Supportive Care in Cancer

, Volume 14, Issue 1, pp 38–43 | Cite as

An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy

  • C. Danjoux
  • E. Chow
  • A. Drossos
  • L. Holden
  • C. Hayter
  • M. Tsao
  • T. Barnes
  • E. Sinclair
  • M. Farhadian
Original Article

Abstract

Background

Waiting for radiation therapy (RT) in Ontario has been a major problem for the past decade. In 1996, the Toronto–Sunnybrook Regional Cancer Centre (TSRCC) initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of patients with terminal cancer.

Purpose

This study reviews the clinical activity of the RRRP over the past 8 years to evaluate if we are meeting the objectives of the program.

Materials and methods

From the TSRCC oncology patient information system (OPIS) database, we retrieved the number of patients referred to the RRRP, their demographics, diagnosis and treatment for the calendar years 1996 to 2003 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of cases who started RT on their initial consultation for all new cases referred to the RRRP.

Results

From 1996 to 2003, the number of cases seen in consultation increased from just over 200 cases annually in the first 2 years to about 500 cases per year in the last 4 years, for a total of 3,290. There were 1,792 (54%) men and 1,498 (46%) women; median age was 69 years (range, 21–95 years). Breast, lung, genitourinary and gastrointestinal primaries accounted for over 80% of all referrals. The majority was referred for palliative treatment of symptomatic bone (70%) or brain (14%) metastases. The dose fractionation for bone metastases was a single 8-Gy fraction in 45%, 20 Gy in five fractions in 42%, 30 Gy in ten fractions in 4% and other dose fractionations in 9%. Nearly 90% were seen within 2 weeks of referral (38% within 1 week). Eighty-five percent were simulated on the day of their initial consultation. Sixty percent started their RT treatment on the day of their consultation visit. The overall median interval from referral to treatment was 8 days.

Conclusion

Over the past 8 years, the annual number of new cases referred to the RRRP has doubled. The overall median interval from referral to consultation was 8 days. Sixty percent were simulated, planned and started treatment on the day of their initial consultation. We therefore are meeting our goal of providing rapid access to palliative RT for symptomatic cancer patients.

Keywords

Palliative Radiotherapy Waiting time Innovative 

Notes

Acknowledgements

Dr. G. Thomas initiated the RRRP at TSRCC in 1996. Dr. D. Hoegler, Lou Andersson (nurse) and Christie Stevenson (radiation therapist) implemented the program. We thank the many radiation oncologists (Drs. A. Loblaw, E. Szumacher, G. Ege, R. Wong and J. Kamra), nurses (J. Pope, G. Chan) and therapist (R. Connolly) who were involved with the RRRP over the past 8 years, and Melissa Frost for secretarial help.

