3381 - Optimizing Palliative Radiotherapy: Analysis of Workflow and Efficiency of a Dedicated Rapid-Access Palliative and Oligometastatic Radiotherapy Program
Presenter(s)
A. Agrawal1, J. Javor2, K. Del poso-Lee2, P. Wong3, R. K. Wong4, B. J. Cummings5, B. A. Millar3, R. Chelvarajah1, N. Wattakiyanon2, E. Taylor3, A. Bezjak5, L. A. Dawson5, and C. J. Tsai1; 1Princess Margaret Cancer Centre, Toronto, ON, Canada, 2Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 3Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 4Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada, 5Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Purpose/Objective(s): Timely delivery of palliative radiotherapy is critical for effective symptom relief in patients with advanced cancer. Our center’s Palliative Radiotherapy and Oligometastases Program (PROP) is a rapid-access clinic that offers expedited consultation as well as same-day simulation and treatment delivery. Established in 1997, the program provided rapid access to treatment for extra-cranial solid tumors and non-stereotactic spine radiotherapy. In 2023, it was expanded to include stereotactic treatment for oligometastatic disease. Here we report several workflow efficiency metrics of this program.
Materials/Methods: We retrospectively reviewed all consecutive patients referred to PROP from January 2024 to December 2024. Patient data were extracted from institutional electronic medical records and radiotherapy treatment information management platform. Workflow efficiency metrics including the intervals from referral to consultation, simulation and treatment delivery were evaluated using descriptive statistics.
Results: During the one-year period, the PROP clinic had 849 consultations, representing 676 unique patients. Most common histologies included genitourinary (24.6%), breast (22.9%), lung (20.2%), and gastrointestinal malignancies (13.4%). Of these, 594 patients (70%) received palliative radiotherapy, with a total of 789 treatment sites targeted. Most frequently irradiated anatomical sites included spine (34%), non-spine bone (42%), visceral organs (14.6%), lung/mediastinum (6%) and brain (3.4%). Radiotherapy was predominantly delivered with Volumetric Modulated Arc Therapy (VMAT) in 44.5% of cases, Intensity-Modulated Radiation Therapy (IMRT) in 25.6%, and three-dimensional conformal radiotherapy (3D-CRT) in the remaining cases. Stereotactic body radiotherapy (SBRT), defined per ASTRO SBRT model policy was administered to 88 lesions (11%). The median time from referral to consultation was 2 days (Interquartile range; IQR; 1-4). Majority of patients (87%) underwent simulation on the same day as their consultation and overall, 90% of the treated patients were simulated within 2 days. Following simulation, radiotherapy was initiated on the same day in 140 (23.5%) patients and the next day in 141 (23.7%) patients utilizing our expedited fast-track workflow. The median time from simulation to treatment was 2 days (IQR: 1–5) for VMAT/IMRT and 7 days (IQR: 4–14) for SBRT. Additionally, 30 patients received simulation-free single-fraction radiotherapy.
Conclusion: Our findings show that a specialized palliative radiotherapy program with a streamlined workflow can deliver efficient care in high-volume settings, utilizing both conventional and advanced radiotherapy techniques. These results highlight the promise of such dedicated programs in improving overall patient outcomes in palliative care.