was 2, 3 and 4 in 24%,9% and 3%.Primary cancer diagnoses were lung (28%),breast(13%),prostate(10%),melanoma(10%),sarcoma(7%) and other diagnoses in 32%.Pain was predominant reason for consult(57%)followed by brain metastases(29%),spinal cord/cauda compression (13%),dyspnea (10%),bleeding (8%),bone fracture(4%)and dysphagia(2%).Clinicians managed pain (69%),neurologic symptoms(51%),fatigue (49%),intestinal(21%),respiratory (19%) symptoms,bleeding (14%),insomnia (13%),nausea/vomiting(12%)and dysphagia(6%).Patients presented at all stages 79% at the time of their diagnosis of metastatic cancer,63% with an established ( > 1 month) metastatic cancer diagnosis and continuing to further cancer therapies and 17% proceeding to hospice care without further anti-cancer therapy after PRT. Conclusions: Radiation oncologists care for patients across time course of metastatic cancer diagnosis managing variety of urgent oncologic issues,most commonly metastases causing pain followed by brain metastases and cord compression.They also manage cancer-related symptoms,mostly pain,neurological symptoms and fatigue.These findings point to need for palliative care to be well integrated into radiation oncology practice including education and systems of care.

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Rapid Access Palliative Radiation Therapy Programs: An Efficient Model of Care

Cited by 25 publications

References 41 publications

Time to Diagnosis and Treatment with Palliative Radiotherapy among Inuit Patients with Cancer from the Arctic Territory of Nunavut, Canada

Time to Diagnosis and Treatment with Palliative Radiotherapy among Inuit Patients with Cancer from the Arctic Territory of Nunavut, Canada

A feasibility study on the use of tomotherapy megavoltage computed tomography images for palliative patient treatment planning

Characteristics of urgent palliative cancer care consultations encountered by radiation oncologists.

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