References

  1. 1.
    Ash DV (2000) Waiting times for cancer treatment. Clin Oncol 12:140Google Scholar
  2. 2.
    Canadian Association of Radiation Oncology (2000) Definition of RT waiting. http://www.caro-acro.ca/caro/abt/committees/manp/definition.pdf. September 2000
  3. 3.
    Chow E, Wong R, Connolly R, Hruby G, Franssen E, Fung K, Vachon M, Andersson L, Pope J, Holden L, Szumacher E, Schueller T, Stefaniuk K, Finkelstein J, Hayter C, Danjoux C (2001) Prospective assessment of symptom palliation for patients attending a rapid response radiotherapy program: feasibility of telephone follow-up. J Pain Symptom Manage 22(2):649–656Google Scholar
  4. 4.
    Chow E, Fung KW, Panzarella T, Bezjak A, Danjoux C, Tannock I (2002) A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 53(5):1291–1302Google Scholar
  5. 5.
    Chow E, Wong R, Vachon M, Connolly R, Andersson L, Szumacher E, Franssen E, Danjoux C (2000) Referring physicians’ satisfaction with the Rapid Response Radiotherapy Programme. Survey results at the Toronto–Sunnybrook Regional Cancer Centre. Support Care Cancer 8(5):405–409Google Scholar
  6. 6.
    Danjoux C, Szumacher E, Andersson L, Franssen E, Wong R, Chow E, Connolly R, Pope J, Hayter CR, Finkelstein J, Axelrod T, Stephen D, Sixel K, Thomas G, Schuller T, Stefaniuk K (2000) Palliative radiotherapy at Toronto–Sunnybrook regional cancer centre: the rapid response radiotherapy program. Curr Oncol 7(1):52–56Google Scholar
  7. 7.
    Hoegler D (1997) Design and assessment of palliative radiotherapy service structure to patients and referring physician need. Clin Invest Med A 463(Suppl 20):S84Google Scholar
  8. 8.
    Hoegler D (1997) Radiotherapy for palliation of symptoms in incurable cancer [review]. Curr Probl Cancer J 21:129–183Google Scholar
  9. 9.
    Lehman M, Jacob S, Delaney G, Papadatos G, Jalaludin B, Cail S, McCourt J, Wright S, O’Brien C, Barton M (2004) Waiting times for radiotherapy—a survey of patients’ attitudes. Radiother Oncol 70:283–289Google Scholar
  10. 10.
    Librach SL (1996) The principles of palliative radiotherapy: palliative care physician’s perspective. Can J Oncol 6(Suppl 1):2–4Google Scholar
  11. 11.
    MacKillop WJ, Fu H, Quirt CF, Dixon, P, Brundage M, Yunzheng Z (1994) Waiting for radiotherapy in Ontario. Int J Radiat Oncol Biol Phys 30:221–228Google Scholar
  12. 12.
    Mackillop WJ, Groome PA, Zhang-Solomons J, Zhou Y, Feldman-Stewart D, Paszat L, Dixon P, Holowaty EJ, Cummings BJ (1997) Does a centralized radiotherapy system provide adequate access to care. J Clin Oncol 15(3):1261–1271Google Scholar
  13. 13.
    Mackillop WJ, O’Brien P, Brundage M, Whitton A, Gallinger D (2003) Radiotherapy: quality and access issues. In: T Sullivan, W Evans, H Angus, A Hudson (eds) Strengthening the quality of cancer services in Ontario. CHA, Ottawa, ONGoogle Scholar
  14. 14.
    Mackillop WJ, Zhou S, Groome P, Dixon P, Cummings BJ, Hayter C, Paszat L (1999) Changes in the use of radiotherapy in Ontario 1984–1995. Int J Radiat Oncol Biol Phys V 22(2):355–362Google Scholar
  15. 15.
    MacKillop WJ, Zhou Y, Quirt CF (1995) A comparison of delays in treatment of cancer with radiation in Canada and the United States. Int J Radiat Oncol Biol Phys 32:531–539Google Scholar
  16. 16.
    Schwartz F, Evans W, Sullivan T, Angus H (2004) Cancer quality council of Ontario report—gaining access to appropriate cancer services: a four point strategy to reduce waiting times in Ontario. http://www.cancercare.on.ca/. Cited 8 Jul
  17. 17.
    Woodward G, Stukel T, Schull M, Gungaj N, Laupacis A (2004) Utilization of Ontario’s health system during the 2003 SARS outbreak. Institute for Clinical Evaluative Sciences Report. MayGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • C. Danjoux
    • 1
    • 5
  • E. Chow
    • 1
  • A. Drossos
    • 2
  • L. Holden
    • 3
  • C. Hayter
    • 1
  • M. Tsao
    • 1
  • T. Barnes
    • 1
  • E. Sinclair
    • 3
  • M. Farhadian
    • 4
  1. 1.Department of Radiation OncologyUniversity of TorontoTorontoCanada
  2. 2.Analytic UnitCancer Care OntarioTorontoCanada
  3. 3.Department of Radiation OncologyToronto–Sunnybrook Regional Cancer CentreTorontoCanada
  4. 4.Department of NursingToronto–Sunnybrook Regional Cancer CentreTorontoCanada
  5. 5.Toronto–Sunnybrook Regional Cancer CentreTorontoCanada

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