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IntroductionPalliative patients with metastatic bone pain endure long waiting times and multiple visits to radiation therapy departments for treatment. This can prolong suffering and may be a factor in patients consenting for treatment. Rapid Access Palliative Clinics (RAPC) have been established around the world to provide a multidisciplinary approach to consultation, simulation and treatment on the same day. This paper describes the implementation and evaluation of a RAPC at Waikato Regional Cancer Centre (WRCC) by reducing the time from referral to first specialist appointment (FSA).MethodsThe structure and process for the RAPC day was outlined and the roles of staff were defined. A retrospective study was undertaken of the 261 consecutive patients seen in the RAPC from April 2009 to April 2013. Tracking sheets were created to record patient information at the initial consultation. Follow-up telephone calls were used to assess the patient post-treatment. Patient information was entered into a database.ResultsA total of 226 patients received radiation therapy treatment to 307 sites. All patients were seen within 1 week of referral. Sixty-three per cent of patients were simulated and treated on the same day. The change in radiation therapy fractionation prescriptions was statistically significant (P = 0.0012). There was a statistically significant difference between initial and follow-up pain scores (P < 0.0001).ConclusionEvaluation of the clinic has shown that it compares favourably with similar international clinics. The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions. This has resulted in rapid reduction in pain for the majority of patients.

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BackgroundIndigenous and/or minority ethnic women are known to experience longer delays for treatment of breast cancer, which has been shown to contribute to ethnic inequities in breast cancer mortality. We examined factors associated with delay in adjuvant chemotherapy and radiotherapy for breast cancer, and its impact on the mortality inequity between Indigenous Māori and European women in New Zealand.MethodsAll women with newly diagnosed invasive non-metastatic breast cancer diagnosed during 1999–2012, who underwent adjuvant chemotherapy (n = 922) or radiation therapy (n = 996) as first adjuvant therapy after surgery were identified from the Waikato breast cancer register. Factors associated with delay in adjuvant chemotherapy (60-day threshold) and radiation therapy (90-day threshold) were analysed in univariate and multivariate models. Association between delay in adjuvant therapy and breast cancer mortality were explored in Cox regression models.ResultsOverall, 32.4% and 32.3% women experienced delays longer than thresholds for chemotherapy and radiotherapy, respectively. Higher proportions of Māori compared with NZ European women experienced delays longer than thresholds for adjuvant radiation therapy (39.8% vs. 30.6%, p = 0.045) and chemotherapy (37.3% vs. 30.5%, p = 0.103). Rural compared with urban residency, requiring a surgical re-excision and treatment in public compared with private hospitals were associated with significantly longer delays (p < 0.05) for adjuvant therapy in the multivariate model. Breast cancer mortality was significantly higher for women with a delay in initiating first adjuvant therapy (hazard ratio [HR] =1.45, 95% confidence interval [CI] 1.05-2.01). Mortality risks were higher for women with delays in chemotherapy (HR = 1.34, 95% CI 0.89-2.01) or radiation therapy (HR = 1.28, 95% CI 0.68-2.40), although these were statistically non-significant.ConclusionsIndigenous Māori women appeared to experience longer delays for adjuvant breast cancer treatment, which may be contributing towards higher breast cancer mortality in Māori compared with NZ European women. Measures to reduce delay in adjuvant therapy may reduce ethnic inequities and improve breast cancer outcomes for all women with breast cancer in New Zealand.

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