ESTRO 2020 Abstract book

S724 ESTRO 2020

Results We defined 4 basic WF processes, with WF1 for urgencies (treatment < 1 day), WF 21 for treatment indications including for example breast and prostate and WF10 for patients who required reduced delays between referral and treatment initiation. WF5 was added for hospitalised patients. The workflow management system is integrated within the other software systems of the RO department to facilitate easy transfer of tasks from 1 healthcare provider to the other. The data extraction and visualisation tool is individually adapted to, among others, monitor the intervals between all steps of the RO process. The reduction of the number of days between the demand of RT and the delivery of the first fraction, thereby including all steps of the RO process following referral, is displayed in the figure. Conclusion Six months after the introduction of the new centralized workflow the mean number of days between the demand of radiation therapy and the first fraction delivered decreased from 55 to 22 days and the number of patients that needed to be delayed to start RT decreased from 213 to 80. Further progress is being made to further reduce the mean delays by gradually transferring patient groups from the WF21 to the WF10 scheme. PO-1283 Public health predictors of the geographical variation of prostatectomy or radiotherapy in Germany D. Medenwald 1 , K. Medenwald 1 , A. Glowka 1 , D. Vordermark 1 1 Martin Luther University Halle-Wittenberg, 1\tDepartment of Radiation Oncology, Halle/Saale, Germany Purpose or Objective To assess the association of public health predictors with the geographical variation in the initial treatment for prostate Cancer. Material and Methods We used data from German epidemiologic cancer registries for the years 2009-2013. Presence of a certified cancer center, a radiotherapy and/or urology institution, the district specific GDP and population density were used as predictors. Patients with indication for adjuvant treatment were excluded (T3b/c). Only districts with defined quality criteria were eligible. We used general linear mixed models (equivalent to logistic regression) with a covariance matrix weighted by the Euclidean distances between districts. Models were adjusted for age, grading and TNM-stage. We performed sensitivity analyses by imputing missing data with multiple imputation and extreme case scenarios. We applied inverse probability weighting for missing values. Results When neither treatment is compared to radiotherapy/surgery, the probability for the former was higher in East than in West Germany (OR=1.7, 95% CI: 1.43- 2.02). The same was true for districts with both, a radiotherapy and urologic treatment facility (OR=1.43, 1.19-1.72). Analyzing radiotherapy vs. surgery, the probability for prostatectomy was inversely associated with the presence of a radiotherapy unit when compared to district with no treatment facility (OR=0.52, 95% CI: 0.38-0.73). Patients treated in East Germany were more likely to receive a

solicited for a description of their radiation oncology residency training program and its syllabus. This was reviewed and organized according to basic training, specialized training, and specialized procedures. Furthermore, a standardized survey regarding the general characteristic of training among residents in each Latin American country was distributed. Results Within Latin America, 13 of 21 countries (61.9%) have residency training programs. Sixty-five radiotherapy clinics with residency training were identified, whose programs were associated with a total of 35 universities. Brazil comprised 36 (55.4%) of all clinics with residency training, followed by Mexico 6 (9.2%), Chile 5 (7.7%), and Peru 3 (4.6%). A total of 19 centers (29.2%) provided a residency training syllabus. One center did not have any radiobiology or physics as part of their training. The topics covered, time dedicated to each, rotations in other cancer specialties, brachytherapy experience, and training in special techniques varied widely among training programs. Conclusion Residency training in radiation oncology in Latin America is heterogeneous. It is imperative to optimize the formation of specialists in radiation oncology to attend to the great underlying demand of cancer patients. Many radiation oncology training programs are in the early stages of development and have an important role to help address the global gap in cancer care. PO-1282 Fast reduction of delays in initiation of radiation therapy after introduction of lean management. P. Poortmans 1 , A. De Olivera 1 , M. Minsat 1 , A.C. Gravigny 1 , J. Billaud 1 , V. Huret 1 , J. Brenot 1 , E. Costa 1 , C. Mella 1 , Y. Cano 1 , H. Colella-Fleury 1 1 Institut Curie Ensemble Hospitalier, Department of Radiation Oncology, Paris cedex 05, France Purpose or Objective To evaluate the benefits at 6 months of the introduction of a workflow (WF) management system based on lean- Our radiation oncology (RO) department is part of a comprehensive cancer centre. Spread over 3 geographical sites, a total of more than 6,000 radiation treatments are delivered annually using eleven linear accelerators, a proton facility and brachytherapy. Referral and planning of patients was organised in a decentralised and doctor- based set-up. Historical delays between referral of patients and the initiation of radiation treatment exceeded in general 8 weeks, with a large variation between the geographical and the tumour sites. The workload associated with the primary process was perceived as excessively high, among others due to a high rate of duplication of work processes induced to long delays. In 2017, we initiated a lean management project to improve and harmonise the WF department-wide, decrease delays and improve satisfaction of patients and healthcare providers. The goal set is to treat ultimately 80% of our patients within 10 working days after the planning CT-scan. The entire workflow was analysed, discussed and improved into a new paperless WF with all patient appointments centrally handled by 1 single back office while patient- and doctor-contacts remained site-dependent via 1 front offices per 3 site. The organisation of the new management processes and tools was completely integrated in an electronic WF management system linked to all related hospital systems including the electronic patient file and the appointment organiser. Finally, the implementation was accompanied by the installation of an associated data visualisation tool enabling to evaluate and follow the optimisation of the entire workflow. management principles. Material and Methods