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“The risk of local recurrence grows with increasing radiotherapy waiting times and this results in decreased survival in some clinical situations”
Staff at radiation oncology departments worldwide are well familiar with the necessary, but painstaking, fragmented and labor-intensive process of navigating the radiotherapy treatment process from patient referral to first fraction. The path from simulation to a workable plan remains a mostly manual process with frequent handovers, waiting times and lags in data transfers between systems. The path entails hundreds of mouse clicks, logging in and out of disparate information systems and an over-reliance on human interaction and communication to ensure quality and certainty along the way.
SWWCC is addressing the complexity of this process. In their co-creation partnership with Philips (see sidebar), SWWCC is involved in the development of both Philips’ IntelliSpace Radiation Oncology* patient management solution (see sidebar) and the allied services that are part of the company’s Radiation Oncology Practice Management*.
IntelliSpace Radiation Oncology is an intelligent patient management solution designed to accelerate the time from patient referral to the start of treatment. With a protocol-driven care pathway the radiotherapy workflow, departmental efficiency as well as operational excellence can be improved.
A key principle underlying IntelliSpace Radiation Oncology is to start with the physician’s treatment intent for the patient, as it will trigger many subsequent steps in the workflow. It is also designed to be vendor-neutral, so a department can interface with many of their third-party solutions, whether it is a treatment planning system or a contouring tool.
To ensure IntelliSpace Radiation Oncology works as designed, a center’s current workflows must be evaluated and optimized first. This is where Philips offers Radiation Oncology Practice Management*. Philips’ experts can work with department staff to analyze existing workflows to reveal where workflow efficiencies can be applied.
Patients also demand shorter waiting times”
“Reducing the time to the patient’s first fraction is important, Dr. Banner says. “The negative clinical impact of delaying patient treatment isn’t just theory anymore, there is an evidence base now. The risk of local recurrence grows with increasing radiotherapy waiting times and this results in decreased survival in some clinical situations.1-3
“Patients also demand shorter waiting times,” he adds. “In Quebec a class-action was brought to court on behalf of patients who were waiting too long for their radiotherapy treatment on the basis it would increase local recurrence rates.”4
“When I started in 2013, I concentrated first on decreasing the time to RT for adjuvant head-and- neck patients to boost overall survival. Delays were far too long with an average time to treatment of 12 weeks and high variation (see figure 1), Dr. Banner says. “We reduced the wait times initially by speaking with our surgeons and stressing the importance of working together, but we also focused on ways to condense the radiotherapy planning workflow. We implemented new ways of workings, such as using checklists and remove approval of plans in MOSAIQ, moving from paper booking to electronic booking and migrating all of our systems onto the Citrix platform to facilitate remote access. Performance continues to improve on this small group of about two patients each week, so that now over 75 percent of patients start within six weeks of surgery. But variability remains, and we want to make similar improvements for all patients having radiotherapy.”
With limited human and treatment resources (see SWWCC Facts), the radiotherapy department of SWWCC is not unlike many UK cancer clinics, Dr. Banner observes.
“Our workforce is stretched and could be bigger, especially since we’re expecting an increase in our workload,” he says. “We already brought down our time to radiotherapy, but in our view it is still not good enough. We have an excellent team with RTTs, physicists, dosimetrists and clinicians working together. We all know what we want to achieve, but we have limited resources. We see the opportunity to go so much further with automation and better interoperability of our systems.”
SWWCC’s experience is a mirror image of many radiation therapy departments throughout the UK; the number and complexity of the different systems departments use compound the problem.
“I recently saw an interesting comment on my Twitter feed,” he says. “The tweet was complaining about the multiple passwords and PINs in daily oncology practice in the 2019 NHS environment. It causes a great deal of frustration.”
Working with Philips we see the opportunity to go so much further with automation”
As a preparatory phase before implementing actual solutions, SWWCC worked to gain an in depth understanding of each radiotherapy workflow – where it is efficient and where the bottlenecks are.
“Being protocol-driven, it is pointless to integrate a patient management solution like IntelliSpace Radiation Oncology without appreciating what the whole pathway looks like,” Dr. Banner says.
Working with Philips consultants, SWWCC chose to initially map its breast radiotherapy pathway, convening a mapping workshop that involved the entire multi-disciplinary team, including administrative staff, radiation oncologists, physicists, dosimetrists and radiation therapy technologists. See figure 4 for the current Swansea Breast Pathway.
In addition to decreasing the patients’ time to treatment, patients will also benefit by helping us as clinicians to consistently treat every patient to the highest quality levels”
“Our breast pathway has 14 high-level workflow steps in it,” Dr. Banner says. “Our previous local workflow optimization activities had brought the referral-to-first treatment interval down from 32 to 28 days. Collaborating with the Philips consultants we aim to get the interval down from 28 to 21 days and that is what we’re implementing for the breast radiotherapy pathway now,” he notes.
“With full implementation of IntelliSpace Radiation Oncology we think it is realistic and achievable to bring the referral-to-first fraction period down to just 14 days.
1. Chen Z, King W, Pearcy R, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: a systematic review. Radiother Oncol. 2008 Apr;87(1):3-16.
2. Ang KK, Trotti A, Brown BW, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001 Nov 1;51(3):571-8.
3. Cattaneo R II, Hanna RK, Jacobsen G, Elshaikh MA. Interval between hysterectomy and start of radiation treatment is predictive of recurrence in patients with endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2014 Mar 15;88(4):866-71.
4. Gupta S, King WD, Korzeniowski M, Wallace DL, Mackillop WJ. The effect of waiting times for postoperative radiotherapy on outcomes for women receiving partial mastectomy for breast cancer: a systematic review and meta-analysis. Clin Oncol (R Coll Radiol) 2016 Dec; 28(12):739-749.
5. Wuthrick EJ, Zhang Q et al. 2015. Institutional Clinical Trial Accrual Volume and Survival of Patients With Head and Neck Cancer. Journal of Clinical Oncology 33:156-164.
*Work in progress and not available for sale.
Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions. This material is not for distribution in the USA.
