A Rapid Access Palliative Clinic to reduce waiting time for palliative radiotherapy in a Regional Cancer Centre in Ireland

Abstract

[CUH] a Regional Cancer Centre in Ireland. Its purpose is to streamline the pathway and facilitate prompt review and timely delivery of palliative radiotherapy [PRT] for symptom relief of patients with terminal cancer. This study reviews the clinical activity of the RAPC over the initial 3 months and compares it to a second 3 months to evaluate if we are meeting the objectives of the program. Materials/Methods: From the CUH oncology patient information system (Lantis) database, we retrieved the number of patients referred to the RAPC, their demographics, diagnosis and treatment for 1st September to 30th November, 2014 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of patients who started PRT on the day of their initial RAPC consultation. We calculated the 30day mortality of the clinic. We also compared the data from the initial 3 months against a 3 month period from 1st May to 31st July, 2016 inclusive, when there was no clinic due to staffing shortages. Results: During the initial 3 month period, the number of cases seen in consultation was 129. Patient's ages ranged from 28.4 to 96 years with a mean age of 69.1 years. Most common primary tumour sites were Genitourinary and Lung accounting for 25% and 21% of the patient population respectively. Most common indication for PRT was bone pain accounting for 69% of patients seen in the clinic. The 30-day mortality rate was 13.95%. Of the 122 patients who received PRT, 57 patients (46.7%) received single fraction PRT whilst 65 patients (53.2%) received fractionated PRT. 98% were seen within 2 weeks of referral (87% within 1 week). The median time from consultation to simulation was 0.9 days vs 2.7 days with no RAPC. 74% were simulated on the day of their initial consultation vs 31.4% with no RAPC. 35% started their PRT treatment on the day of their consultation visit vs 23% with no RAPC. Conclusion: The overall median interval from referral to consultation was 4 days. Thirty-five percent were simulated, planned and started treatment on the day of their initial consultation. The 30-day mortality rate suggests appropriate patient selection. The comparison between the initial 3 months of the RAPC vs the 3 months with no RAPC showed the median time from consultation to simulation tripled and only twenty-three percent received same day 2 Morris; A Rapid Access Palliative Clinic to reduce waiting time for palliative radiotherapy in a Regional Cancer Centre in Ireland treatment. Setting up a dedicated clinic decreased waiting times, reduced the number of visits to the Regional Cancer Centre and provided prompt PRT to symptomatic patients in the terminal phase of their illness. The RAPC is therefore meeting our objectives.

Does a radiographer-led palliative radiotherapy pathway provide an efficient service for patients with symptoms of advanced cancer? The Northampton experience

“…The median time from referral to consultation was 4 days, with 35% of patients commencing treatment on the day of consultation. 29 This study group had a similar age range to the NGH study, but the distribution of single-fraction to multiple-fraction prescriptions varied, with 46•7% in our analysis receiving single fraction versus 65•6% in the NGH study. This variation could be explained by the rapid-access clinic being a general palliative service rather than bone pain-specific.…”

Rapid Access Palliative Radiotherapy Programmes

“…In the years after its introduction, the service saw between 15 and 16 consults weekly, about 60% of them within an inpatient setting. The RAPC opened in 2014 in Cork University Hospital, Cork, Ireland [35]. In its first 3 months of operation, the RAPC assessed 129 patients.…”