New Workflow Slashes Wait Time for Urgent Palliative Radiation Therapy

A recent study suggests that substituting previously acquired diagnostic computed tomography (CT) scans for CT simulation scans in the planning of basic palliative radiation treatments can significantly reduce wait times for urgent treatment, thereby enhancing the patient experience. This expedited process is particularly beneficial for patients experiencing severe pain or obstructive airway conditions. Utilizing existing, recent scans instead of conducting new ones resulted in a substantial reduction in the time these patients spent at a cancer treatment center, decreasing it from almost five hours to under 30 minutes on average, thus facilitating swifter care.

Positive Effects of Cutting Down Waiting Time for Radiation Treatments

Reducing a patient's time spent in a cancer center has far-reaching positive effects. Prompt treatment initiation leads to faster relief of symptoms. Moreover, employing existing scans can cut costs and free up clinic schedules to accommodate more patients. Palliative radiation therapy is administered to alleviate symptoms in patients whose cancers are incurable. Typically, it is prescribed when tumors are causing the patient significant pain, neurological issues, or respiratory difficulties, such as airway obstruction.

Currently, the standard protocol mandates that patients referred for palliative radiation must undergo a CT simulation scan prior to treatment commencement. The patient's care team employs this process involving the generation of 3D images to devise a tailored radiation treatment plan. This procedure typically consumes several hours, even with expedited workflows (1^✔ ✔Trusted Source
Dosimetry Comparison of Palliative Radiation Plans Generated From Available Diagnostic CT Images Versus Dedicated CT Simulation for Inpatients

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However, many of these patients have undergone recent diagnostic CT scans as part of routine follow-up or other medical care conducted in imaging departments outside the cancer center. Previous research established that radiation oncology teams can create clinically acceptable palliative treatment plans for patients with bone and soft tissue metastases using these existing diagnostic CT scans, obviating the need for the more time-consuming simulation scans. In this study, O'Neil and her colleagues explored whether utilizing existing CT scans for pre-planned treatment could reduce patient time at the cancer center while ensuring appropriate care.

Thirty-three patients requiring palliative radiation for tumors in various areas (thoracic, abdominal, pelvic, or proximal limb) were randomly assigned to either standard treatment planning with on-site CT simulation scans or to treatment planning ahead of their appointment using diagnostic CT scans taken up to 28 days earlier.

Treatments were administered for bone and soft tissue metastases (25 patients, or 76%) or visceral lesions, which are soft tissue lesions occurring outside the bones (8 patients, or 24%). The median patient age was 72 years. The most frequently prescribed radiation doses were 8 Gy in one fraction (50% of plans) and 20 Gy in five fractions (43% of plans).

The researchers measured the time each patient spent at the cancer center on the day of treatment, from the time of their appointment to the completion of treatment delivery. Patients in the standard treatment planning group averaged nearly five hours (4.8 ± 1.1 hours) at the cancer center, compared to just under half an hour for those not receiving CT simulation scans (0.4 ± 0.1 hours) (p<0.001).

Planning before the Arrival of the Patient

"This new workflow completes all planning prior to the patient's arrival," O'Neil stated. "As a result, when the patient comes to the center, their visit is swift. This marks a substantial reduction in time commitment."

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All treatment plans in both groups were successfully executed. Anonymized treatment plans were evaluated by an independent team of physicians for adequacy of target coverage, and dose distribution was deemed acceptable (80% in the control arm, 81% in the dCT arm) or acceptable with minor deviation (20% in the control arm, 19% in the dCT arm).

The researchers also conducted surveys with patients, radiation therapists, medical physicists, and radiation oncologists at the cancer center to gauge their perception of the new workflow's acceptability.

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Half of the patients in the standard planning group found their time at the cancer center to be acceptable, compared to 90% of those whose diagnostic CT scans were repurposed for treatment planning (p=0.025). Except for the time spent, patients in both groups had a similar perception of the acceptability of their treatment experience. On a five-point acceptability scale, 90% of clinical stakeholders rated the new workflow as four or higher.

While the study's findings are encouraging, O'Neil stressed that repurposing diagnostic scans may not be suitable for all types of cancers or patients. "We also have to be treating an area that's compatible with this type of technique," she noted. "For example, diagnostic CT scans do not require a patient's head to be reproducibly immobilized, so they cannot be used to plan treatment for brain tumors. But they are appropriate for patients who need simple palliative radiation for pain control and symptom management."

"Innovations like this not only save time but also bring much-needed relief to patients in their most critical moments. It's a testament to the power of creative solutions in healthcare."

Reference:

1. Dosimetry Comparison of Palliative Radiation Plans Generated From Available Diagnostic CT Images Versus Dedicated CT Simulation for Inpatients - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496742/)

Source-Medindia