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Implementation and evaluation of a rapid access palliative clinic in a New Zealand cancer centre.

Casson C, Johnson J - J Med Radiat Sci (2014)

Bottom Line: There was a statistically significant difference between initial and follow-up pain scores (P < 0.0001).The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions.This has resulted in rapid reduction in pain for the majority of patients.

View Article: PubMed Central - PubMed

Affiliation: Waikato Regional Cancer Centre, Lomus Building, Waikato Hospital Hamilton, New Zealand.

ABSTRACT

Introduction: Palliative patients with metastatic bone pain endure long waiting times and multiple visits to radiation therapy departments for treatment. This can prolong suffering and may be a factor in patients consenting for treatment. Rapid Access Palliative Clinics (RAPC) have been established around the world to provide a multidisciplinary approach to consultation, simulation and treatment on the same day. This paper describes the implementation and evaluation of a RAPC at Waikato Regional Cancer Centre (WRCC) by reducing the time from referral to first specialist appointment (FSA).

Methods: The structure and process for the RAPC day was outlined and the roles of staff were defined. A retrospective study was undertaken of the 261 consecutive patients seen in the RAPC from April 2009 to April 2013. Tracking sheets were created to record patient information at the initial consultation. Follow-up telephone calls were used to assess the patient post-treatment. Patient information was entered into a database.

Results: A total of 226 patients received radiation therapy treatment to 307 sites. All patients were seen within 1 week of referral. Sixty-three per cent of patients were simulated and treated on the same day. The change in radiation therapy fractionation prescriptions was statistically significant (P = 0.0012). There was a statistically significant difference between initial and follow-up pain scores (P < 0.0001).

Conclusion: Evaluation of the clinic has shown that it compares favourably with similar international clinics. The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions. This has resulted in rapid reduction in pain for the majority of patients.

No MeSH data available.


Related in: MedlinePlus

Number of referrals by modality. MO, Medical Oncologist; GP, General Practitioner; URO, Urologist; HAEM, Haematologist; RESP, Respiratory Physician; PC, Palliative Care Physician; ORTHO, Orthopaedic Surgeon; HOSP, Hospice; OTHER. Other Specialist.
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fig01: Number of referrals by modality. MO, Medical Oncologist; GP, General Practitioner; URO, Urologist; HAEM, Haematologist; RESP, Respiratory Physician; PC, Palliative Care Physician; ORTHO, Orthopaedic Surgeon; HOSP, Hospice; OTHER. Other Specialist.

Mentions: Between April 2009 and April 2013, 261 patients presented with 351 sites, all of whom were new to the radiation oncology department. Patient characteristics are shown in Table 1. Of 261 patients seen for FSA, 254 patients (97%) presented with bone pain. Twenty-four patients (9%) required further diagnostic investigation and could not, therefore be treated on the day of consultation. Twenty-nine patients (11%) were admitted to the ward. About 147 (48%) of the sites treated were in the spinal vertebra. Sixty-five (29%) patients were treated for multiple sites. Five patients were assessed and treated for more than three sites (see Table 2). The referring clinician was most commonly a medical oncologist (Fig. 1). About 146 (56%) of patients travelled more than 100 km to attend the clinic (Fig. 2).


Implementation and evaluation of a rapid access palliative clinic in a New Zealand cancer centre.

Casson C, Johnson J - J Med Radiat Sci (2014)

Number of referrals by modality. MO, Medical Oncologist; GP, General Practitioner; URO, Urologist; HAEM, Haematologist; RESP, Respiratory Physician; PC, Palliative Care Physician; ORTHO, Orthopaedic Surgeon; HOSP, Hospice; OTHER. Other Specialist.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4282077&req=5

fig01: Number of referrals by modality. MO, Medical Oncologist; GP, General Practitioner; URO, Urologist; HAEM, Haematologist; RESP, Respiratory Physician; PC, Palliative Care Physician; ORTHO, Orthopaedic Surgeon; HOSP, Hospice; OTHER. Other Specialist.
Mentions: Between April 2009 and April 2013, 261 patients presented with 351 sites, all of whom were new to the radiation oncology department. Patient characteristics are shown in Table 1. Of 261 patients seen for FSA, 254 patients (97%) presented with bone pain. Twenty-four patients (9%) required further diagnostic investigation and could not, therefore be treated on the day of consultation. Twenty-nine patients (11%) were admitted to the ward. About 147 (48%) of the sites treated were in the spinal vertebra. Sixty-five (29%) patients were treated for multiple sites. Five patients were assessed and treated for more than three sites (see Table 2). The referring clinician was most commonly a medical oncologist (Fig. 1). About 146 (56%) of patients travelled more than 100 km to attend the clinic (Fig. 2).

Bottom Line: There was a statistically significant difference between initial and follow-up pain scores (P < 0.0001).The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions.This has resulted in rapid reduction in pain for the majority of patients.

View Article: PubMed Central - PubMed

Affiliation: Waikato Regional Cancer Centre, Lomus Building, Waikato Hospital Hamilton, New Zealand.

ABSTRACT

Introduction: Palliative patients with metastatic bone pain endure long waiting times and multiple visits to radiation therapy departments for treatment. This can prolong suffering and may be a factor in patients consenting for treatment. Rapid Access Palliative Clinics (RAPC) have been established around the world to provide a multidisciplinary approach to consultation, simulation and treatment on the same day. This paper describes the implementation and evaluation of a RAPC at Waikato Regional Cancer Centre (WRCC) by reducing the time from referral to first specialist appointment (FSA).

Methods: The structure and process for the RAPC day was outlined and the roles of staff were defined. A retrospective study was undertaken of the 261 consecutive patients seen in the RAPC from April 2009 to April 2013. Tracking sheets were created to record patient information at the initial consultation. Follow-up telephone calls were used to assess the patient post-treatment. Patient information was entered into a database.

Results: A total of 226 patients received radiation therapy treatment to 307 sites. All patients were seen within 1 week of referral. Sixty-three per cent of patients were simulated and treated on the same day. The change in radiation therapy fractionation prescriptions was statistically significant (P = 0.0012). There was a statistically significant difference between initial and follow-up pain scores (P < 0.0001).

Conclusion: Evaluation of the clinic has shown that it compares favourably with similar international clinics. The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions. This has resulted in rapid reduction in pain for the majority of patients.

No MeSH data available.


Related in: MedlinePlus