Pilot of a Team-Based Urgent and Palliative RT Clinic Delivering Same-Day Access to Complex Care
Abstract
Purpose
At BC Cancer-Victoria, existing pathways for patients requiring rapid, same-day RT are limited to simple field-based planning. Patients who would benefit from more conformal techniques or who require consideration of prior treatment history currently experience treatment delays of several days. The aim of a pilot clinic was to establish a same-day treatment pathway that accommodates more complex clinical and planning requirements.
Methods
A multidisciplinary team composed of nurses, therapists, dosimetrists, oncologists, and physicists met to discuss patient needs, treatment priorities, and agree on what was clinically achievable for each patient, allowing the standard pathway for VMAT or complex conformal planning to be condensed to a 4-hour timeline from CT to treatment. Team members communicated using Microsoft Teams meetings and chats, facilitating increased awareness of clinical decision making and reduced delays. Data was collected from Teams chats, Aria, and practitioner notes to determine efficiency of the workflow.
Results
Between February and May 2025, 12 patients were treated in the pilot clinic. The mean referral to physician consult time for these patients was 13 days. The average time from start of CT simulation to treatment of first fraction was 4h32m. A total of 17 targets were treated, which were delivered in 13 VMAT plans, and 2 conformal field plans. Treatment sites included: pelvis, sacrum, T-spine, L-spine, hip, and femur. Generation of RT plans took an average of 24 minutes, while all post-planning QA processes took 116 minutes per patient.
Conclusion
Using a team-based approach to urgent/palliative RT with strictly defined deadlines and aggressive communication enabled a reduction in time-to-treatment for urgent and palliative radiotherapy patients while maintaining a high standard of care. Following the pilot clinic, high satisfaction was reported from the supporting radiation oncologist and other team members. Translating the developed pathway to sustainable clinical practice is ongoing.