Abstract:The VARA clinic has improved wait times for palliative RT, increased patient access to supportive services, and improved the workload for lung radiation oncologists. This clinic could serve as a model for other patients with incurable cancer.
“…In some cases delays in receiving treatment can impact survival and increase unnecessary anxiety in patients . In response to this problem dedicated multidisciplinary rapid response clinics have been developed around the world to provide patients with a streamline service which involves faster referral to treatment times and fewer hospital visits . Often these clinics are restricted to patients with metastatic disease in one organ, that is, palliative bone, lung or brain .…”
Introduction
The purpose of the study was to evaluate the palliative advanced practice radiation therapy (APRT) role with respect to the impact on waiting times for patients from referral to radiation treatment delivery, the ability of the APRT to define palliative radiation therapy fields and patient satisfaction. The evaluation of the impact of the APRT role and referral pathway on patient waiting times has been previously published.
Methods
Patients were allocated to two different pathways; APRT and standard. Patients in the APRT pathway had their radiotherapy treatment managed by the APRT including defining their palliative fields blinded to the radiation oncologist (RO).
Results
Of the 150 palliative patients, 94 had their radiation therapy managed by the APRT and 56 were managed through the standard pathway. 82/92 APRT defined fields were accepted by the RO.
Conclusions
Inter‐observer variability between the APRT and the RO in defining palliative radiation therapy fields is similar to that reported in the literature between clinicians. With previously published reduced wait times from referral to treatment for palliative patients, the establishment of the APRT role is justified.
“…In some cases delays in receiving treatment can impact survival and increase unnecessary anxiety in patients . In response to this problem dedicated multidisciplinary rapid response clinics have been developed around the world to provide patients with a streamline service which involves faster referral to treatment times and fewer hospital visits . Often these clinics are restricted to patients with metastatic disease in one organ, that is, palliative bone, lung or brain .…”
Introduction
The purpose of the study was to evaluate the palliative advanced practice radiation therapy (APRT) role with respect to the impact on waiting times for patients from referral to radiation treatment delivery, the ability of the APRT to define palliative radiation therapy fields and patient satisfaction. The evaluation of the impact of the APRT role and referral pathway on patient waiting times has been previously published.
Methods
Patients were allocated to two different pathways; APRT and standard. Patients in the APRT pathway had their radiotherapy treatment managed by the APRT including defining their palliative fields blinded to the radiation oncologist (RO).
Results
Of the 150 palliative patients, 94 had their radiation therapy managed by the APRT and 56 were managed through the standard pathway. 82/92 APRT defined fields were accepted by the RO.
Conclusions
Inter‐observer variability between the APRT and the RO in defining palliative radiation therapy fields is similar to that reported in the literature between clinicians. With previously published reduced wait times from referral to treatment for palliative patients, the establishment of the APRT role is justified.
“…Edmonton, Canada 2009 [22] Waikato Regional Cancer Center Hamilton, New Zealand 2009 [23] Vancouver Rapid Access clinic Vancouver, Canada 2011 [24] Tom Baker Cancer Center; brain metastases clinic Calgary, Canada 2011 [25] Supportive and Palliative Radiation Oncology service Boston, MA, USA 2011 [26] Clinic Offering Affordable Radiotherapy Richmond, VA, USA 2012 [27] RT for bone metastases at the same center but outside the RRPRC, the corresponding figure was 58%. The Rapid Access Palliative Radiotherapy Program (RAPRP) bone metastases clinic was established in 2007 in Edmonton, Canada at the Cross Cancer Institute [21].…”
“…The Vancouver Rapid Access (VARA) clinic was established in 2011 in Vancouver, Canada at the British Columbia Cancer Agency, Vancouver center [24]. Only patients with newly diagnosed incurable lung cancer are eligible for referral.…”
Palliating symptoms of advanced and metastatic cancers are one of the most common indications for radiation therapy (RT), and the demand for palliative RT is increasing. Dedicated rapid access palliative RT programs improve access to care, and can deliver RT in a more efficient and evidence-based manner than standard RT programs. In this narrative review, we discuss the role of palliative RT in comprehensive cancer care, and challenges that have faced patients trying to access it. We describe how rapid access programs developed to address these challenges and provide an overview of dedicated programs worldwide. Finally, we show how these programs can serve as models for multidisciplinary care and education, and sources of exciting research opportunities in clinical care and advanced technologies.
“…However, even a cost-effectiveness study would not be able to capture all the indirect costs and benefits of a rdu. For instance, decreasing patient wait time to diagnosis leads to less patient anxiety and increased patient access to support services, both of which are challenging to quantify economically 6,10,25 . Thus, to truly determine whether incremental costs lead to improved patient-centred outcomes or even possibly long-term savings, a cost-effectiveness analysis examining implementation of a rdu, if desired, has to be assessed from the societal perspective.…”
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