3189 - In the Eye of the Beholder: Utilizing Lean Process Improvement of Uveal Melanoma Brachytherapy Service Line to Expand Rural Oncology Equity

Purpose/Objective(s): Uveal melanoma (UM) is categorized as a NIH rare cancer, with an estimated 3,500 yearly cases in the United States (1). At diagnosis, one third of patients present with an asymptomatic, morphologically evolving nevus (2). Plaque brachytherapy is an effective but complicated modality in the management of non-metastatic UM. Successful plaque brachytherapy requires collaboration of an ophthalmic oncologist, medical physicist, and ocular radiation oncologist.

Multi-disciplinary management of UM is complicated by social determinants of health in our tri-state region with under- or uninsured citizens, low health literacy, and transportation obstacles. We aim to improve the metrics of patient compliance, accurate information exchange for planning, and reduce overall treatment time to enhance rural oncology equity.

Materials/Methods: We performed a comprehensive procedural analysis under radiation oncology leadership to identify areas of improvement. We consolidated the complex workflows via a Kaizen approach to operationalize work-up efficiency and enhance compliance. Subsequently, we instituted 1) same day staging CT and MRI, 2) MRI orbital protocol with dedicated neuroradiologist interpretation, 3) newly designed and standardized schematic for ocular measurements, and 4) same day safety consult with radiation physicist.

Results: In patients for whom this revised lean workflow has been implemented, we have seen nearly 100% compliance from consult to brachytherapy execution. Time from initial consultation to plaque insertion is now often within 4 weeks.

Conclusion: A UM plaque program with this new lean approach allows teams to streamline care by decreasing medical errors and miscommunications. Streamlining is a promising start to increase compliance, reduce trips for patients, and compressed treatment time for a potentially life-limiting disease, which when treated accurately and expediently has 5-year overall survival 85% (1). This lean approach significantly improved efficiency and access to UM brachytherapy for our rural patients. Kaizen incremental improvement method was taken for continual improvement with further goals including same day multi-disciplinary consult, tele-health, standardized radiology report, patient educational modules, and transition from COMS-based plaque planning to plaque simulator planning system. Stepwise streamlining also opens the door for in-house trial generation, cooperative trial enrollment in a region that historically has close to zero protocol enrollment. Future goals include expanding eye health outreach and mobile screening programs for rural communities. To the best of our knowledge, this is the first formally reported workflow refinement in the literature with regards to eye plaque brachytherapy in the treatment of non-metastatic UM.