ESTRO 2024 - Abstract Book

S2836

Interdisciplinary - Health economics & health services research

ESTRO 2024

Medline, Embase, PubMed and Cochrane were searched with a broad strategy to identify literature describing access to radiotherapy in the palliative setting, with search limits set from January 1995 to July 2022. Publications which described a model of delivering palliative radiotherapy were selected. Minimum inclusion criteria included a description of the programme and the care setting where it was provided. Papers describing same day consultation and treatment and the use of hypofractionated schedules were of particular focus. Data from multiple articles which described the same model were aggregated for the purpose of analysis. Reviews were excluded and only articles published in English were included. Due to significant differences in the methodological approach of analysis across the programmes, it was not possible to aggregate the information for the purposes of a meta analysis. It was also beyond the scope to assess appropriateness of RT use and the choice of RT complexity. 44 publications were selected, describing 29 programmes in 9 countries providing palliative radiotherapy across Asia, Europe, North America and Oceania. A variety of publication types including original articles, review articles and abstracts were included. The included programmes were set up in a variety of socioeconomic settings, although the majority of programmes were based in high income countries . 16 programmes were identified which provided radiotherapy treatment to patients on the same day of consultation and either described this as treatment time target or quoted the proportion of patients treated on the same day as the initial consultation. Single visits for evaluation and treatment were introduced to improve accessibility with additional potential benefits including travel burden reduction especially if a single fraction of treatment was used. 18 programmes described the use of hypofractionation, with significant variability on whether hypofractionated schedules were prioritized in the clinic. 6 programmes indicated what groups of patients would receive palliative RT including 2 programmes which aimed to treat all patients with hypofractionated schedules. Reasons for choice of hypofractionated schedules included efficacy, affordability, optimization of resource use, convenience, and greater accessibility. 12 programmes described a reduction in outpatient waiting times for treatment and 3 programmes found a reduction in inpatient stay. 3 programmes reported a decrease in financial toxicity attributable to reduction of out of-pocket expenditure due to hypofractionation travel costs reduction. Task sharing with radiation therapists and nursing staff (including advanced practice professionals) facilitated access, treatment delivery and provided needed clinical input in specific settings. Higher rates of referrals and increased involvement of palliative care professionals was seen in some programmes indicating improved care integration. In programmes that evaluated satisfaction, moderate to high rates of approval were described in patient and clinical staff alike. Access to non-radiotherapy measures and a reduction of inappropriate treatment may be associated with a multidisciplinary model approach. Results:

Conclusion:

This study identified a few interventions for improvement of timeliness, efficiency, and therefore, quality of palliative radiotherapy. The incorporation of multiple disciplines into single appointments could provide more holistic care for subgroups of patients. Limitations to the delivery of same day treatment include the need for volumetric planning, the potential to increase pressure on staff and longer hospital appointments for patient. New palliative RT programmes must be carefully designed within a particular healthcare-system, socioeconomic context and emerging technological innovations, such as automated radiotherapy planning. The knock-on effect on other clinical services provided and on staff must however be considered, especially if timelines are shortened.